Keiser University Radiation Therapy Rat1001 Intro To Radiation Therapy Wlch1

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Somatic Cells

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Contain genes that both promote and suppress growth

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Proto-oncogenes

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Normal genes that take part in the normal and differentiation of a cell

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Oncogenes

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The abnormal genes that regulate the development and growth of cancerous tissues

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Responsibilities of a radiation therapist include

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Providing quality care

Patient education

Making referrals when needed

Daily patient assessments

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Biopsy

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A biopsy is the surgical removal of a small tissue sample from a solid tumor to determine the pathology for the diagnosis of disease.

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Cellular differentiation

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occurs when a cell undergoes mitosis and divides into daughter cells.

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Abnormal cellular proliferation

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When the cellular differentiation process is disrupted, the daughter cells may continue to divide with noresulting mature cell, causing abnormal cellular proliferation

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When are cells most sensitive to radiation?

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Cells are most sensitive to radiation during G2 and M Phases ofthe cell cycle

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What causes tissue necrosis?

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While the tumor grows larger , the blood, oxygen, and nutrient supply is inadequate,creating areas of dead, or necrotic, tissue

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Well differentiated tumors

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tumors that closely resemble their cell of origin, and easily classified bytheir histology

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Undifferentiated tumors

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do not resemble normal cells, so classification is more difficult.

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Anaplastic

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Undifferentiated are also referred to as Anaplastic, described as a loss of differentiation and a more primitive appearance

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Benign Tumors

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Generally well differentiated

Do not metastasize or invade surrounding tissue.

Often encapsulated and slow growing

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Chondroma

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benign tumor of the cartilage

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Malignant tumors

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Often invade and destroy surrounding tissue.

Can be life threatening to the host.

Can be well differentiated to poorly differentiated.

Also has the ability to spread to sites distant from the primary site.

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Sarcomas

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tumors that arise from mesenchymal cells. These cells form connective tissue such as cartilage and bone.

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mesenchymecells

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Although blood and lymphatic's are considered mesenchyme cells, they are categorized separately as leukemias and lymphomas,respectively.

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Carcinomas

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tumors that originate from epithelium cells. These are cells of tissues that line a cavity or cover a surface.

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Adenocarcinoma

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tumors that originate from epithelium tissue that is glandular (meaning that it secretes something)

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adenocarcinoma of the stomach.

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Lining of the stomach, which secretes stomach acid, would host adenocarcinoma of the stomach.

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In situ cancers

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arean earlier form of cancer defined by the absence of invasion. (usually localized because it is in its early stages, but can metastasize)

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The most common types of invasive cancers in the United States in men include:

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Prostate

Lung

Colorectal

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The most common types of invasive cancers in the United States in women include:

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Breast

Lung

Colorectalcancers

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Etiology

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is the study of the cause of disease.

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Epidemiology

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is the study of disease incidence.

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Screening test examples

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Examples –

Pap Smear –for Cervical Cancer

Fecal Occult Blood Test/Colonoscopy – Colorectal Cancer

Mammograms –Breast Cancer

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Sensitive screening examination

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in order to be effective, screening examinations must be sensitive(meaning the test’s ability to deliver a true positive result)

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Specific screening examination

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the test must be specific– (meaning the test’s ability to deliver a true negative result) for the specific tumors they identify.

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False-negative

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a sensitive screening will not produce a false-negative finding.(meaning that it won’t report that there is no cancer when cancer is present)

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False-positive

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when a test reports cancer when there is none

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Grade

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The grade of a tumor provides information about its aggressiveness and is based on the degree of differentiation.

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Differentiationis divided into 4 categories

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Well differentiated-cancer cells have most characteristics of the original cell

Moderately well differentiated

Poorly differentiated-original cell is barely or not distinguishable

Undifferentiated

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Tumor board

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This means multiple specialists conglomerate to establish a treatment plan. This is usually conducted in a meeting called a ‘tumor board’

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Participants of tumor boards include

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surgeons

radiation oncologists

medical oncologists

radiologists

pathologists

social workers

plastic surgeons

nursing staff.

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fine needle aspiration

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is used for the histology of a suspicious breast mass.

The contents of needle are then examined under microscope.

Advantages

quick and easy, minimal patient discomfort.

