Your SlideShare is downloading. ×
0
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Radiation for Cervix Cancer
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Radiation for Cervix Cancer

3,051

Published on

The role of radiation in treating cervix cancer

The role of radiation in treating cervix cancer

Published in: Health & Medicine, Technology
1 Comment
4 Likes
Statistics
Notes
  • i want to save dis ppt. plz help me
    :(
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total Views
3,051
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
274
Comments
1
Likes
4
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Robert Miller MD www.aboutcancer.com Cervix Cancer the Role of Radiation
  • 2. Most common gynecologic cancers in women in 2012 Site Number Breast 232,340 Uterus 49,560 Ovary 22,240 Cervix 12,340 Vulva 4,700
  • 3. Median age at diagnosis for cancer of the cervix uteri was 49 years of age (uterus 61, ovary 63, vulva 68) Lifetime risk is 0.66% or 1 in 151 of women born today will be diagnosed with cancer of the cervix Stage Distribution 5 Year Survival Local (confined site) 47% 91% Regional (into nodes) 36% 57% Distant (metastases) 12% 16%
  • 4. •Avoidance of Human Papillomavirus Infection (abstinence, or condoms (lower risk by 60%) •HPV16/18 vaccination will lower the risk by 92% •Screening (pap smear) will lower incidence and mortality by 80% •Smoking cessation (smoking cigarettes increases the risk in HPV+ women by 2 to 3 times)
  • 5. Importance of screening because of disease progression uterus cervix vagina Spreading cancer parametrium Into vagina Early Stage IA more advanced IA stage II
  • 6. Work up or evaluation of a patient with cervix cancer before deciding on therapy
  • 7. biopsy
  • 8. Pathology Report • Invasive cancer or just dysplasia or in situ • Histology or type of cancer • Squamous cancer (69%) • Adenocarcinoma (25%) • Depth of invasion and lateral spread
  • 9. Stages of Cervix Cancer uterus Cervix cancer
  • 10. Stage I = confined to the cervix IA = too small to see (found only on microscope) IA1 = no deeper than 3mm or lateral than 7mm IA2 = 3 to 5mm deep and lateral up to 7mm IB = visible or bigger than a IA2 IB1 = up to 4cm IB2 = bigger than 4cm Stages of Cervix Cancer
  • 11. Stage II = beyond the cervix IIA = onto the upper vagina IIA1 = up to 4cm IIA2 = over 4cm IIB = parametrial invasion Stages of Cervix Cancer
  • 12. Stages of Cervix Cancer Stage IIIA = lower third vagina Stage IIIB = side wall or nodes + Stage IVA = into bladder or rectum Stage IVB = distant metastases
  • 13. Cross section anatomy of the female pelvis bladder rectum cervix
  • 14. Cross section anatomy of the female pelvis rectum vagina rectum
  • 15. PET Scan = Cervix Cancer Cancer cells use more glucose or sugar and so “light up” on a PET scan which uses radioactive glucose
  • 16. Lymph Nodes spread from the cervix
  • 17. Frequency of lymph node metastases in cervical carcinoma.
  • 18. Cervix cancer that has spread to para-aortic and pelvic nodes as seen on PET scan
  • 19. Internal view (cross section) from PET
  • 20. PET = Stage IIIB Cervix Cancer
  • 21. Stage 5 Year Survival IB 80% IIA 63% IIB 58% III 30% IVA 16% Cervix Cancer Survival by Stage
  • 22. Stage Survival Survival IA IA1 (97.5%) IA2 (94.8%) IB IB1 (89.1%) IB2 (75.7%) II IIA (73.4%) IIB (65.8%) III IIIA (39.7%) IIIB (41.5%) IV IVA (22%) IVB (9.3%) Cervix Cancer Survival
  • 23. NCCN.org
  • 24. Treatment of cervix cancer •Early stages: surgery (hysterectomy) or radiation •More advanced cases: radiation +/- chemotherapy (cisplatin) then possibly surgery
  • 25. Early Stages: Surgery or Radiation
  • 26. More Advanced Stages: Radiation or Surgery
