This presentation includes indications for radiotherapy and surgery in common malignancies. Management of some common malignancies is also explained (breast cancer , cervical cancer , colorectal cancer)

1. Indications for surgery
and Radiation therapy for
common malignancies
Roll no. - 6

2. Topics to be covered
1. Indications for surgery
2. Indications for radiation therapy
3. Common malignancies- Breast cancer
Cervical cancer
colorectal cancer

3. Surgical Treatment in Cancer Management
• Surgery plays a crucial role in cancer management.
• Three main situations where surgery is necessary:
1. Biopsy
2. Excision
3. Palliation

4. Biopsy
• Required for histological or cytological diagnosis of cancer.
• Provides information on tumour type and differentiation for further
management.
• Cytology can be done via fine needle aspiration, but biopsy is preferred.
• Types of biopsy:
Core biopsy
Image-guided biopsy
Excision biopsy

5. Excision
• Main curative approach for most solid cancers.
• High cure rates in early, localized cases of colorectal, breast, and skin cancer.
• Outcome depends on surgical expertise.
• Multidisciplinary teams usually include experienced surgeons.
• Some cancers have surgery as one of two or more primary treatment
options.

6. Palliation
• Surgical procedures provide quick and effective
symptom relief.
• Examples:
• Defunctioning colostomy for faecal incontinence
• Fixation of pathological fractures and spinal cord
decompression

7. Prophylactic (Preventive) Surgery
• High-Risk Patients: Individuals with genetic predispositions (e.g., BRCA
mutations) may choose prophylactic mastectomy or oophorectomy to reduce
cancer risk.
Debulking (Cytoreductive) Surgery
• Advanced Ovarian Cancer: Surgical debulking can improve outcomes by
reducing tumor burden before adjuvant therapy.
• Other Metastatic Cancers: Sometimes indicated to relieve symptoms or
reduce tumor load, thereby enhancing the effectiveness of chemotherapy or
radiation.

8. Radiation therapy
• Definition: Treatment of cancer with ionizing radiation.
• Purpose: Used as a curative treatment for localized cancers and as
palliative care for widespread disease.
• Types of Radiation Therapy:
1. Teletherapy
2. Brachytherapy
3. Intravenous injection of a radio isotope.

9. Teletherapy (External beam radiotherapy)
• Radiation applied from a distance using a
linear accelerator.
•Produces electron or X-ray beams of high
energy.
• Used to target tumor tissue.
• Shielding is used to protect normal
tissues.

10. Brachytherapy (Internal radiotherapy)
• Direct application of a radioactive
source inside the tumor.
• Provides a high localized dose of
radiation.
• Used in the management of localized
cancers of the head and neck.

11. • Radioisotope Therapy
• Uses intravenous or oral administration of radioisotopes.
• Example:
Iodine-131 for thyroid cancer.
Strontium-89 for bone metastases from prostate cancer.

12. Radiotherapy Techniques
Fractionation:
• Dividing total radiation dose into multiple smaller doses.
• Allows normal cells to recover while maximizing tumor damage.
• Usually delivered over 20–30 daily fractions, spanning 4–6
weeks.
• Palliative therapy requires fewer fractions.

13. Adjuvant (Postoperative) Radiation
• Breast Cancer: After breast-conserving surgery (lumpectomy),
radiation to the breast significantly reduces local recurrence.
• Rectal Cancer: After surgical resection (especially in stage II and
III), adjuvant chemoradiation may reduce local recurrence.
• Head and Neck Cancers: Postoperative radiation, often
combined with chemotherapy, helps control residual microscopic
disease.

14. Neoadjuvant (Preoperative) Radiation
• Rectal Cancer: Preoperative chemoradiation can shrink
the tumor, making surgery more effective and possibly
allowing sphincter preservation.
• Esophageal Cancer: Combined with chemotherapy,
preoperative radiation can improve surgical outcomes.

15. Definitive Radiation (Primary Treatment)
• Prostate Cancer: Early-stage disease can be treated definitively with
radiation alone or with androgen deprivation therapy.
• Head and Neck Cancers: In some cases, definitive chemoradiation can
preserve organ function (e.g., larynx preservation).
• Cervical Cancer: Stages IA2–IIA may be treated with surgery or radiotherapy,
depending on the patient’s choice and tumor specifics.

16. Palliative Radiation
• Bone Metastases: To relieve pain, stabilize fractures, and
improve mobility.
• Brain Metastases: Whole brain radiation or stereotactic
radiosurgery to relieve symptoms and reduce intracranial
pressure.
• Spinal Cord Compression: Urgent radiation to prevent or
treat neurological deficits.

17. Treatment Planning:
• Uses modern imaging
techniques like CT and MRI
for better visualization and
precision.
• Aims to maximize tumor
exposure while sparing
normal tissues.

