This document provides information about cervical cancer, including:
1. The anatomy of the cervix and epidemiology and risk factors for cervical cancer. Squamous cell carcinoma makes up 80% of cases.
2. The pathology, lymph node spread, diagnosis, staging according to FIGO, and prognostic factors like tumor size and lymph node involvement.
3. The treatment approaches for different stages, including surgery, radiation therapy alone or with chemotherapy. Concurrent chemotherapy with radiation improves outcomes for stages 1B2 or higher.
4. Details on radiation therapy techniques including target volume delineation and field arrangements tailored to the tumor extent and lymph node areas. Intensity-modulated radiation therapy can better spare normal
Management of Early Stage Carcinoma CervixSubhash Thakur
This presentation covers the management of early stage carcinoma cervix (FIGO stage I to IIA). A brief introuduction to different surgical procedures and the radiation treatment techninques have been described.
The document discusses cervical cancer, including its epidemiology, risk factors, pathogenesis, clinical presentation, investigations, complications, treatment, and prevention. Cervical cancer is caused by human papillomavirus (HPV) and is the most common gynecologic cancer in women globally. Screening through Pap smear testing and HPV DNA testing can detect pre-cancerous lesions early and reduce cervical cancer incidence and mortality rates. Prevention involves HPV vaccination, screening programs, and sexual health education and advocacy.
Cervical cancer is caused by persistent HPV infection and develops from normal cervical cells turning precancerous and then cancerous, mainly in the area where the cervix meets the womb. It is the fourth most common cancer in women worldwide with over 500,000 new cases in 2012. The majority of cases and deaths occur in less developed regions, with sub-Saharan Africa having the highest rates. Risk factors include HPV infection, low screening, smoking, HIV/AIDS, young age of first sexual activity, and many sexual partners. Prevention includes vaccination against HPV, screening programs for early detection and treatment of precancerous lesions, and lifestyle behaviors to reduce risk of HPV exposure and persistence.
This document provides an overview of breast carcinoma, including its development, anatomy, risk factors, subtypes, and diagnosis. It begins with the development of the breast from fetal stages through adulthood. It describes the anatomy of the breast including blood supply, lymphatic drainage, and subareolar plexus. Risk factors associated with breast carcinoma include age, family history, personal history, reproductive history, and lifestyle factors. The document discusses the molecular subtypes of breast cancer and genes associated with inherited forms. It provides details on non-invasive and invasive breast carcinomas and concludes with an overview of the clinical examination and workup for diagnosing breast cancer.
The document discusses management dilemmas in cervical cancer. It notes that cervical cancer is the third most common cancer worldwide yet is preventable. Treatment options depend on the stage of cancer and may involve surgery such as radical hysterectomy or radiation therapy. Close follow up is important after treatment due to the risk of recurrence. Proper screening and early detection are emphasized to improve outcomes for cervical cancer patients.
Cervical cancer begins in the cells of the cervix and is caused by human papillomavirus (HPV) infection in most cases. Regular cervical screening can detect pre-cancerous changes that may develop into cancer if left untreated. Early stage cervical cancer is often treated with surgery to remove the tumor while more advanced stages may require a combination of surgery, radiation therapy, and chemotherapy. The document discusses risk factors, symptoms, screening, diagnosis, staging, and treatment options for cervical cancer in detail.
This document provides background information on ovarian cancer, including its pathophysiology, etiology, epidemiology, clinical presentation, diagnosis, and screening. It states that ovarian cancer typically spreads within the peritoneal cavity. Several risk factors are identified, including genetic and reproductive factors. Epithelial ovarian cancer represents the most common histology and has a poor prognosis when diagnosed at advanced stages, due to nonspecific symptoms. No approved screening methods exist for ovarian cancer detection.
Vulvar cancer is a rare malignancy that represents less than 1% of cancers in women. Risk factors include older age, precancerous skin changes, HPV infection, smoking, and immune disorders. There are two main types characterized by different precursor lesions and histologies. Treatment involves radical surgery with groin lymph node dissection, with postoperative radiation used for high-risk features. Advanced cases may receive neoadjuvant chemoradiation to downsize tumors prior to surgery or definitive chemoradiation without surgery. Radiotherapy planning requires delineation of primary tumors and nodal volumes, with techniques including 3DCRT and IMRT to optimize dose distribution and spare organs-at-risk.
Management of Early Stage Carcinoma CervixSubhash Thakur
This presentation covers the management of early stage carcinoma cervix (FIGO stage I to IIA). A brief introuduction to different surgical procedures and the radiation treatment techninques have been described.
The document discusses cervical cancer, including its epidemiology, risk factors, pathogenesis, clinical presentation, investigations, complications, treatment, and prevention. Cervical cancer is caused by human papillomavirus (HPV) and is the most common gynecologic cancer in women globally. Screening through Pap smear testing and HPV DNA testing can detect pre-cancerous lesions early and reduce cervical cancer incidence and mortality rates. Prevention involves HPV vaccination, screening programs, and sexual health education and advocacy.
Cervical cancer is caused by persistent HPV infection and develops from normal cervical cells turning precancerous and then cancerous, mainly in the area where the cervix meets the womb. It is the fourth most common cancer in women worldwide with over 500,000 new cases in 2012. The majority of cases and deaths occur in less developed regions, with sub-Saharan Africa having the highest rates. Risk factors include HPV infection, low screening, smoking, HIV/AIDS, young age of first sexual activity, and many sexual partners. Prevention includes vaccination against HPV, screening programs for early detection and treatment of precancerous lesions, and lifestyle behaviors to reduce risk of HPV exposure and persistence.
This document provides an overview of breast carcinoma, including its development, anatomy, risk factors, subtypes, and diagnosis. It begins with the development of the breast from fetal stages through adulthood. It describes the anatomy of the breast including blood supply, lymphatic drainage, and subareolar plexus. Risk factors associated with breast carcinoma include age, family history, personal history, reproductive history, and lifestyle factors. The document discusses the molecular subtypes of breast cancer and genes associated with inherited forms. It provides details on non-invasive and invasive breast carcinomas and concludes with an overview of the clinical examination and workup for diagnosing breast cancer.
The document discusses management dilemmas in cervical cancer. It notes that cervical cancer is the third most common cancer worldwide yet is preventable. Treatment options depend on the stage of cancer and may involve surgery such as radical hysterectomy or radiation therapy. Close follow up is important after treatment due to the risk of recurrence. Proper screening and early detection are emphasized to improve outcomes for cervical cancer patients.
Cervical cancer begins in the cells of the cervix and is caused by human papillomavirus (HPV) infection in most cases. Regular cervical screening can detect pre-cancerous changes that may develop into cancer if left untreated. Early stage cervical cancer is often treated with surgery to remove the tumor while more advanced stages may require a combination of surgery, radiation therapy, and chemotherapy. The document discusses risk factors, symptoms, screening, diagnosis, staging, and treatment options for cervical cancer in detail.
