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HSC 340  12-19-10 Gastrointestinal Cancer Genitourinary Cancer Gynecological Cancer
Gastrointestinal Cancer <ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Pancreas </li></ul><ul><li>Rectum </...
Esophageal Cancer <ul><li>Usually squamous cell </li></ul><ul><li>Males more than females </li></ul><ul><li>Cure rates <10...
Esophageal Anatomy <ul><li>Cervical esophagus </li></ul><ul><li>Upper thoracic </li></ul><ul><li>Middle thoracic </li></ul...
Esophageal routes of spread <ul><li>Spreads longitudinally through lymphatics </li></ul><ul><ul><li>Upper </li></ul></ul><...
Esophageal CA Treatment <ul><li>Surgery only- poor control </li></ul><ul><li>External beam only- curative and palliative <...
Esophageal Radiation Therapy Techniques <ul><li>Cervical Esophagus </li></ul><ul><ul><li>Lateral opposed, Obliques </li></...
 
 
Esophageal Immobilization & Positioning Devices <ul><li>Prone sometimes used to pull esophagus away from sc. </li></ul><ul...
Esophageal Doses <ul><li>Palliative </li></ul><ul><ul><li>30 Gy over two weeks to 50 Gy over five weeks </li></ul></ul><ul...
Stomach Cancer <ul><li>Majority Ulcerative Adenocarcinomas </li></ul><ul><li>High incidence in Japan </li></ul>
Stomach Anatomy <ul><li>Begins at Gastroesophageal Junction and ends at pylorus </li></ul><ul><li>Many critical structures...
Stomach CA Routes of Spread <ul><li>Direct Extension </li></ul><ul><li>Widespread </li></ul>
Stomach CA Treatment <ul><li>Surgery & Post-op Radiation Therapy with Concurrent chemo </li></ul><ul><li>Radiation alone i...
Stomach Radiation Therapy Techniques <ul><li>AP:PA </li></ul><ul><li>Doses: </li></ul><ul><ul><li>40-45 Gy w/ 5FU </li></u...
 
Stomach Immobilization and Positioning <ul><li>Supine </li></ul><ul><li>Arms above head </li></ul><ul><li>Vac-lok, body ca...
Pancreatic Cancer <ul><li>Ductal adenocarcinoma </li></ul><ul><li>Occur in the head of pancreas </li></ul>
Pancreas Anatomy <ul><li>Three sections </li></ul><ul><ul><li>Head, tail, body </li></ul></ul><ul><ul><li>L1-L2 </li></ul>...
Pancreatic CA routes of spread <ul><li>Direct extension </li></ul><ul><li>Lymphatics </li></ul>
Pancreatic CA Treatment <ul><li>Surgery (you want the cancer in the tail!) </li></ul><ul><li>Surgery, Post-op Radiation Th...
Pancreatic radiation therapy techniques <ul><li>Three field (AP, Lats), four field (AP:PA, Lats), IGRT –couch rotation use...
 
Pancreatic Immobilization & Positioning  <ul><li>Supine </li></ul><ul><li>Arms above head </li></ul><ul><li>Vac-lok, alpha...
Rectal Cancer <ul><li>Adenocarcinomas </li></ul><ul><li>Men = Women </li></ul><ul><li>Rectal bleeding </li></ul><ul><li>2 ...
Rectal Anatomy <ul><li>13-15 cm long </li></ul><ul><li>Upper, middle and lower valves divide into sections </li></ul>
Rectal CA routes of spread <ul><li>Direct extension </li></ul><ul><li>Wide spread dissemination </li></ul>
Rectal CA Treatment <ul><li>Surgery </li></ul><ul><li>Surgery + Radiation Therapy + Chemo </li></ul><ul><li>Pre-op, post-o...
Rectal CA Radiation Therapy <ul><li>Three field (PA and lats) patient prone </li></ul><ul><li>IGRT </li></ul><ul><li>Doses...
 
