Date post: | 07-May-2015 |
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Health & Medicine |
Upload: | robert-j-miller-md |
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Uterine cancer is the most common gyn malignancy with a 2.6 % lifetime risk
The average age is 61 years. The majority are diagnosed at an early stage (68 percent)
fundus
body
isthmus
cervix
vagina
Cervical canal
Endometrium
Myometrium
Internal Anatomy of the Uterus
Internalorifice
1. Ovary, 2. Endometrial Cancer, 3. Uterus, 4. Urinary Bladder, 5.
Rectum, 6. Vagina
Endometrial cancer – adenocarcinoma of the lining of the uterus
Prognostic Factors in Endometrial Cancer
Stage (has it spread to the cervix, ovaries or lymph nodes)
Muscle Invasion (deep invasion in more serious)
Grade (higher grade is more serious) Histology (certain types like serous
cancer or sarcoma are more serious)
T and N Stage of Uterine Cancer
T1: confined to the uterus T1a : less than halfway into muscle T1b: deeper than halfT2: into cervix (stromal connective tissue)T3a: into serosa or adnexaT3b: into vagina or parametriumT4a: into bladder or rectum
N1: pelvic nodesN2: para-aortic nodes
Stages of Uterine Cancer
Stage I (T1N0) Stage II (T2N0) Stage IIIa (T3aN0) Stage IIIb (T3bN0) Stage IIIC1 (T1-3N1) Stage IIIC2 (T1-3N2) Stage Iva (T4) Stage IVb (M1)
PET Scan
Single area of metastases in right para-aortic lymph nodes
Biopsy confirmed recurrent cancer
Treatment of Endometrial Cancer
For most stages surgery (hysterectomy, TAH-BSO-PPLND) is performed and postOp radiation is indicated for high risk features:
•Deep muscle invasion (stage T1b)
•Involvement of cervix (stage T2)
•Spread to nodes, ovaries or tubes (Stage T3)
•High risk pathology: high grade, vascular invasion, serous or clear cell
•outer one-third myometrial invasion•grade 2 or 3 differentiation •lymphovascular invasion within the cancer.
Adverse prognostic factors are used to stratify women with intermediate-risk endometrial cancer:
High-intermediate risk – This is based on a combination of age and number of prognostic factors present:
•Patients of any age with all three factors•Patients 50 to 69 years old with two factors•Patients 70 years or older with only one factor
CT scan is obtained at the time of simulation
CT images are then imported into the treatment planning computer
In the treatment the lasers are used to line up the beam and the patient receives the radiation treatment
Computer reconstruction of radiation fields to cover groin and pelvic lymph nodes but avoid the bladder and rectum in vulva cancer patient
Combine a CT scan and linear accelerator to ultimate in targeting (IGRT) and ultimate in delivery (dynamic, helical IMRT) ability to daily adjust the beam (ART or adaptive radiotherapy)
HDR = high dose rate machine that can run radiation through a tube that reaches the patient through vaginal applicators
Internal radiation devices
Procedure can be performed in hospital and the patient stays over night using a Cesium isotope applicator or the procedure can be done as an outpatient with a faster technique (called high dose rate or HDR) using an Iridium isotope source (Iridium 192 with half life of 74 days)
Vaginal cylinder is inserted into the vagina, the radiation tube or wire stays inside the tube and doesn’t touch the patient’s skin
A Wire or Tube connects the vaginal cylinder the machine that holds the radioactive (Iridium) source
The woman lays on the radiation table and the treatment usually takes about 5 minutes and then the cylinder is removed
Side Effects of Vaginal Cylinder HDR Radiation
•Vaginal irritation or discharge
•Bladder irritation or frequency
•Bowels more frequent, soft or mild rectal irritation