This document provides background information on ovarian cancer, including its pathophysiology, etiology, epidemiology, clinical presentation, diagnosis, and screening. It states that ovarian cancer typically spreads within the peritoneal cavity. Several risk factors are identified, including genetic and reproductive factors. Epithelial ovarian cancer represents the most common histology and has a poor prognosis when diagnosed at advanced stages, due to nonspecific symptoms. No approved screening methods exist for ovarian cancer detection.
Vulvar cancer is a rare malignancy that represents less than 1% of cancers in women. Risk factors include older age, precancerous skin changes, HPV infection, smoking, and immune disorders. There are two main types characterized by different precursor lesions and histologies. Treatment involves radical surgery with groin lymph node dissection, with postoperative radiation used for high-risk features. Advanced cases may receive neoadjuvant chemoradiation to downsize tumors prior to surgery or definitive chemoradiation without surgery. Radiotherapy planning requires delineation of primary tumors and nodal volumes, with techniques including 3DCRT and IMRT to optimize dose distribution and spare organs-at-risk.
Clinical presentation and investigations for breast carcinomaViswa Kumar
This document provides an overview of breast carcinoma, including:
1) The embryology, functional anatomy, blood supply, innervation, and lymphatics of the breast.
2) The epidemiology of breast cancer, noting it is the most common cancer in women worldwide.
3) Clinical presentations like palpable masses, pain, nipple discharge, and skin changes.
4) Recommendations for diagnostic tools like mammography, ultrasound, and MRI to evaluate symptoms based on patient age and risk factors.
5) The BI-RADS assessment system to categorize imaging findings and guide next steps.
Breast Cancer Management & Surgical ConsiderationsRiaz Rahman
Clinical overview and surgical considerations for management of Primary Breast Cancer and other subtypes. Covers screening recommendations, mammography (including BIRADS score interpretation), pathophysiology, staging, prognosis, surgical management, breast anatomy, non-surgical management, follow-up considerations. Given at Jackson Park Medical Center on 1/30/2014. Includes references.
Cervical cancer is caused by HPV infection and is the leading cause of cancer deaths in many developing countries. HPV is present in over 99% of cervical cancers. Risk factors include young age of first sexual activity, multiple partners, early pregnancy, and smoking. Precancerous lesions usually develop over 10-15 years. Cervical cancer spreads locally through the cervix and vagina, and can metastasize to nearby lymph nodes and distant sites like the lungs and liver. Diagnosis involves identifying dysplastic cervical cells, and treatment depends on the cancer stage.
This document discusses the management of colon cancers. It covers various treatment options including surgery, chemotherapy, and radiation therapy depending on the stage of cancer. For stage III colon cancer, adjuvant chemotherapy with FOLFOX or CapeOx is preferred after surgery to improve disease-free and overall survival based on clinical trials. Surgery aims to do an R0 resection with adequate margins and lymph node sampling. Laparoscopic surgery has comparable oncologic outcomes to open surgery.
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
1. Carcinoma of the cervix is a major cause of cancer deaths in women in India, with HPV infection being the primary risk factor.
2. It typically presents with vaginal bleeding and spreads locally and via lymph nodes to distant sites like lungs and bones.
3. Diagnosis involves cervical smears, biopsies and imaging while FIGO staging classifies the extent of disease.
4. Treatment depends on stage but commonly includes surgery, radiation therapy and chemotherapy with the goal of maximizing cure rates while minimizing treatment related morbidity.
This document discusses cervical cancer, including its epidemiology, risk factors, mechanisms, evaluation, staging, treatment options, and prognosis. Key points include:
- Human papillomavirus (HPV) infection is the main risk factor and causal agent for cervical cancer. High-risk HPV subtypes 16 and 18 are responsible for most cases.
- Early detection through Pap screening can prevent 30% of cases in developed countries and up to 60% in developing countries. Symptoms often include abnormal bleeding.
- Staging follows the FIGO system and determines prognosis and treatment. Surgery (e.g. radical hysterectomy), radiotherapy, and chemotherapy are common treatment options.
- Prognosis
Cervical cancer arises from the transformation of cervical cells through dysplasia, metaplasia, and neoplasia. The majority are squamous cell carcinomas and adenocarcinomas. Cervical intraepithelial neoplasia (CIN) describes abnormal cervical cells on a scale of CIN I to CIN III based on severity. Colposcopy allows physicians to examine the cervix with magnification after acetic acid application to detect abnormalities. Cervical cancer screening through Pap smears aims to detect precancerous lesions early through cell sampling and analysis. Risk factors include early sexual activity, multiple partners, HPV infection, and smoking.
Cancer of the cervix occurs when the cells of the cervix change in a way that leads to abnormal growth and invasion of other tissues or organs of the body.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
This document discusses endometrial carcinoma (cancer of the uterus). It begins with an anatomy of the uterus and defines endometrial cancer as beginning in the endometrial lining of the uterus. Some risk factors include obesity, hormonal imbalances, and nulliparity. Diagnosis involves ultrasound, biopsy and imaging. Treatment depends on cancer stage and grade, and may include surgery, radiation, chemotherapy. Prognosis is generally good, though older age and advanced stage indicate poorer outcomes.
Endometrial cancer starts when cells in the inner lining of the uterus grow abnormally and can spread. Some key risk factors include excess estrogen exposure without progesterone opposition, obesity, late menopause, and family history. Common symptoms are abnormal vaginal bleeding or discharge. Diagnosis involves endometrial biopsy and other imaging tests. Treatment options include surgery to remove the uterus and surrounding tissue, radiation therapy, chemotherapy, hormone therapy, and targeted therapies. The cancer is staged based on how much it has spread in the body.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
1) The document discusses the management of breast cancer including surgical approaches such as mastectomy, radiotherapy, hormone therapy, and chemotherapy.
2) Surgical approaches range from conservative surgeries to radical mastectomies and include procedures such as lumpectomy, quadrantectomy, and total mastectomy.
3) Management depends on the stage of breast cancer and may involve a multi-pronged approach using combinations of surgery, radiotherapy, hormone therapy, and chemotherapy. Single modalities are generally not effective.
Cervical cancer is a major public health problem that is largely preventable. It is the third most common cancer in women worldwide, with over 500,000 new cases and 200,000 deaths each year. While often asymptomatic in early stages, if detected early through screening it can be treated effectively. Screening allows for detection and treatment of precancerous lesions before they develop into invasive cancer. The document discusses the causes, risk factors, natural history, screening methods such as Pap smear and visual inspection with acetic acid, diagnostic tools, and treatment options including ablation, excision and hysterectomy for prevention and management of cervical cancer.
Breast cancer is the most common cancer in women. There are several types including ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), and invasive ductal carcinoma. Treatment depends on cancer type and stage. For early-stage disease, lumpectomy with radiation or mastectomy are equivalent options. Lumpectomy is preferred for cosmetic reasons when possible. Reconstruction options are available for patients undergoing mastectomy.