Rectal Immobilization and Positioning <ul><li>Prone </li></ul><ul><li>Belly board (to help “drop” small bowel) </li></ul><...
Anal Cancer <ul><li>Squamous cell </li></ul><ul><li>3cm in length </li></ul>
Anal CA Routes of Spread <ul><li>Direct Extension, Lymphatics, Blood stream </li></ul>
Anal CA Treatment <ul><li>Surgery </li></ul><ul><li>Chemo and Radiation </li></ul>
Anal CA Radiation Therapy <ul><li>AP:PA, IGRT </li></ul><ul><li>Doses </li></ul><ul><ul><li>45 Gy with Chemo </li></ul></u...
 
Anal CA Immobilization and Positioning <ul><li>Supine </li></ul><ul><li>Vac-lok, body cast </li></ul><ul><li>Marker on low...
Genitourinary Cancer <ul><li>Bladder </li></ul><ul><li>Prostate </li></ul>
Bladder Cancer <ul><li>Blood in urine </li></ul><ul><li>Cigarette smoke common cause </li></ul><ul><li>Transitional cell c...
Bladder CA Routes of Spread <ul><li>Direct Extension </li></ul><ul><li>Lymphatics </li></ul>
Bladder CA Radiation Therapy <ul><li>Radiation therapy alone </li></ul><ul><li>Surgery & Radiation Therapy </li></ul><ul><...
Bladder CA Radiation Therapy Techniques <ul><li>Four field technique, IGRT </li></ul><ul><li>Dose: </li></ul><ul><ul><li>P...
 
 
 
Bladder CA Immobilization & Positioning <ul><li>Supine </li></ul><ul><li>Contrast- Bladder (air introduced to see anterior...
Prostate Cancer <ul><li>Most common cancer in men </li></ul><ul><li>Adenocarcinoma </li></ul><ul><li>60+ </li></ul><ul><li...
Prostate CA Routes of Spread <ul><li>Local invasion </li></ul><ul><li>Lymphatics </li></ul><ul><li>Bone </li></ul>
Prostate CA Treatments <ul><li>Observation </li></ul><ul><li>Radical Prostatectomy </li></ul><ul><li>Implant Therapy </li>...
Prostate CA Radiation Therapy Techniques <ul><li>Four field, IGRT </li></ul><ul><li>Doses: </li></ul><ul><ul><li>75-81Gy w...
Prostate CA Positioning and Immobilization <ul><li>Supine/Prone (study done) </li></ul><ul><li>Vac-lok </li></ul><ul><li>A...
 
 
Gynecological Cancer <ul><li>Uterine Cervix </li></ul>
Uterine Cervix <ul><li>Squamous cell </li></ul><ul><li>Incidence of Invasive CA decrease due to PAP smear detection </li><...
Uterine Cervix Routes of Spread <ul><li>Direct extension </li></ul><ul><li>Lymphatics </li></ul>
Uterine Cervix Treatment <ul><li>Surgery (TAH) </li></ul><ul><li>Radiation Therapy (external & implant) </li></ul><ul><li>...
Uterine Cervix Radiation Therapy Treatment <ul><li>Four field to 40-45Gy </li></ul><ul><li>Boost intercavitary  </li></ul>
 
 
Uterine Cervix Positioning and Immobilization <ul><li>Anal marker </li></ul><ul><li>Rectal barium </li></ul><ul><li>Vagina...
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Hsc 340 12 9

