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93 Cards in this Set
- Front
- Back
Meds to reduce diarrhea
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Lomotil
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outermost layer of the uterus
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perimetrium
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abnormal cells, not yet cancerous
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dysplasia
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burning off of dysplasia cells
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electrocautery
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fallopian duct
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oviduct
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tandum and ovoids after loading device for brachytherapy of uterus/cervix
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Flecter Apparatus
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removal of usterus
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hysterectomy
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reduction division of sex cells
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meiosis
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placing radioactive materials in after patient is in restricted room. (not OR)
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after loading
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removal of uterus of ovaries
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complete hysterectomy
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3 categories of organs in the female reproductive systems
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primary, internal accessory, and external parts
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examples of primary
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ovaries
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examples of internal accessory
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uterine tubes (fallopian tubes or oviducts), infundibulum, uterus, vagina, vainal oriface
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examples of external parts
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labia majora, labia minora, clitoris, vestibule and vestibular glands (Bartholin's glands) -This group surrounds the openings of the urethra and vagina compose the vulva
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description of ovaries, location, lymph drainage from ovaries?
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solid, ovoid structures, unshelled almond, located on the lateral walls of the pelvic cavity on either side. Lymphatic drainage to periaortic lymph nodes (lumber chain of nodes)
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what and where is broad ligament
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largest formed fold in the peritoneum, attached to the fallopian (or uterine) tubes and uterus.
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what and where is suspensory ligament
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at the upper end, the ovary is held by a small fold of peritoneum that contains the ovarian blood vessels and nerves
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define oocyte
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eggs that go under meiosis (reduction from 46 to 23). At time of birth 600,000 primary oocytes in each ovary.
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define ovarian follicles
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Each ovary contains these follicles that contain primary oocytes.
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State the function of the uterine tubes (4) and give 2 other names for them
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Aka fallopian tube or oviducts, 1. convey egg cells toward uterus by cilia 2. suspended by broad ligament 3. expands to form funnel shaped infundibulum 4. is 10 cm (4 in.) and opends medially into uterus
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Describe the infundibulum and the fimbriae of the uterine tube
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-infundibulum is near the ovary
-funnel shaped -encircles the ovary -has irregular- branched extentions- fimbriae -does not touch ovary but is connected directly to it |
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Describe how movement of the egg from the ovary to the uterus is accomplished
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egg goes from ovary to uterus by uterine tube where cilia sweeps egg forward with muscular peristalisis too.
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Describe the uterus and state its function
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-Function is to recieve the embryo and sustain its life during development.
-It is hollow, muscular shaped organ, like an inverted pear. -located medially within the ant. pelvic cavity, above vagina and bent forward over the urinary bladder -normal size is 7cm (2.8 in.) long and 5 cm (2in) wide. |
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State the significance of the rectouterine pouch
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posterior to the uterus and between it and rectum, is a ligament that forms deep pouch which prevents the spread of uterine ca to rectum
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Describe and locate the parts of the uterus, including the: fundus, body corpus, cervix, internal os, external os
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Fundus- rounded portion above the level of the entrance of the uterine tubes
Body/Corpus- upper 2/3 of uterus, is dome shaped and joined by uterine tubes that enter its wall Tubular Cervix- lower 1/3 uterus, tubular, extends downward into the upper portion of the vagina, Internal os- junction of the uterine cavity with the cervical canal External os- lower end of the cervical canal which opens into the vagina Cervix- surrounds the opening where uterus communicates with vagina |
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Describe the location of the vagina and identify the following parts; vault, fornices
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-fibromuscular tube 9cm (3.6 in) in length, extending from the uterus to the vestibule.
-post. to urinary bladder and urethra and ant. to rectum and is attached by connective tissue Vault- part of vagina which surrounds the cervix Fornices- the recesses that occur between the vaginal wall and the cervix, thin walled and allow the internal abd organs to palpated during physical exam |
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List the structures which make make up the vulva
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labia majora, labia minora, clitoris, vestibule, and vestibular glands (Bartholin's glands)
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Discuss the importance of early screening methods for gynecologic cancers
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almost all gyn cancers are curable if treated in precancerous stage.