Uterine sarcoma is a rare and challenging type of cancer that grows rapidly. It accounts for 2-5% of uterine malignancies and is diagnosed in about 17 per 1000 women annually. Risk factors include prior pelvic radiation and black race. Long-term tamoxifen use also increases the risk. The most common presenting symptom is vaginal bleeding. Surgery is the primary treatment but the benefits of adjuvant radiation and chemotherapy are unclear due to limited data. Prognosis is generally poor, especially for later stages, and more research is needed to determine optimal adjuvant therapies.
The uterus is a pear-shaped organ divided into the fundus, body, and cervix. Lymph drainage from the fundus goes to para-aortic nodes at L1, while the body and cervix drain to internal and external iliac nodes. Endometrial cancer is the most common gynecologic malignancy in the US, with risk factors including age, estrogen exposure, genetics, and medical history. Treatment depends on staging and includes surgery, radiation, chemotherapy, and hormonal therapy.
Bladder cancer most commonly presents as hematuria and is usually transitional cell carcinoma. Risk factors include smoking, industrial chemical exposure, and past pelvic radiation. Diagnosis involves cystoscopy and biopsy. Staging uses TNM system and determines prognosis and treatment. Treatment depends on stage and includes transurethral resection for superficial disease or radical cystectomy for invasive disease, with chemotherapy sometimes used as well. Prognosis depends on stage, with 5-year survival rates ranging from 85% for stage Ta to 10-20% for stage IV disease.
Clinical presentation and investigations for breast carcinomaViswa Kumar
This document provides an overview of breast carcinoma, including:
1) The embryology, functional anatomy, blood supply, innervation, and lymphatics of the breast.
2) The epidemiology of breast cancer, noting it is the most common cancer in women worldwide.
3) Clinical presentations like palpable masses, pain, nipple discharge, and skin changes.
4) Recommendations for diagnostic tools like mammography, ultrasound, and MRI to evaluate symptoms based on patient age and risk factors.
5) The BI-RADS assessment system to categorize imaging findings and guide next steps.
Breast Cancer Management & Surgical ConsiderationsRiaz Rahman
Clinical overview and surgical considerations for management of Primary Breast Cancer and other subtypes. Covers screening recommendations, mammography (including BIRADS score interpretation), pathophysiology, staging, prognosis, surgical management, breast anatomy, non-surgical management, follow-up considerations. Given at Jackson Park Medical Center on 1/30/2014. Includes references.
Cervical cancer is caused by HPV infection and is the leading cause of cancer deaths in many developing countries. HPV is present in over 99% of cervical cancers. Risk factors include young age of first sexual activity, multiple partners, early pregnancy, and smoking. Precancerous lesions usually develop over 10-15 years. Cervical cancer spreads locally through the cervix and vagina, and can metastasize to nearby lymph nodes and distant sites like the lungs and liver. Diagnosis involves identifying dysplastic cervical cells, and treatment depends on the cancer stage.
This document discusses the management of colon cancers. It covers various treatment options including surgery, chemotherapy, and radiation therapy depending on the stage of cancer. For stage III colon cancer, adjuvant chemotherapy with FOLFOX or CapeOx is preferred after surgery to improve disease-free and overall survival based on clinical trials. Surgery aims to do an R0 resection with adequate margins and lymph node sampling. Laparoscopic surgery has comparable oncologic outcomes to open surgery.
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
1. Carcinoma of the cervix is a major cause of cancer deaths in women in India, with HPV infection being the primary risk factor.
2. It typically presents with vaginal bleeding and spreads locally and via lymph nodes to distant sites like lungs and bones.
3. Diagnosis involves cervical smears, biopsies and imaging while FIGO staging classifies the extent of disease.
4. Treatment depends on stage but commonly includes surgery, radiation therapy and chemotherapy with the goal of maximizing cure rates while minimizing treatment related morbidity.
This document discusses cervical cancer, including its epidemiology, risk factors, mechanisms, evaluation, staging, treatment options, and prognosis. Key points include:
- Human papillomavirus (HPV) infection is the main risk factor and causal agent for cervical cancer. High-risk HPV subtypes 16 and 18 are responsible for most cases.
- Early detection through Pap screening can prevent 30% of cases in developed countries and up to 60% in developing countries. Symptoms often include abnormal bleeding.
- Staging follows the FIGO system and determines prognosis and treatment. Surgery (e.g. radical hysterectomy), radiotherapy, and chemotherapy are common treatment options.
- Prognosis
Cervical cancer arises from the transformation of cervical cells through dysplasia, metaplasia, and neoplasia. The majority are squamous cell carcinomas and adenocarcinomas. Cervical intraepithelial neoplasia (CIN) describes abnormal cervical cells on a scale of CIN I to CIN III based on severity. Colposcopy allows physicians to examine the cervix with magnification after acetic acid application to detect abnormalities. Cervical cancer screening through Pap smears aims to detect precancerous lesions early through cell sampling and analysis. Risk factors include early sexual activity, multiple partners, HPV infection, and smoking.
Cancer of the cervix occurs when the cells of the cervix change in a way that leads to abnormal growth and invasion of other tissues or organs of the body.
This document discusses carcinoma of the rectum. It begins by explaining the anatomy of the rectum and its blood supply, lymphatic drainage and innervation. It then discusses the epidemiology, risk factors, staging systems including Dukes and TNM classification. Signs and symptoms, diagnostic workup including endoscopic, radiological and biopsy evaluation are explained. Principles of surgical treatment including resection margins are outlined. The goal of surgery is eradication of the primary tumor along with adjacent mesorectal tissue.
This document discusses endometrial carcinoma (cancer of the uterus). It begins with an anatomy of the uterus and defines endometrial cancer as beginning in the endometrial lining of the uterus. Some risk factors include obesity, hormonal imbalances, and nulliparity. Diagnosis involves ultrasound, biopsy and imaging. Treatment depends on cancer stage and grade, and may include surgery, radiation, chemotherapy. Prognosis is generally good, though older age and advanced stage indicate poorer outcomes.
Endometrial cancer starts when cells in the inner lining of the uterus grow abnormally and can spread. Some key risk factors include excess estrogen exposure without progesterone opposition, obesity, late menopause, and family history. Common symptoms are abnormal vaginal bleeding or discharge. Diagnosis involves endometrial biopsy and other imaging tests. Treatment options include surgery to remove the uterus and surrounding tissue, radiation therapy, chemotherapy, hormone therapy, and targeted therapies. The cancer is staged based on how much it has spread in the body.
A multidisciplinary approach that includes surgery, medical oncology, and radiation oncology is required for optimal treatment of patients with rectal cancer
1) The document discusses the management of breast cancer including surgical approaches such as mastectomy, radiotherapy, hormone therapy, and chemotherapy.