  • 27. Indications for post-operative radiation and or chemotherapy based on pathology report after surgery •Positive lymph node spread •Positive surgical margins •Invasion into the parametrium •Other high risk features: •Large primary tumor •Deep stromal invasion •Lymphovascular invasion
  • 28. Advanced Stages: Radiation plus Chemotherapy
  • 29. 5 Trials Demonstrating Improved Survival with Chemo-Radiation compared to Radiation Alone
  • 30. External Beam Radiation Radioactive sourceApplicators Internal Radiation
  • 31. CT scan is obtained at the time of simulation CT images are then imported into the treatment planning computer
  • 32. In the simulation and treatment planning process the CT and PET scan images are used to create a “target” for the radiation and a computer plan is generated
  • 33. During the treatment lasers are used to line up the beam and the patient receives the radiation treatment External beam radiation is usually 5 to10 minutes, Monday though Friday, 5 days a week for 5 to 30 treatments
  • 34. Normal structures identified on CT scans that can be affected by radiation and cause side effects
  • 35. Normal Structures Identified on MRI uterus uterus cervix cervix vagina vagina rectum rectum bladderparametrium
  • 36. Computer generated targets for IMRT Radiation for advanced cervix cancer to treat pelvis plus para-aortic lymph nodes
  • 37. 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)
  • 38. Radiation for cervix cancers •External beam irradiation (daily for 5 weeks) sometimes combined with chemotherapy (e.g. cisplatin) •Low dose radiation (LDR) Internal radiation (radium or cesium implants, in hospital for 2-3 days •High dose rate radiation (HDR) with Nucletron (Iridium) once a week for 3-5 weeks as an outpatient
  • 39. Radiation Dose Techniques •External beam 45Gy (40-50Gy) plus possible sidewall boost of 10-15Gy •Brachytherapy: Point A total dose of 30-40Gy (LDR or 6Gy X 5 with HDR) to 80- 85Gy total dose
  • 40. Internal radiation devices or brachytherapy
  • 41. Internal radiation devices Tandem goes into the uterus Ovoids go into the corners (fornices) next to the cervix
  • 42. Internal Radiation Devices
  • 43. HDR = high dose rate machine that can run radiation through a tube that reaches the patient through vaginal applicators
  • 44. HDR Cervix Applicators
  • 45. 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)
  • 46. Vaginal cylinder is inserted into the vagina, the radiation tube or wire stays inside the tube and doesn’t touch the patient’s skin
  • 47. A Wire or Tube connects the vaginal or cervical applicators to the machine that holds the radioactive (Iridium) source
  • 48. The woman lays on the radiation table and the treatment usually takes about 5 minutes and then the applicator is removed
  • 49. Radiation Fields and Side Effects Pelvic field Para- aortic Node field
  • 50. Side Effects of Radiation are Related to Organs that are near the Cancer
  • 51. Side Effects of Pelvic Radiation ovary
  • 52. Side Effects of Pelvic Radiation Radiation may hit the bowel causing some more bowel frequency, cramps, diarrhea and fatigue Radiation fields
  • 53. Side Effects of Pelvic Radiation Radiation fields Radiation may hit the bladder and rectum causing urinary burning or frequency and rectal irritation as well as vaginal irritation Patients may benefit from Imodium, cranberry juice, skin creams and rectal ointments
  • 54. Long Term Side Effects of Pelvic Radiation •Chronic bowel irritation (looseness or bleeding) •Chronic bladder irritation (more frequency or burning) •Sexual dysfunction (more vaginal dryness or fibrosis) •Ovarian dysfunction (normal pelvic radiation doses to the ovaries will cause menopause) •Osteitis of the bone (more brittle bones)
  • 55. Robert Miller MD www.aboutcancer.com Cervix Cancer the Role of Radiation

×