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State what took is most effective in screening for gynecologic cancers
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Papanicolaou (Pap) smear developed in 1941
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State the most common histologic type of cancer of the cervix and state where they are most likely to arise
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Most ca of cervix are squamous cell ca...some are adenocarcinomas. Arise freq in posterior lip of cervix
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State the chemical to which clear cell ca is most closely linked
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diethylstilbestrol when exposed in utero, occurs in 1-2% of cases
-clear cell is a variant of adenoca |
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List risk factors for ca of the cervix and give the peak age of incidence
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-sexual history, intercourse before 20 and multiple partners, or larger number of pregnancies
-low socioeconomic classes -arises and peaks between 45-55, and 48 for average age |
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State the most common method of spread for ca of the cervix
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sexually transmitted
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Describe the pattern of lymphatic spread usually followed by cancers of the cervix
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spreads principally by direct (blood) or local extention as well as lymphatically- but related to stage of disease.
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List some common metastatic sites for cervical cancers
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-lungs
-mediastinal and supra clavicular nodes -bones -liver |
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Discuss and describe pap smear classification, class I -class IV
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Class I- normal
Class II- atypical Class III- dysplasia Class IV- carcinoma in situ Class V- invasive carcinoma |
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List the most common symptom of ca of the cervix
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-vaginal bleeding/discharge, generally caused by ulceration but is not always present.
-also pain or blood after sex |
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Describe a complete diagnostic workup for cervical ca
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-history
-physical exam- including detailed pelvic and rectal exams -IVP -Chest Xray -cystoscopy -sigmoidscopy -BE |
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List the 2 primary treatments for cervical cancer
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surgery and XRT
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Discuss the treatment of precancerous lesions of the cervix
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hysterectomy, especially is past child bearing age
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Discuss internal vs. external radiation of cervical cancers
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-External beam RT is used to shrink the tumor and to treat the surrounding lymph node areas prior to brachytherapy
- Brachytherapy is then used to treat the central disease |
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Describe external RT ports used for cervical cancer
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-parallel opposed fields
-4 field box -modified rotational arcs (partially spare the bladder and rectum) -paraortic field extentions is lymph node mets |
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Describe an afterloading system
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Brachytherapy that allows te applicators to be inserted unloaded and verifiction films are taken with dummy metal sources and active sources inserted once the pt is in a private room
-radium and cesium 137 most common -Most common is Fletcher apparatus (tandum and 2 ovoids) |
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Define tandum, ovoids, copostats, give the purpose and positioning for each. Also give the 3 sizes of ovoids.
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-tandum- hollow metal tube applicator inserted up to the fundus of uterus
-ovoids- aka colpostats- should be as large as the vault size permits and lie in the lateral fornices on each side of cervix -Size........ask tracey??????? |
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Describe the Manchester System, locate point A and B and state what each point represents
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System to report radiation doses in cervical cancer.
-point A- is located 2cm lateral and 2cm above external os.- is dose that reaches uterus -point B- located 3cm lat to point A (5cm total lateral) is dose to nodal areas |
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Describe the side effects of XRT treatment for cervical ca
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-diarrhea- by irratating SML bowel
-dysuria -freq urination -ocassional pyelonephritis or cystitis -10% develope superficial vault necrosis -ocassional sigmoiditis, vaginal stenosis, enteritist, vaginal/cervical fibrosis, fistula, uretral strictures and other bowel complications |
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Discuss the overall prognosis for ca of cervix
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-5 yr is 67%.
-5 yr for early stages is 90% -Patients whose cervical ca recurs, tumors tend to appear at distant sites- poor prognosis (most die within 3 yrs) |
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Ovaries produce
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-female sex cell or egg cell
-hormones estrogen and progesterone |
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Lymphatic drainage of the ovaries goes almost exclusively to
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periaortic lymph nodes (lumbar chain of nodes
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When do oocytes begin to produce eggs?
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During puberty, 1 per month from puberty to menapause
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Flattened band within the broad ligament connects the upper end of the uterus to the pelvic wall
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round ligament
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The tissues of the uterus are arranged in 3 distinct layers.