2) Surgical approaches range from conservative surgeries to radical mastectomies and include procedures such as lumpectomy, quadrantectomy, and total mastectomy.
3) Management depends on the stage of breast cancer and may involve a multi-pronged approach using combinations of surgery, radiotherapy, hormone therapy, and chemotherapy. Single modalities are generally not effective.
Cervical cancer is a major public health problem that is largely preventable. It is the third most common cancer in women worldwide, with over 500,000 new cases and 200,000 deaths each year. While often asymptomatic in early stages, if detected early through screening it can be treated effectively. Screening allows for detection and treatment of precancerous lesions before they develop into invasive cancer. The document discusses the causes, risk factors, natural history, screening methods such as Pap smear and visual inspection with acetic acid, diagnostic tools, and treatment options including ablation, excision and hysterectomy for prevention and management of cervical cancer.
Breast cancer is the most common cancer in women. There are several types including ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), and invasive ductal carcinoma. Treatment depends on cancer type and stage. For early-stage disease, lumpectomy with radiation or mastectomy are equivalent options. Lumpectomy is preferred for cosmetic reasons when possible. Reconstruction options are available for patients undergoing mastectomy.
Uterine sarcoma is a rare and challenging type of cancer that grows rapidly. It accounts for 2-5% of uterine malignancies and is diagnosed in about 17 per 1000 women annually. Risk factors include prior pelvic radiation and black race. Long-term tamoxifen use also increases the risk. The most common presenting symptom is vaginal bleeding. Surgery is the primary treatment but the benefits of adjuvant radiation and chemotherapy are unclear due to limited data. Prognosis is generally poor, especially for later stages, and more research is needed to determine optimal adjuvant therapies.
The uterus is a pear-shaped organ divided into the fundus, body, and cervix. Lymph drainage from the fundus goes to para-aortic nodes at L1, while the body and cervix drain to internal and external iliac nodes. Endometrial cancer is the most common gynecologic malignancy in the US, with risk factors including age, estrogen exposure, genetics, and medical history. Treatment depends on staging and includes surgery, radiation, chemotherapy, and hormonal therapy.
Bladder cancer most commonly presents as hematuria and is usually transitional cell carcinoma. Risk factors include smoking, industrial chemical exposure, and past pelvic radiation. Diagnosis involves cystoscopy and biopsy. Staging uses TNM system and determines prognosis and treatment. Treatment depends on stage and includes transurethral resection for superficial disease or radical cystectomy for invasive disease, with chemotherapy sometimes used as well. Prognosis depends on stage, with 5-year survival rates ranging from 85% for stage Ta to 10-20% for stage IV disease.
The document discusses testicular seminoma, including:
- It is the most common solid tumor in men aged 15-35 and has increasing incidence. Risk factors include cryptorchidism, family history, and genetic factors.
- Presentation is usually a unilateral testicular mass. Staging involves imaging and tumor markers. Pathology shows seminoma cells that are typically PLAP positive.
- Treatment depends on stage. Stage I options include surveillance, chemotherapy, or radiotherapy. Advanced stages receive chemotherapy. Outcomes are generally excellent even for advanced disease.
This document discusses the management of early stage breast carcinoma. It covers the work up, types of surgery including lumpectomy and mastectomy, reconstructive options, complications of surgery, sentinel lymph node biopsy, radiotherapy techniques including whole breast irradiation and boost to tumor bed, and partial breast irradiation methods like intraoperative radiation therapy. It provides guidelines on indications for radiotherapy and highlights several large randomized trials investigating radiotherapy after lumpectomy and breast conservation surgery.
The document discusses carcinoma of the colon and its management. It provides details on epidemiology, risk factors, staging, diagnostic workup, surgery, adjuvant therapy including chemotherapy and radiation therapy. Surgery is the primary treatment but adjuvant therapy with chemotherapy improves survival outcomes, especially in stage III disease. Chemotherapy regimens like FOLFOX and 5-FU plus leucovorin are commonly used in the adjuvant and metastatic settings.
This document discusses treatment options for locally advanced breast cancer (LABC). It notes that LABC is a heterogeneous disease and standard primary chemotherapy includes anthracyclines and taxanes. Neoadjuvant chemotherapy is now the standard of care as it allows for breast conservation in some cases and those who achieve a pathological complete response have improved survival rates. The response to neoadjuvant therapy and molecular subtypes (e.g. triple negative, HER2-positive) can help determine the most effective adjuvant treatment strategy. Targeted therapies like trastuzumab improve outcomes for HER2-positive breast cancer when given with chemotherapy in the neoadjuvant setting.
Colon cancer is the fourth most commonly diagnosed cancer. About 70% of cases are sporadic, while 23% are genetic. It most commonly presents in the descending and sigmoid colon as a change in bowel habits with blood or mucus in the stool. Staging involves clinical exams, imaging like CT scans, and blood tests like CEA. Treatment depends on the stage, with surgery being the main treatment and chemotherapy sometimes used adjuvantly or palliatively. The 5-year survival ranges from 100% for stage 0 to 3-30% for stage 4 disease.
The document provides an overview of the Egyptian HCC Guidelines presented by Mohamed A. Ezzel Arab MD. It summarizes the guidelines on primary, secondary, and tertiary prevention of HCC. It also outlines recommendations for screening, diagnosis, staging, treatment including surgical resection, locoregional therapies, transplantation, and systemic therapies. Post-treatment monitoring guidelines are also presented. The document aims to provide evidence-based guidelines tailored to factors in Egypt based on international guidelines and expert opinion.
- A newborn boy presented with a large, firm left flank mass found on physical examination. An ultrasound revealed a solid renal mass.
- The most likely diagnosis is congenital mesoblastic nephroma (CMN), a rare renal tumor that typically presents in infants less than 3 months old as a painless abdominal or flank mass.
- CMN is usually benign and curable with surgical excision alone, though cellular variants and incomplete resection can cause more aggressive behavior.
This document discusses the management of early breast cancer. It covers staging, pathologic assessment, treatment options including surgery, radiation therapy, systemic therapy, and follow-up guidelines. The stages included in early breast cancer are T1-T2 N0-N1 M0. Treatment involves lumpectomy or mastectomy with radiation therapy and/or systemic therapy depending on tumor biology and other risk factors. The goal is local control and prevention of distant metastases.
This document provides information on carcinoma of the stomach, including:
- Risk factors include H. pylori infection, diet, genetics, smoking.
- Types include intestinal and diffuse. Staging uses TNM and other classifications.
- Common symptoms are weight loss, abdominal pain, vomiting. Investigations include endoscopy and biopsy.
- Treatment depends on stage but commonly includes surgery such as gastrectomy along with lymph node dissection. Endoscopic resection may be used for early stages. Adjuvant therapy is sometimes used for later stages.
This document discusses testicular cancer, including:
- 95% of testicular cancers are germ cell tumors known as seminomas or non-seminomas.
- Risk factors include undescended testes, male infertility, and family history.