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Hsc 340 12 9

  1. 1. HSC 340 12-19-10 Gastrointestinal Cancer Genitourinary Cancer Gynecological Cancer
  2. 2. Gastrointestinal Cancer <ul><li>Esophagus </li></ul><ul><li>Stomach </li></ul><ul><li>Pancreas </li></ul><ul><li>Rectum </li></ul><ul><li>Anus </li></ul>
  3. 3. Esophageal Cancer <ul><li>Usually squamous cell </li></ul><ul><li>Males more than females </li></ul><ul><li>Cure rates <10% </li></ul><ul><li>Accounts for 1% of all US cancers </li></ul>
  4. 4. Esophageal Anatomy <ul><li>Cervical esophagus </li></ul><ul><li>Upper thoracic </li></ul><ul><li>Middle thoracic </li></ul><ul><li>Lower thoracic </li></ul>
  5. 5. Esophageal routes of spread <ul><li>Spreads longitudinally through lymphatics </li></ul><ul><ul><li>Upper </li></ul></ul><ul><ul><li>Middle </li></ul></ul><ul><ul><li>Lower </li></ul></ul>
  6. 6. Esophageal CA Treatment <ul><li>Surgery only- poor control </li></ul><ul><li>External beam only- curative and palliative </li></ul><ul><li>Chemo, radiation </li></ul><ul><li>Chemo, radiation & surgery </li></ul><ul><li>Curative vs. Palliative </li></ul>
  7. 7. Esophageal Radiation Therapy Techniques <ul><li>Cervical Esophagus </li></ul><ul><ul><li>Lateral opposed, Obliques </li></ul></ul><ul><li>Thoracic Esophagus </li></ul><ul><ul><li>AP:PA, Obliques or AP:PA & Obliques combo </li></ul></ul>
  8. 10. Esophageal Immobilization & Positioning Devices <ul><li>Prone sometimes used to pull esophagus away from sc. </li></ul><ul><li>Supine more common </li></ul><ul><li>Arms above head, may-be hard to hold if elderly </li></ul><ul><li>Vac-lok, body casts </li></ul><ul><li>*problems w/arms at sides…3 pt set-up </li></ul>
  9. 11. Esophageal Doses <ul><li>Palliative </li></ul><ul><ul><li>30 Gy over two weeks to 50 Gy over five weeks </li></ul></ul><ul><li>Preoperative + chemo </li></ul><ul><ul><li>30 Gy over three weeks to 45 Gy over five weeks </li></ul></ul><ul><li>No surgery </li></ul><ul><ul><li>Above dose with a boost to 60-65 Gy </li></ul></ul><ul><li>HDR and LDR are options…. </li></ul>
  10. 12. Stomach Cancer <ul><li>Majority Ulcerative Adenocarcinomas </li></ul><ul><li>High incidence in Japan </li></ul>
  11. 13. Stomach Anatomy <ul><li>Begins at Gastroesophageal Junction and ends at pylorus </li></ul><ul><li>Many critical structures surrounding organ </li></ul>
  12. 14. Stomach CA Routes of Spread <ul><li>Direct Extension </li></ul><ul><li>Widespread </li></ul>
  13. 15. Stomach CA Treatment <ul><li>Surgery & Post-op Radiation Therapy with Concurrent chemo </li></ul><ul><li>Radiation alone in palliative cases (unresectable) </li></ul>
  14. 16. Stomach Radiation Therapy Techniques <ul><li>AP:PA </li></ul><ul><li>Doses: </li></ul><ul><ul><li>40-45 Gy w/ 5FU </li></ul></ul><ul><ul><li>Boost to 50-55Gy if needed </li></ul></ul>
  15. 18. Stomach Immobilization and Positioning <ul><li>Supine </li></ul><ul><li>Arms above head </li></ul><ul><li>Vac-lok, body cast </li></ul><ul><li>Contrast? </li></ul>
  16. 19. Pancreatic Cancer <ul><li>Ductal adenocarcinoma </li></ul><ul><li>Occur in the head of pancreas </li></ul>