Disadvantages

collected cells examined without viewing of neighboring cells. Also, chance of malignant ‘seeding’ along the needle when withdrawn

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Core Needle Biopsies

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Alarge 14 to 16 gauge needle used to remove a core of the suspected tissue,while keeping the architecture of the tissue intact (this helps identify the origin

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Incisional Biopsies

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sample of the tumor is removed with no attempt to remove the whole tumor (method used for larger tumors more locally advanced)

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Excisional Biopsies

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attempt is made to remove the whole tumor(in example, a mole malignant melanoma)

The nevi and normal surrounding margin of tissue is removed in one piece (en bloc)

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Incontinent

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Lack of bladder control

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Impotence

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lack of achieving an erection

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Radical mastectomy

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Early treatments for breast cancer limited patients to radical mastectomies. (remove of lymph node, muscle, and breast tissue.) This left the patient disfigured.

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Partial mastectomy

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With the combination of surgery and radiation, patients receive a partial lumpectomy(removal of mass in breast),conserving the breast.

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High energy x-ray photon beams

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used to treat deep-seated tumors in the body.

Example:

Lung, Prostate, Cervix, Breast

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Electron beam energy

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used to treat superficial target closer to skin surface.

Example:

skin lesions, scar boost treatments.

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Brachytherapy

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This ‘short distance’ or ‘internal’ method uses uses ‘live’ radioactive seeds to irradiate the tumor internally.

Seeds are comprised of the following sources: -Cesium137

Iridium192

Palladium103

Iodine125

Sourced are placed next to, or directly into, the tumor.

The source is considered:

low dose to adjacent normal tissues

very high to the tumor tissue because of placement location.

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Brachytherapy Interstitial Implant

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The source is placed in permanently(most common)

Ex: Prostate Brachytherapy – permanent placement

Because of the low dose, patient is in no danger to family or friends. Radioactivity decreases with time.

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Brachytherapy High-Dose Afterloading

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During lumpectomy surgery, a balloon catheter is placed. End of catheter extends outside patient’s chest. Patient then returns to radiation oncology department. Catheter connected to an after-loader machine.

High dose seed is released into balloon catheter, then retracted after calculated period of time. (to achieve desired dose)

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Brachytherapy Intracavitary Implants

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Places radioactive material in a body cavity (not a tumor)

Ex: cervical and endometrial cancer An applicator, or cervical sleeve, is implanted during surgery.

Later, a radioactive source is implanted and dwells for calculated amount of time to achieve certain dose, then removed.

Low-Dose delivery = multiple days inpatient

High Dose delivery = one day outpatient

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Brachytherapy Intraluminal

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Radioactive material is placed in a body tube, such as esophagus or bronchial tree

Source is placed via catheter in the lumen(internal portion of body tube) and removed when desired dose is achieved.

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concurrent

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Chemotherapy can be used as a primary treatment, or used concurrently with surgery and radiation therapy

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Radiosensitizers

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chemo drugs that help enhance the lethal effects of radiation on tumor cells.

(i.e..Doxorubicin)

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Radioprotectors

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chemo drugs that diminish theresponse of cells to radiation.

(i.e..Amifostine,which helps protect normal cells and reduces side effects)

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Immunotherapy

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Still in its beginning phases, amplifies the body’s own immune system defenses to attack cancer cells.

Interferon

Interleukin 2

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Interferon

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a drug administered to make the tumor antigens more visible and identifiable to the immune system

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Interleukin 2

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a drug that increases number of lymphocytes, or mature killer cells.

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Prognosis

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is an estimation of the life expectancy of a cancer patient based on all information obtained (staging, grading,diagnostic exams, pathology)

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Exophytic tumors

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Tumors that are exophytic grow outward.

Exophytic tumors also do not communicate with blood vessels and lymphatic vessels until later in the disease process.

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Multicentric tumors

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are tumors that have more than one focal spot of disease. These are harder to treat because wider treatment margins are needed (increases side effects and chance for residual disease)

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Tumor dissemination

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aka ‘spread’,can happen through the:

Blood

Lymphatics

andfrom seeding.

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Seeding

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occurs when tumor cells ‘break off’ and invade neighboring tissues (ie. Ovarian cancer invading abdominal cavity)

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Clinical trials

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provide research based evidence about specific treatment effectiveness. It is through these trials that the most effective treatment with the fewest long term side effects can be achieved