- Staging involves evaluating tumor size, lymph node involvement, and serum tumor marker levels.
- Treatment depends on cancer type and stage but may include surgery, radiation therapy, platinum-based chemotherapy, and surveillance. Outcomes are generally very good even for metastatic disease.
Testicular tumors-Cassification, Biomarkers and Staging by Dr RajeshRajesh Sinwer
This document discusses testicular tumors, including:
- Germ cell tumors are the most common type, comprising 95% of cases. Seminomas and non-seminomatous germ cell tumors are the main subtypes.
- Important biomarkers for testicular cancer include AFP, HCG, LDH, and PLAP. Elevated levels can indicate the presence of a non-seminoma.
- Staging is important and is based on whether the cancer is confined to the testis or has spread to lymph nodes or other organs. Spread beyond the retroperitoneum is considered stage III.
- Diagnostic workup involves imaging like ultrasound, CT, MRI and PET scans
Management of anal canal tumors with emphasis on treatment(1)SabaMajid5
This document discusses the management of anal canal tumors with an emphasis on radiation therapy planning. It provides details on:
1) The anatomy of the anal canal and blood supply, lymphatic drainage, and nerve innervation.
2) Risk factors, staging, and patterns of spread for anal canal cancer.
3) The standard of care for anal canal cancer, which is concurrent chemoradiation therapy using radiation doses between 50-59 Gy along with chemotherapy drugs like 5-FU and mitomycin.
4) Techniques for radiation therapy planning including target volume delineation, field arrangements, and dose guidelines to maximize tumor coverage while minimizing dose to surrounding organs.
This document discusses esophageal cancer, including:
- Risk factors like tobacco, alcohol, nutritional deficiencies are common in developing countries.
- Diagnosis involves endoscopy, biopsy, imaging like CT, EUS to determine stage. Advanced stages present with dysphagia, weight loss.
- Treatment depends on stage but may include surgery, chemotherapy, radiation. Surgery involves resection and lymph node dissection.
- Palliative treatments like stenting can relieve dysphagia from obstruction.
- Prognostic factors include stage, tumor markers, lymph node involvement. Early detection and treatment improve outcomes.
1. Locally advanced rectal cancers are defined as T4 or node-positive lesions that cannot be completely resected without a high risk of residual disease. Management involves pre-operative chemotherapy with or without radiation therapy followed by surgery and adjuvant chemotherapy.
2. For resectable stage II/III cancers, pre-operative chemoradiation or radiation followed by surgery and adjuvant chemotherapy improves local control and survival compared to surgery alone.
3. For unresectable T4 cancers, induction chemotherapy and long-course chemoradiation may enable resection. Adjuvant chemotherapy is recommended in all cases.
The document discusses the management of cancer of unknown primary presenting as neck lymph node metastases, including definitions, epidemiology, diagnostic evaluation, and treatment approaches such as chemotherapy, radiation therapy, and surgery. Identification of the primary site can help guide more targeted treatment but often remains challenging given the metastatic presentation; combined modality therapy is generally recommended.
This document discusses esophageal cancer. Some key points:
- Squamous cell carcinoma and adenocarcinoma are the most common histologies. Risk factors include smoking, alcohol, obesity, and Barrett's esophagus.
- Staging uses the TNM system. Treatment depends on stage but may include surgery, chemotherapy, radiation therapy, or a combination.
- For locally advanced stages, neoadjuvant chemoradiation can improve resectability and survival compared to surgery alone. The MAGIC trial showed improved survival with perioperative chemotherapy compared to surgery alone.
- Prognosis remains poor with 5-year survival rates of 15-20%, though outcomes have improved with multimod
The document discusses the non-surgical management of carcinoma cervix. It describes the FIGO staging system and evaluation procedures. For early stage disease (IA-IB1), options include radical hysterectomy or radiotherapy. For stage IB2-IIA, concurrent chemoradiation is the standard treatment. Brachytherapy is an essential component of definitive treatment and aims to deliver high radiation doses to the cervix and paracervical tissues. Proper radiation treatment planning and adherence to timelines are important to achieve optimal outcomes while minimizing toxicity.
This document discusses different types of radiation used in radiation oncology. It describes the evolution from kilovoltage x-ray units to modern megavoltage linear accelerators. Key developments include the use of higher voltage x-rays called supervoltage therapy, and later the advent of megavoltage x-rays and electrons generated by linear accelerators. The document outlines the main components of linear accelerators including the electron gun, RF power source like klystrons or magnetrons, accelerating structure, and treatment head for beam shaping and monitoring.
Brachytherapy involves placing radioactive sources inside or next to the area requiring treatment. There are two main types - high dose rate (HDR) and low dose rate (LDR) brachytherapy. Sources must be encapsulated to protect against radiation exposure. Common photon-emitting sources used include iridium-192, cobalt-60, and cesium-137. Brachytherapy is commonly used as a boost with external beam radiation therapy (EBRT) or as a monotherapy for conditions like cervical, prostate, breast, and head and neck cancers. Dose specifications and fractionation schedules vary depending on the clinical application and brachytherapy technique used.
This case report describes the treatment of a 55-year-old male patient diagnosed with gastric diffuse large B-cell lymphoma (DLBCL) at the Portsudan Oncology Center in Sudan from August 2018 to July 2021. The patient received 8 cycles of CHOP chemotherapy, followed by 8 cycles of rituximab and 30GY radiotherapy to the gastric region and lymph nodes. The treatment resulted in regression of lesions. However, the patient later experienced a relapse and was treated with 8 cycles of ICE chemotherapy, with regression of lesions observed again. The report discusses DLBCL and the challenges of treating it at a small oncology center with limited resources and capabilities.
Protons are the dominant baryonic particle in the universe, comprising 87% of particle mass. Protons have a positive charge and are present in every atom, participating in all matter interactions. Proton therapy delivers a high radiation dose localized to the tumor site using proton beams, which deposit more energy at the tumor compared to X-rays due to the Bragg peak effect, sparing surrounding healthy tissues. Clinical applications of proton therapy include treatment of ocular melanoma, skull base and spine sarcomas, optic pathway gliomas, astrocytomas, and meningiomas.
This case report describes a 55-year-old man diagnosed with gastric diffuse large B-cell lymphoma (DLBCL) in 2018 in Port Sudan, Sudan. He received 8 cycles of CHOP chemotherapy, followed by 8 cycles of rituximab after a relapse in 2019. When a mesenteric lymph node mass recurred in 2021, he received 8 cycles of ICE chemotherapy. The report discusses DLBCL diagnosis, treatment challenges at the regional oncology center due to limited resources, and the patient's response to three lines of chemotherapy and radiotherapy over three years.