18. Sensitivity of Different Tissues
• Highly radiosensitive: Germ cell tumors, lymphomas.
• Moderately radiosensitive: Carcinomas.
• Less radiosensitive: Normal tissues and adjacent structures.
Damage to Normal Tissue:
• Occurs when normal tissues are irradiated beyond tolerance doses.
• Sensitivity varies based on normal tissue type and dose delivered.

19. Adverse Effects of Radiotherapy
Acute Effects:
• Inflammatory reaction occurs towards the end of treatment.
• Localized to the treated area.
• Examples:
• Skin reactions with breast or chest wall radiotherapy.
• Proctitis and cystitis with bladder or prostate treatment.
• Acute reactions settle within a few weeks, assuming normal tissue
tolerance is not exceeded.

20. Late Effects:
• Develop 6 weeks or more after treatment.
• Occur in 5-10% of patients.
• Examples:
Brachial nerve damage.
Subcutaneous fibrosis after breast cancer treatment.
Bladder shrinkage and fibrosis after bladder cancer treatment.
Risk of inducing cancer at the treatment site.
Risk varies based on whether the patient has had other treatments like
chemotherapy.

21. Common malignancy-
● Breast cancer
● Cervical cancer
● Colorectal cancer

22. Management of Breast cancer
1. Surgery
• Mainstay of treatment.
• Options:
Lumpectomy – Removal of only the tumor.
Mastectomy – Removal of the entire breast.
• Breast-conserving surgery is as effective as mastectomy if
complete excision with negative margins is achieved.
• Lymph node sampling is done at the time of surgery.

23. 2. Adjuvant Radiotherapy
• Given to reduce local recurrence risk (4–6%).
3. Adjuvant Hormonal Therapy
• Improves disease-free and overall survival in pre- and post-menopausal patients with ER-positive tumors.
• Low-risk patients (small, ER-positive tumors) Tamoxifen alone.
→
• Pre-menopausal, ER-positive patients LHRH analogues.
→

24. 4. Adjuvant Chemotherapy
• Given for higher risk of recurrence, such as:
• Tumor >1 cm.
• ER-negative tumors.
• Presence of axillary lymph node involvement.
• Improves disease-free and overall survival.
• HER2-positive breast cancer:
• Adjuvant trastuzumab (HER2 monoclonal
antibody) + standard chemotherapy.

25. 5. Metastatic Disease Management
• Radiotherapy For palliative care (bone metastases).
→
• Second-line endocrine therapy Aromatase inhibitors
→
(inhibit peripheral estrogen production in adrenal &
adipose tissues).
• Advanced ER-negative disease Combination
→
chemotherapy.

26. Management of cervical cancer
1. Based on Stage of Disease
• Pre-malignant disease Treated with laser ablation or
→
diathermy.
• Microinvasive disease Managed with:
→
Large loop excision of the transformation zone (LLETZ) OR
Simple hysterectomy.

27. 2. Localized Disease
• Requires radical surgery or radiotherapy (including brachytherapy).
3. Advanced Disease
• Bulky or locally advanced tumors with adverse prognostic features (e.g., parametrial invasion) →
• Chemotherapy + Radiotherapy as primary treatment.

28. 4. Metastatic Disease
• Lymph node or distant metastases Cisplatin-based
→
chemotherapy may help in symptom improvement but
does not significantly increase survival.

29. Management of colorectal cancer
1. Surgery
• Total tumor resection is the best option for localized
malignancies.
• Preoperative evaluation:
Physical examination.
•Liver function tests ; Plasma CEA measurement ; CT scan
of chest, abdomen, pelvis ; Colonoscopy (to detect
synchronous neoplasms/polyps).
Laparotomy: Entire peritoneal cavity, liver, pelvis, and bowel
should be examined.

30. • Post-surgery monitoring:
• Regular clinical exams, blood tests, and colonoscopy (if not done preoperatively).
• CEA levels measured every 3 months to check for recurrence.
• CT scans in uncertain cases.

31. 2. Radiation Therapy
• Recommended for rectal cancer to reduce regional recurrence (by 20–25%).
• Preoperative radiation improves outcomes in T3/T4 tumors.
• Postoperative radiation further lowers pelvic recurrence but does not improve survival.

32. 3. Chemotherapy
Systemic therapy:
• 5-FU-based regimens are the mainstay.
• Leucovorin (LV) + 5-FU improves efficacy.
For metastatic disease:
• FOLFIRI (Irinotecan + 5-FU + LV) for metastatic adenocarcinoma.
• FOLFOX (Oxaliplatin + 5-FU + LV) for advanced disease.

33. Bibliography
Davidson 23rd edition
Harrison 21st edition

34. THANK YOU