  17. 20. Pancreas Anatomy <ul><li>Three sections </li></ul><ul><ul><li>Head, tail, body </li></ul></ul><ul><ul><li>L1-L2 </li></ul></ul>
  18. 21. Pancreatic CA routes of spread <ul><li>Direct extension </li></ul><ul><li>Lymphatics </li></ul>
  19. 22. Pancreatic CA Treatment <ul><li>Surgery (you want the cancer in the tail!) </li></ul><ul><li>Surgery, Post-op Radiation Therapy, Combination Chemotherapy </li></ul><ul><li>Unresectable tumors- palliative radiation therapy and chemotherapy </li></ul>
  20. 23. Pancreatic radiation therapy techniques <ul><li>Three field (AP, Lats), four field (AP:PA, Lats), IGRT –couch rotation used to create unique fields that spare structures </li></ul><ul><li>Doses </li></ul><ul><ul><li>45-50 Gy with combo chemo </li></ul></ul><ul><ul><li>Limit lateral fields to 18-20Gy to preserve kidneys </li></ul></ul><ul><ul><li>60 Gy in 3 two week courses (20 Gy/week) for palliative with field reduction @ 45 Gy </li></ul></ul>
  21. 25. Pancreatic Immobilization & Positioning <ul><li>Supine </li></ul><ul><li>Arms above head </li></ul><ul><li>Vac-lok, alpha cradle, body cast </li></ul><ul><li>Contrast- swallowed and/or injected (to see kidneys) </li></ul>
  22. 26. Rectal Cancer <ul><li>Adenocarcinomas </li></ul><ul><li>Men = Women </li></ul><ul><li>Rectal bleeding </li></ul><ul><li>2 nd most common cause of CA death in US </li></ul>
  23. 27. Rectal Anatomy <ul><li>13-15 cm long </li></ul><ul><li>Upper, middle and lower valves divide into sections </li></ul>
  24. 28. Rectal CA routes of spread <ul><li>Direct extension </li></ul><ul><li>Wide spread dissemination </li></ul>
  25. 29. Rectal CA Treatment <ul><li>Surgery </li></ul><ul><li>Surgery + Radiation Therapy + Chemo </li></ul><ul><li>Pre-op, post-op, pre-op & post-op </li></ul>
  26. 30. Rectal CA Radiation Therapy <ul><li>Three field (PA and lats) patient prone </li></ul><ul><li>IGRT </li></ul><ul><li>Doses </li></ul><ul><ul><li>45 Gy </li></ul></ul><ul><ul><li>May boost to 50Gy </li></ul></ul>
  27. 32. Rectal Immobilization and Positioning <ul><li>Prone </li></ul><ul><li>Belly board (to help “drop” small bowel) </li></ul><ul><li>Arms above head </li></ul><ul><li>Contrast- Oral for sm. Bowel, rectal </li></ul><ul><li>Rectal marker </li></ul><ul><li>Anal marker </li></ul><ul><li>Vaginal marker </li></ul>
  28. 33. Anal Cancer <ul><li>Squamous cell </li></ul><ul><li>3cm in length </li></ul>
  29. 34. Anal CA Routes of Spread <ul><li>Direct Extension, Lymphatics, Blood stream </li></ul>
  30. 35. Anal CA Treatment <ul><li>Surgery </li></ul><ul><li>Chemo and Radiation </li></ul>
  31. 36. Anal CA Radiation Therapy <ul><li>AP:PA, IGRT </li></ul><ul><li>Doses </li></ul><ul><ul><li>45 Gy with Chemo </li></ul></ul><ul><ul><li>Boost to 50-55 Gy if large tumor </li></ul></ul><ul><ul><li>60-65 Gy radiation only </li></ul></ul><ul><ul><li>e- beams may be used if inguinal nodes have disease </li></ul></ul>
  32. 38. Anal CA Immobilization and Positioning <ul><li>Supine </li></ul><ul><li>Vac-lok, body cast </li></ul><ul><li>Marker on lowest pt. of tumor </li></ul><ul><li>Vaginal marker </li></ul>