This case report describes a 55-year-old man diagnosed with gastric diffuse large B-cell lymphoma (DLBCL) in 2018 in Port Sudan, Sudan. He received 8 cycles of CHOP chemotherapy, followed by 8 cycles of rituximab after a relapse in 2019. When a mesenteric lymph node mass recurred in 2021, he received 8 cycles of ICE chemotherapy. The report discusses DLBCL diagnosis, treatment challenges at the regional oncology center due to limited resources, and the patient's response to three lines of chemotherapy and radiotherapy over three years.
Omer Hashim Mohammed Ebrahim is a radiation oncologist who has been practicing since July 2010. He has over 4 years of experience in radiotherapy, chemotherapy, and caring for cancer patients. He is currently working as a radiation oncologist at Portsudan Oncology Center in Portsudan, Sudan, a position he has held since March 2018. Previously, he worked as a radiation oncologist at the Radiation and Isotope Center in Khartoum, Sudan from March 2016 to March 2018. He received his fellowship training in radiation oncology from the Egyptian Fellowship Board of Radiation Oncology in Cairo, Egypt from July 2010 to December 2016 and holds a Bachelor of Medicine and Surgery degree
This document provides technical specifications for radiotherapy equipment used in cancer treatment. It covers specifications for external beam radiotherapy equipment like linear accelerators and cobalt-60 units, as well as brachytherapy equipment like high-dose rate afterloaders. The document is intended to help procurement of appropriate equipment and establishment of safe and effective radiotherapy services that meet quality standards. Technical requirements are provided for individual pieces of equipment as well as considerations for project management, maintenance, quality assurance, and training when setting up a new radiotherapy facility. Emerging technologies in radiotherapy are also briefly discussed.
This document provides a summary of the key elements of a specialty portfolio in radiation oncology, including:
1. An overview of the methodology, mission, vision, and authority governing the portfolio.
2. Details of the CanMEDS competencies and roles, as well as general core competencies required for radiation oncology training.
3. Guidelines on training structure, including levels, milestones, length of training, accredited centers, admission criteria, and regulation.
4. Components of the training program, including goals, opportunities, references, academic credits, evaluation, and maintenance of certification.
5. An outline of the clinical and basic science syllabus covered during training.
6.
1. Radiation therapy is the only curative treatment for non-metastatic recurrent nasopharyngeal cancer (rNPC). The addition of concurrently administered chemotherapy has been shown to significantly improve outcomes including overall survival for locally advanced cases.
2. Re-irradiation for rNPC provides a benefit, but carries risks of toxicity due to damage from previous radiation. Modern radiotherapy techniques like IMRT can help deliver a therapeutic dose while sparing nearby critical organs.
3. Doses over 60 Gy are typically used for re-irradiation of rNPC, though the optimal dose has not been established. Late effects depend on factors like recurrence site, prior treatment doses and volumes, time since initial radiation, and
1) Portsudan Oncology Center was established in 2015 to serve cancer patients in Red Sea state.
2) Breast cancer was the most common cancer type seen at the center, accounting for over 50% of cases in some years.
3) The center provides medical oncology services including chemotherapy, hormonal therapy, and targeted therapy, but is deficient in radiotherapy equipment.
This document provides information about breast cancer including what it is, risk factors, screening tools and recommendations, types of treatment, and myths. Some key points:
- Breast cancer is a malignant tumor that develops from breast tissues, usually the milk ducts or lobules.
- Risk factors include age, gender, family history, genetic factors, reproductive history, and lifestyle.
- Screening tools include breast self-exams, clinical exams, mammography, and ultrasound. Mammography is recommended annually starting at age 40.
- Early detection through screening can help prevent death and suffering by finding cancer early when it may be easier to treat.
This document discusses head and neck cancer, including:
- Squamous cell carcinomas make up 78% of head and neck cancers.
- Staging uses the TNM classification system to determine tumor size, nodal status, and metastasis.
- Treatment planning considers the patient's age, medical history, and potential complications.
- Primary treatments include surgery, radiation therapy, chemotherapy, or a combination.
- Acute complications of radiation therapy include mucositis, dysphagia, xerostomia, and trismus. Chronic complications include osteoradionecrosis and soft tissue necrosis.
This document discusses modern radiotherapy techniques including conformal radiotherapy and intensity-modulated radiation therapy (IMRT). It describes the planning steps which involve CT scanning of the patient, delineating the tumor and organ-at-risk volumes, dose analysis, and treatment delivery with quality assurance and patient positioning. IMRT allows for improved target conformality and reduced radiation exposure to surrounding healthy tissues compared to traditional radiotherapy through inverse planning optimization of multiple modulated radiation beams. Image-guided radiotherapy (IGRT) further improves treatment accuracy by accounting for organ motion and setup variations using frequent imaging.
Beam modification techniques include blocks, wedges, and compensators to modify the spatial distribution of radiation. Shielding blocks are commonly made of lead and are used to shield organs at risk. Wedge filters cause a progressive decrease in beam intensity to tilt isodose lines and provide a dose boost. Compensators are customized materials that account for tissue irregularities and ensure uniform dose distribution within the target. Flattening filters reduce the central exposure rate relative to the beam edges to produce a uniform beam density.
The document discusses prostate cancer including its anatomy, epidemiology, diagnosis, staging, treatment and outcomes. Key points include:
- Prostate cancer is the most commonly diagnosed cancer in men. Risk factors include age, family history, and ethnicity. Screening includes PSA testing and biopsy.
- Treatment depends on risk classification based on PSA, Gleason score, and stage. Options include active surveillance, surgery, radiation therapy and hormone therapy.
- Studies show dose escalation radiation therapy and use of IMRT/3D conformal radiation improve biochemical control rates with acceptable toxicity compared to conventional radiation. Adjuvant hormone therapy with radiation improves outcomes for intermediate-high risk disease.
This document summarizes cancer of the larynx, including its risk factors, diagnosis, staging, and treatment options. It describes the anatomy of the larynx and discusses how cancer can spread locally or to lymph nodes. Treatment depends on the stage and location of the cancer, and may include radiation therapy or surgery like laryngectomy. For early stage cancers, radiation is usually the preferred initial treatment to preserve the larynx and voice. More advanced cancers may be treated with chemoradiation to try to avoid laryngectomy when possible.
1) Breast cancer is the second most common cancer in the US and the leading cause of cancer death in women over 65 years old. Risk factors include family history, genetic factors, age of first birth, and hormone use.
2) Breast cancer is divided into in situ carcinoma and invasive carcinoma. Invasive ductal carcinoma makes up 70-80% of cases. Staging involves the TNM system and considers tumor size, lymph node involvement, and presence of metastases.
