radio therapeutic and oncological treatment of cancer of the
TRANSCRIPT
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RADIOTHERAPEUTIC ANDRADIOTHERAPEUTIC AND
ONCOLOGICALONCOLOGICAL
TREATMENT OF CANCERTREATMENT OF CANCER
OF THE CERVIXOF THE CERVIXBY
DR SHAGAYA U. N.
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INTRODUCTION PRE TREATMENT EVALUATION STAGINGTREATMENT OPTIONS
RADIOTHERAPY CHEMORADIATION CHEMOTHERAPY COMPLICATIONS
RECURRENT DISEASE PROGNOSIS CONCLUCION
OUTLINEOUTLINE
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INTRODUCTIONINTRODUCTION
A major health public health problem. About 0.5Million new cases occur annually
worldwide. WHO 2002. Vast majority occurs in the developing
countries. Commonest female genital cancer in
developing countries.
Account for 231,000 deaths annually . 80% occurs in developing countries. Parkin et al 2000.
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Over 25,000 new cases are seen in Nigeriaannually i.e. 480cases per week.
SolankeT.F.1996. At the UCH Ibadan 2-5 new cases are seen
weekly Edozien &Adewole 1993
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AETIOLOGYAETIOLOGY
INFECTIOUS AGENTSLargely regarded as STD
Sexually transmitted Human papilloma virus(HPV) implicated Types 16 and 18 (associated
with 70-80% of cervical cancers)HIV infection
Associated with faster progression of preinvasive disease.
Smoking
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Radiation therapy [XRT] is a clinical modality
dealing with the use of ionising radiation intreatment of patients with malignantneoplasias and occasionally benign dx.
The aim of XRT is to deliver a precisely
measured dose of irradiation to a definedtumour volume with as minimal damage aspossible to surrounding healthy tissueresulting in eradication of the tumour, highquality of life &prolongation of survival at
competitive cost. In addition to curative effort XRT plays a
major role in cancer mgt in effectivepalliation or prevention of symptoms of
disease.
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The biologic effects of ionizing radiation arelargely the result of DNA damage, which iscaused directly by ionization within theDNA molecule or indirectly from the action
of chemical radicals formed as a result oflocal ionization in water.
Following exposure to radiation cells maydie attempting the next mitosis [mitotic
death] or they may die programmed celldeath [apoptotic death]
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History and physical examination For stage II B, III or IV A disease or for
symptoms perform cystoscopy,sigmoidoscopy and/or barium enema
Labs Imaging
PRE TREATMENTPRE TREATMENT
EVALUATIONEVALUATION
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STAGE I-Confined to the cervix STAGE IA-
Invasive carcinoma diagnosed microscopically onlymax depth 5mm max width 7mm STAGE IB-Macroscopic tumour size>IA
STAGE II-Invades beyond the cervix to upper 2/3rd ofthe vagina STAGE IIA-No
parametrial involvement STAGE IIB-Withparametrial involvement
STAGE III- Extends to lower 1/3rdof the vagina, pelvicside wall, causes hydronephrosis or non-functioningkidney
STAGE IIIA-Extends to the lower third of vaginabut not to the pelvic side wall STAGEIIIB-Extends to pelvic side wall or causeshydronephrosis or non-functioning kidneys
STAGING -FIGOSTAGING -FIGO
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STAGE IV-Extends beyond the true pelvis orhas clinically involved the mucosa of thebladder or rectum STAGE IVA-Spread to adjacent organs bladder/rectum
STAGE IVB-Spread to distantorgans
STAGINGSTAGING
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RADIOTHERAPY Indication for XRT
-Goal of XRT -Planned TX volume -Planned technique -Planned TX dose
Simulation position, field and borders
TREATMENT OPTIONSTREATMENT OPTIONS
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External beam radiotherapyTreat with 4 field or AP/PA technique Borders -Superior =L4/5, Inferior=3cm below
most inferior vaginal involvement,
Lateral=2cm lateral to pelvic brim,posterior=include entire sacrum, anterior=1cm anterior to pubic symphsis
Dose -40Gy in 20# AP/PA, 14Gy in 7# lat
using photons EFRT for Para aortic nodes
RADIOTHERAPYRADIOTHERAPY
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Radiation treatment with source placedclose to the tumour
Proceed when tumour is
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Chemo radiation- Cisplatinum, 5-FUwith/without Mitomycin C
In hypoxic or oxygenated cells free radicalswith altered binding of platinum to DNA
are formed at the time of irradiation Interaction inhibits repair of sub lethal
damage
CHEMORADIATIONCHEMORADIATION
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ACUTE SEQUELAE Diarrhoea, abd cramping, rectal
discomfort/bleeding Dysuria, frequency and nocturia Erythema and dry or moist desquamationThromboembolism Uterine perforation
Rare sepsis, pulmonary dx, arterialhypotension, change in mental status andmyocardial infarction
COMPLICATIONSCOMPLICATIONS
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Chemotherapy Radiotherapy
RECURRENT DISEASERECURRENT DISEASE
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Prognostic factors Age Race/socioeconomic status Anaemia and tumour hypoxiaTumour volume Histology
PROGNOSISPROGNOSIS
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Radiotherapy is a main mode ofmanagement of ca cervix
Not enough radiotherapy centres Hope for improvement HPV vaccine
CONCLUSIONCONCLUSION
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THANK YOU FORTHANK YOU FOR
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