  33. 39. Genitourinary Cancer <ul><li>Bladder </li></ul><ul><li>Prostate </li></ul>
  34. 40. Bladder Cancer <ul><li>Blood in urine </li></ul><ul><li>Cigarette smoke common cause </li></ul><ul><li>Transitional cell carcinoma </li></ul>
  35. 41. Bladder CA Routes of Spread <ul><li>Direct Extension </li></ul><ul><li>Lymphatics </li></ul>
  36. 42. Bladder CA Radiation Therapy <ul><li>Radiation therapy alone </li></ul><ul><li>Surgery & Radiation Therapy </li></ul><ul><li>Surgery, Chemo & Radiation Therapy </li></ul><ul><li>3 most common: </li></ul><ul><ul><li>Preop radiation followed by cystectomy </li></ul></ul><ul><ul><li>Radiation after transurethral resection </li></ul></ul><ul><ul><li>Transurethral resection, chemo, radiation </li></ul></ul>
  37. 43. Bladder CA Radiation Therapy Techniques <ul><li>Four field technique, IGRT </li></ul><ul><li>Dose: </li></ul><ul><ul><li>Pre-op 45-50Gy </li></ul></ul><ul><ul><li>No chemo, no surgery 45-50 Gy with a boost to 65-70 Gy </li></ul></ul><ul><ul><li>Trials </li></ul></ul>
  38. 47. Bladder CA Immobilization & Positioning <ul><li>Supine </li></ul><ul><li>Contrast- Bladder (air introduced to see anterior surface of bladder) </li></ul><ul><li>Arms on chest </li></ul>
  39. 48. Prostate Cancer <ul><li>Most common cancer in men </li></ul><ul><li>Adenocarcinoma </li></ul><ul><li>60+ </li></ul><ul><li>PSA, Gleason Score </li></ul>
  40. 49. Prostate CA Routes of Spread <ul><li>Local invasion </li></ul><ul><li>Lymphatics </li></ul><ul><li>Bone </li></ul>
  41. 50. Prostate CA Treatments <ul><li>Observation </li></ul><ul><li>Radical Prostatectomy </li></ul><ul><li>Implant Therapy </li></ul><ul><li>External Therapy </li></ul><ul><li>Combination Implant & External </li></ul><ul><li>Hormone Therapy for Metastatic disease </li></ul>
  42. 51. Prostate CA Radiation Therapy Techniques <ul><li>Four field, IGRT </li></ul><ul><li>Doses: </li></ul><ul><ul><li>75-81Gy with conedown off rectum if possible </li></ul></ul><ul><ul><li>Post-op 60-66 Gy </li></ul></ul>
  43. 52. Prostate CA Positioning and Immobilization <ul><li>Supine/Prone (study done) </li></ul><ul><li>Vac-lok </li></ul><ul><li>Arms on chest holding ring </li></ul><ul><li>Contrast- bladder, nodal, rectal**, sm. Bowel </li></ul>
  44. 55. Gynecological Cancer <ul><li>Uterine Cervix </li></ul>
  45. 56. Uterine Cervix <ul><li>Squamous cell </li></ul><ul><li>Incidence of Invasive CA decrease due to PAP smear detection </li></ul>
  46. 57. Uterine Cervix Routes of Spread <ul><li>Direct extension </li></ul><ul><li>Lymphatics </li></ul>
  47. 58. Uterine Cervix Treatment <ul><li>Surgery (TAH) </li></ul><ul><li>Radiation Therapy (external & implant) </li></ul><ul><li>Surgery, Radiation Therapy, Chemo </li></ul>
  48. 59. Uterine Cervix Radiation Therapy Treatment <ul><li>Four field to 40-45Gy </li></ul><ul><li>Boost intercavitary </li></ul>
  49. 62. Uterine Cervix Positioning and Immobilization <ul><li>Anal marker </li></ul><ul><li>Rectal barium </li></ul><ul><li>Vaginal marker </li></ul><ul><li>Bladder contrast </li></ul><ul><li>Prone w/belly board to move sm.bowel </li></ul>

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