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Uterus video

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These are the slides that accompany the video found on www.aboutcancer.com

These are the slides that accompany the video found on www.aboutcancer.com

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Uterus video Uterus video Presentation Transcript

  • Cancer of the Uterus or Endometrium Robert Miller MD www.aboutcancer.com
  • Uterine cancer is the most common gynmalignancy with a 2.6 % lifetime riskThe average age is 61 years. The majority arediagnosed at an early stage (68 percent)
  • Anatomy
  • Internal Anatomy of the Uterus fundus body isthmus Internal Endometrium orifice Myometrium cervix Cervical vagina canal
  • Cross section anatomy of the female pelvis
  • PET Scans may be more useful than CTscans in GYN cancers
  • Endometrial cancer – adenocarcinoma of thelining of the uterus1. Ovary, 2. Endometrial Cancer, 3. Uterus, 4. Urinary Bladder, 5.Rectum, 6. Vagina
  • 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 CancerT1: 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 rectumN1: 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)
  • Uterine cancer can spread to lymph nodes
  • PET ScanSingle area ofmetastases inright para-aorticlymph nodesBiopsyconfirmedrecurrent cancer
  • Internal view (cross section) from PET
  • PET Scan = mets in para-aortic andpelvic nodes so stage IIIC endometrialcancer
  • Uterinecancer thathas spreadto para-aortic andpelvic nodesas seen onPET scan
  • 5 Year Survival for Endometrial Cancer based on the Stage
  • 5 Year Survival for Endometrial Cancer based on the histology of the 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, serousor clear cell
  • Adverse prognostic factors are used to stratify women with intermediate-risk endometrial cancer: •outer one-third myometrial invasion •grade 2 or 3 differentiation •lymphovascular invasion within the cancer.High-intermediate risk – This is based on a combination of age andnumber 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
  • Guidelines for the use of radiation after a hysterectomy
  • Guidelines for the use of radiation after a hysterectomy
  • Dose Guidelines
  • CT scan is obtained at the time of simulation CT images are then imported into the treatment planning computer
  • In the simulationprocess the CTand PET scanimages are usedto create acomputer plan
  • In the treatmentthe lasers areused to line upthe beam and thepatient receivesthe radiationtreatment
  • Radiation for advanced uterine cancer totreat pelvis plus para-aortic lymph nodes
  • Tomotherapy for Advanced Uterine Cancer
  • Computer reconstruction of radiation fields tocover groin and pelvic lymph nodes but avoidthe bladder and rectum in vulva cancer patient
  • Combine a CT scan and linear accelerator to ultimate intargeting (IGRT) and ultimate in delivery (dynamic, helicalIMRT) ability to daily adjust the beam (ART or adaptiveradiotherapy)
  • Tomotherapy fields used to hit the groin andpelvic nodes but avoid the bladder andrectum
  • HDR = high dose rate machine that can runradiation through a tube that reaches thepatient 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 isinserted into thevagina, the radiationtube or wire staysinside the tube anddoesn’t touch thepatient’s skin
  • A Wire or Tube connects the vaginal cylinderthe machine that holds the radioactive(Iridium) source
  • The woman lays on the radiation table and the treatmentusually takes about 5 minutes and then the cylinder isremoved
  • PostOp radiation for endometrial cancer isgenerally vaginal vault cylinder with HDR
  • Very little radiation reaches the bladder orrectum
  • Side Effects of Pelvic Radiation
  • Smallbowel
  • Rectum
  • Bone
  • Bladder
  • Vagina
  • Side Effects of Vaginal Cylinder HDR Radiation •Vaginal irritation or discharge •Bladder irritation or frequency •Bowels more frequent, soft or mild rectal irritation
  • Cancer of the Uterus or Endometrium Robert Miller MD www.aboutcancer.com