3) Treatment involves surgery such as lumpectomy or mastectomy, radiation, chemotherapy, hormonal therapy, and targeted therapy. The type of treatment depends on cancer stage and biological markers. Neoadjuvant therapy is often used
This document summarizes the production of x-rays. It describes how x-rays are produced when electrons are accelerated toward a metal target in an x-ray tube. The tube contains a cathode that emits electrons and an anode, made of tungsten or similar high atomic number metal, that absorbs the electrons. When electrons strike the target, they cause two types of x-rays to be emitted - bremsstrahlung and characteristic x-rays. Bremsstrahlung x-rays are produced when electrons are deflected by the target's nuclei, while characteristic x-rays are emitted when electrons fill vacancies left by ejected inner shell electrons. The document also discusses components of the x-ray
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kol...rightmanforbloodline
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. ANATOMY OF CERVIX
The cervix is the lower 1/3 of the uterus, it is the
narrower part of the uterus (neck of uterus) .it is
rounded and directed downward and posteriorly
.
Portio is the portion of the cervix that protrudes
into the vagina (about 1cm long and covered by
vaginal epithelium .
3.
4.
5. EPIDEMIOLOGY AND ETIOLOGY
Ca cervix is the fifth most common cancer in the
women worldwide . In USA new case 11,270 and
deaths n 4,070 (in2010) .
The incidence is ↓ due to screening and human
papilloma virus (HPV) vaccines in the past 4th
decades .but still in some area in developing
countries ca cervix is the most common cancer
and leading cause of death .
Risk factors ;- early age of sexual intercourse/ high
number of lifetime sexual intercourse /exposure to
to sexually transmitted diseases (HPV)
(AIDS)/smoking / oral contraceptive/DES exposure
in utero
6. PATHOLOGY
80% of ca cervix is squamous cell carcinoma
(SCC) usually originate at the squamocolumnar
junction and progress from mild,moderate,and
sever dysplasia to carcinoma insitu, to invasive
carcinoma .
10%--20% of ca cervix is adenocarcinoma .
Usually arise in high endocervical region and
originate from endocervical gland .
While SCC have ↓ in USA the incidence of
Adenocarcinoma ↑
9. INVOLVEMENT OF LNS GROUP( IN%) BY
STAGE
Lymph nodes group stage
1 11 111
Pelvic LNs 15% 30% 50%
Para-aortic LNs 5% 20% 30%
10. DIAGNOSIS
CILNICAL PRESENTATION ;-
Abnormal vaginal bleeding > 80% .
Vaginal discharge .
Late symptoms include symptoms of pelvic organ
compression or extension e.g ;-
Sciatic pain /lower extremity edema
Hydronephrosis /pelvic pain /rectal symptoms
Urinary obstruction
11. INVESTIGATION
investigation description
Tissue diagnosis Pap smear –ve not excluded .
biopsy by endocervical curettage
lab work CBC to assess HB & CBC and
differential
Count in anticipation chemotherapy
Serum chemistries to assess renal
function
Imaging studies CXR or chest
CT /abdominoplevic CT or
MRI which is better in delineation .
Or PET which is higher in senitivity in
staging LNs or METs
12. DIAGNOSIS AND PRETHERAPY EVALUATION
Ca cervix suspected
complete history and physical
examination
Physical exam focus;-
Procedure ;-
pelvic and Lab ;CBC /blood
colposcopy
rectovaginal chem/urinalysis
Papsmear if no
exam/cervical portio Radiology;-
bleeding
/tumor extension to CXR/Ctor MRI of abd-
Biopsy
vagina /abd-ex &pelvis OR PET
Cold knife conization
/supraclavicular LNs
13. con→
Exam under anesthesia
Cystoscopy,proctoscopy
Ureteral
staging FIGO
→radical hysterectomy vs definite
radiation chemotherapy
14. STAGING
Generally staging depend on history and
examination and radiologic and laboratory
workup . The most common used staging
system is Federation Gynecology and
Obstetrics (FIGO) Is based on clinical examation
. FIGO permits minimal information from plain
radiograph and does not incorporate
information on LNs involve-
Ment .despite not altering stage categories ,cross
sectional imaging (CT/MRI/PET) and invasive
surgical staging provide important additional
information on the extent of loco regional nodal
involvement and distant disease status
15. FIGO &TNM STAGING OF CA CERVIX
FIGO TNM Description
- Tx 1ry Tumor not assessed
- T0 No evidence of 1ry tumor
-a Tis Carcinoma in situ
1 T1 Ca cervix confined to uterus
1A T1a Invasive carcinoma (diag-microscopy) stromal
invasion depth 5.0 mm & wide 7.0mm
1B T1b Visible lesion confined to the cervix or mic->7
11 T2 Ca cervix invades out uterus but not pelv-wal
11A T2 a Tumor without parametrial invasion
11B T2b Tumor with parametrial invasion
111 T3 Tumor→plevic wall /lower1/3vagina/affet kid-
111A T3a tumor →Lower 1/3 of vagina/ no plevic wall
111B T3b Tumor→plevic wall or cause hydronephrosis
1v T4 Bladder or rectal invasion
1vA T4a Invade of mucosa of bladder or rectal
16.
17.
18. CON→
FIGO TNM DESCRIPTION
1VB T4b Mets-peril-/supraclavicular
LNs/lunge...
3/4 Nx Reg-LNs not assess
3/4 N0 No regional LNs mets
3/4 N1 Regional LNs mets-
3/4 Mo N o distant mets
3/4 M1 Distant met(peri-/supraclavicularLN or
mediastinal LNs
21. PROGNOSIS
Ca cervix is curable when diagnosis early ,these lead
to improve out come in countries with access heath
care and cytological screening .
In more advanced disease, tumor recure 1/3 of PTs-.
The outcome is improved significantly with the
Introduction of of concurrent chemotherapy in stage
1B2_ 1v A . Neuroendocrine carcinoma of the cervix
has ↑mets rate ,poor prognosis and spread in
pattern similar to that of small cell cancer .
Low HB associated with ↓local control and survival
rates specially during RT. Hypoxia also associated
with poor out come
22. stage Local control Disease –free treatment
survival
1A—1B 93-95% 92% Surgery/Radiatio
n
1B All 94% All 81-85% Radiation
4-5cm 90% 4-5cm 86% therapy
>5cm 82% >5cm 67%
11A 94– 96% 70– 85% Radiation
therapy
1B-11 87% 74%
Radiation/chemo
therapy
111—1v 71% 40—50% Radiation
/chemotherapy
1vB -- 0% Palliative
chemotherapy
no Radiation
23. TREATMENT
In stage 1A , non bulky 1B ,and early stage 11A , The
1ry treatment is surgery with hysterectomy and 1ry
radiation result in similar outcome
Stage 1B1 radiation alone a choice or radical
hysterectomy .
Stage ≥1B2 radiation with concurrent cisplatin
based chemotherapy .
Treatment modalities ;-
surgery ;-
Modified radical hysterectomy ;- in which remove
done to the uterus ,cardinal ligament , partially the
uterosacral ligament ,pelvic LNs .
Survival > 95% /preserving ovarian function
/avoidance of radiation complication
24. Radical hysterectomy ;-
For stage 1A2 with LVS1 IB1 , non bulky 1B2 –
11A. In which remove done to the uterus
.cardinal ligament & upper 1/3 of the vagina
/pelvic LNs .
