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Uterus video


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Uterus video

  1. 1. Cancer of the Uterus or Endometrium Robert Miller MD
  2. 2. 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)
  3. 3. Anatomy
  4. 4. Internal Anatomy of the Uterus fundus body isthmus Internal Endometrium orifice Myometrium cervix Cervical vagina canal
  5. 5. Cross section anatomy of the female pelvis
  6. 6. PET Scans may be more useful than CTscans in GYN cancers
  7. 7. Endometrial cancer – adenocarcinoma of thelining of the uterus1. Ovary, 2. Endometrial Cancer, 3. Uterus, 4. Urinary Bladder, 5.Rectum, 6. Vagina
  8. 8. 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)
  9. 9. 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
  10. 10. 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)
  11. 11. Uterine cancer can spread to lymph nodes
  12. 12. PET ScanSingle area ofmetastases inright para-aorticlymph nodesBiopsyconfirmedrecurrent cancer
  13. 13. Internal view (cross section) from PET
  14. 14. PET Scan = mets in para-aortic andpelvic nodes so stage IIIC endometrialcancer
  15. 15. Uterinecancer thathas spreadto para-aortic andpelvic nodesas seen onPET scan
  16. 16. 5 Year Survival for Endometrial Cancer based on the Stage
  17. 17. 5 Year Survival for Endometrial Cancer based on the histology of the cancer
  18. 18. 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
  19. 19. 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
  20. 20. Guidelines for the use of radiation after a hysterectomy
  21. 21. Guidelines for the use of radiation after a hysterectomy
  22. 22. Dose Guidelines
  23. 23. CT scan is obtained at the time of simulation CT images are then imported into the treatment planning computer
  24. 24. In the simulationprocess the CTand PET scanimages are usedto create acomputer plan
  25. 25. In the treatmentthe lasers areused to line upthe beam and thepatient receivesthe radiationtreatment
  26. 26. Radiation for advanced uterine cancer totreat pelvis plus para-aortic lymph nodes
  27. 27. Tomotherapy for Advanced Uterine Cancer
  28. 28. Computer reconstruction of radiation fields tocover groin and pelvic lymph nodes but avoidthe bladder and rectum in vulva cancer patient
  29. 29. 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)
  30. 30. Tomotherapy fields used to hit the groin andpelvic nodes but avoid the bladder andrectum
  31. 31. HDR = high dose rate machine that can runradiation through a tube that reaches thepatient through vaginal applicators
  32. 32. 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)
  33. 33. Vaginal cylinder isinserted into thevagina, the radiationtube or wire staysinside the tube anddoesn’t touch thepatient’s skin
  34. 34. A Wire or Tube connects the vaginal cylinderthe machine that holds the radioactive(Iridium) source
  35. 35. The woman lays on the radiation table and the treatmentusually takes about 5 minutes and then the cylinder isremoved
  36. 36. PostOp radiation for endometrial cancer isgenerally vaginal vault cylinder with HDR
  37. 37. Very little radiation reaches the bladder orrectum
  38. 38. Side Effects of Pelvic Radiation
  39. 39. Smallbowel
  40. 40. Rectum
  41. 41. Bone
  42. 42. Bladder
  43. 43. Vagina
  44. 44. Side Effects of Vaginal Cylinder HDR Radiation •Vaginal irritation or discharge •Bladder irritation or frequency •Bowels more frequent, soft or mild rectal irritation
  45. 45. Cancer of the Uterus or Endometrium Robert Miller MD