Survival 80—90% .
Radiation ;- used to as definitive treatment for
stage 1—11A inside of surgery .
Definitive treatment for stage 11B– 1VA with
concurrent chemotherapy .
For bulky disease >5—6cm should complete in
7weeks .stage 1B-11A .
Postoperative pelvic radiation for involved LNs
+ve SM (EBRT integrated with brachytherapy )
.RT
25. Diagnosis of ca cervix
Clinical and radiological staging
Stage 1A– B1 Stage 1B– 11A Stage 11B– 1vA
RH/pelvicL
Ndissect- RH pelv
ERBT+BT/
±PALN LN disse-
CH
sam- PA samp
OR or
↑ ↑
ERBT +BT
ERBT+BT risk/LV/de risk/SM/LN
/CH
pth inve- /param-
Post op- RA- Post op radia-
Concu-chem-
Follow up
26. CHEMOTHERAPY
AS part of definitive treatment with concurrent with RT
for locally advanced cervical cancer.
Stage 1B1 concurrent CH not validated. Adjuvant
CH following concurrent RT/CH may↓ overall
recurrence rate used for palliation for local, regional
or systemic disease.
We use weekly cisplatin during 5weeks with pelvic
EBRT with or without CH during BT.
3-weekly cisplatin/5-FU is also validated level
Evidence. No benefit to cisplatin to other CH.
5-FU alone is not recommended .
27. Tow randomized trial defined the 1)utilizing of the adjuvant
radiation ,and 2)adjuvant radiation with concurrent
chemotherapy after hysterectomy
Eligibility criteria arm 1 arm2
LVS1 stromal tumor
Pelvic RT 46GY in 23 Observation
+ve deep1/3 any size fr . 50.4 GY in 28 fr
.
+ve middle1/3 ≥2cm N=140
n= 137
+ ve superficial1/3 ≥5cm
-ve deepormidlle ≥ 4cm
28. In the first trial show 46% reducation in risk of
recurrence favoring RT arm (p=0.0007) . Deferent in
overall survival
29. The 2nd trial 109 evaluated addition of concurrent
CH. Taking stage 1A,1B, or 11A (LN +ve /paramet-
+ve /SM +ve). Pts treated with RH then randomized
To RT alone versus RT with 4 cycles of cisplatin/5
FU. Overall survival was significantly improve.
Analysis show particular benefit for large tumor,
Multiple LNs.
HR for overall survival was 1.96 (p=0.007) favoring
RT/concurrent CH. OS for 4 yrs 71% with R and
81% for with RT/CH.
30. Clinical stage 1A,1B ,11A + any of ;-
1- +ve LN S
2- +ve parametria
3- +ve SM
randomization
ARM1 ARM2
Plevic RT 49.3GY IN 29 fr Same RT +
Cisplatin /5fu96 hours infusion
n=116 Every 3weeks x4 cycles
n=127
GOG protocol 109 evaluated the addition of concurrent chemotherapy
Is of benefit .*HR overall survival was 1.96 (p=0.007) favoring concurrent
Chemo-overall survival was 4 yrs 71% with RT .and 81% with RT+CHEMO-
31. Trial FIGO Number Compari- Follow up HR ↑ in
stage Of pts son survival
GOG85 11B-1VA 368 PF veru- 8.7 yrs 0.7 10%
HU
RTOG 1B(>5cm) 388 PF veru- 43 0.59 15%
9001 -1vA none months
GOG 11B-1VA 526 P /HU 35 0.61 18%
120 11B-1VA 526 PFHU/H months 0.58 18%
U 35 month
GOG 1B(>5cm 369 P versus 36 0.54 9%
123 -1vA none months
NCI/cana 1B(>5cm 253 P versus 64 0.91 3%
da -1vA none months
meta 1B-1VA 3,452 cth/none 62 0.78 ¾%
analysis months
Level evidence for the benefit from 5 randomized trial evaluating radiation
With concurrent cisplatin base cth-
32. RT TECHNIQUES
Definitive RT ;-
The definitive RT for ca cervix require EBRT (with
Pelvic and parametrical and nodal boosts if approp-
Riate) and BT . Treatment must be individualized based
on the patient‘s tumor extend ,normal tissue anatomy
,tumor response characteristics during
The therapy
EBRT ;- the field include 1ry tumor /local extension
(parametria / uterosacral ligament, vagina) draining
Regional LNs,
33. Simulation, target volume delineation & field
arrangement ;-
3-dimensional image- guide is high recommended to
Improve the delineation of target structures and
Exclusion of normal tissues include bowel ,bladder
And bone marrow . By use of intravenous contrast
For CT can differentiate regional LNs from vessels
CT can not differentiate tumor from normal tissues
In side the uterus ,so we use the MRI which show
Us the tumor extend in the uterus,parametria,
34. 1ry tumor GTV ;-entire uterus and tumor extension to para-
Metria based on imagi & implanted markers
CTV ;-additional 0.7 to 1cm margin,3-cm margin to
lower extension
PTV 0.5 -1cm margin
LNs Gross involved lymph nodes
CTV;- gross involved LNs+ 1cm margin in
obturator,external and common iliac LNs in 111A
In distal half vagina inginal LNs. Post surgical clips
&post operative seroma add0.7-cm/1-2 cm anterior
to theS1-S3
PTV ;-0.5 –cm margin
Target volume for definitive radiation therapy using Ctbased planing
35. The final PTV = 1ry tumor PTV +nodal PTV and because of
The viabilities in the aortic bifurcation 40% of common iliac LNs
are be higher to the L4-L5 interspace ,so in these case
The upper border can shifted up word by 1-3 vertebrae .
Contouring of normal structure include the rectum (up to the
recto sigmoid junction), bowel (large bowel &mesentery)
With in 5cm upper border of target, the bladder and femoral
Head .if 3D NOT available the field design should be guided
By bony landmark
36. field borders
AP/PA Superior; L4-L5 interspaced
Inferior ;- 3cm bellow the lowest tumor extend (determined by
Gold seed or bottom of obturator formen .
Lateral ;- 2cm lateral to the pelvic brim and include any surgical
clips with 1-1.5 cm margin
lateral superior;- same as AP/PA
inferior ;- same as AP/PPA .
Anterior ;- 1cm anterior to pubic pubic symphsis .
Posterior ;- at least anterior half of the sacrum
37. Dose and treatment delivery ;-
The EBRT prescribed dose to the range 45– 50.4 GY IN 1,8
GY.the BT boost 5.4—14.4 .
The total dose will be 50 in small stage 1B.and 55 GY in
moderately involved parametrial involved. And 60 GY for
Bulky parametrial .
IMRT ;- is used in the treatment of the ca cervix and show to
decrease the dose to the organ at risk (bowel,bladder
Acute gasterointestinsl toxicity and bone marrow dose