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perimetrium-outer
myometrium-middle endometrium-inner |
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Orifice that allows uterine and vaginal secretions to pass to the outside and opens into the vestibule
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vaginal oriface
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The most common sites of cancer in women and accounts for _____ new cases and ____ deaths in the US each year
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genital organs
94,000 27,000 |
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Almost all gyn ca are curable if treated in precancer stage except
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ovarian cancer
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Cervical ca is diagnosed as ____ 2/3 of the time
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in-situ
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Unfortunately only ___% of women in the US get a pap each year
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20%
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Other rare cervical ca, (besides clear cell ca), include
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-adenosquamous ca
-verrucous ca -basal cell ca -primary sarcomas -serous ca -malignant lymphomas in cervix are also possible |
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Cervical ca is the __ most common gyn ca and the ___ most common leading to death
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3rd most common gyn
2nd leading death |
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Ca of the cervix more common in ___ and __. Less freq in
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Latin America and Africa- common
Jewish and european -less |
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Hormonal or chemical agents such as __(3)_____ play roles in cervical ca
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-Cigarettes
-oral controceptives- maybe -diet and lack of folic acid |
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Viral agents too such as ___ may be a factor to cervical ca
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-herpes simplex virus type II
-HPV |
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Pap smear should start at age ___ or earlier if ____
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18 or if she is sexually active
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At the onset of the disease, growth of cervical ca is ___ and may take __-__ years to progress.
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slow growth and may take 10-20 years to progress
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As the cervical ca progresses it breaks through the basement membrane of the ____ and invades the ___ ___. But once invasion begins the disease rapidly and can cause death in __-__ years.
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breaks thru the basement of the epithium and invades the cervical stroma.
can cause death in 2-3 yrs |
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Extention of the lesion into the cervix may eventually be manifested by (4)
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-superficial ulceration
-exophytic tumor -extensive infiltration -spread to vaginal fornices or paracervical tissues with eventual direct invasion of the bladder, rectum or both |
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Cervical ca can spread by direct extention downward into the ____ ___ for considerable distance beyond the palpable or visible disease. It can also spread upward into the ___ or ___ of the ___.
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-downward to vaginal mucosa
-upward to corpus/body of uterus |
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Dissemination does not always follow an orderly pattern. The cervix is a rich lymphatic network and more abundant in ___ layers with high probability of spread to ___ ___ ____
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more abundant in muscular layers that spread to regional lymph nodes
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Ca of cervix may spread to
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-paracervical and parametrial lymphatics
-mets to obturator -external iliac and hypogastric (internal iliac) lymph nodes -then mets to common iliac or periaortic lymph nodes |
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Physical signs of disease beyond pelvis convey poor prognosis. The ___ ___ __ may be the most noticable site of extrapelvic spread and should be bx if palpable
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left supraclavicular node
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It is reccomended that patients with documented paraaortic node metastasis have a rountine ___ ___ bx.
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supraclavicular node
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T1
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confined to cervix
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T1a
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microinvasive- depth 3mm or less
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T1b
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invasive- depth greater that 3mm
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T2
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extention into vagina (upper 2/3 -parametrium)
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T2a
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extention to vagina
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T2b
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extention to parametrium (not pelvic wall
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T3
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extention to lower third vagina/ parametrium/ pelvic wall
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T3a
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extention to lower third of vagina
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T3b
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extention into parametrium and pelvic wall
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T4
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extention to bladder/ rectum /beyond true pelvis
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met pelvic lymph node
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I- 15%
II- 25% III- 35-45% IV- 50% |
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Surgery for cervical ca cancer is for pt
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insitu to stage 2a
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XRT for cervical ca is for pt
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Stage 2b to stage 3
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Stage IV cancer is managed by
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combo of surgery, RT, and chemo
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Conservation therapy as an outpatient and is accomplished by
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-cryosurgery (freezing)
-electrocautery (burning) -laser vaporation |
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In stage I disease RT and surgery acheive similar rates however surgeryy is generally preferred in order to avoid
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the delayed side effects of RT -sexually dysfunction
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External RT- AP/PA and LAT fields are
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15x15 AP/PA
9x15 Lat to ischial tuberosity |
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Doses for external RT is approx
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4500-5500 cGy
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bracytherapy is ideally suited for cervix ca because
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high doses delivered to central tumor and its rapid dose fall off. But is inadequate to treat lymph nodes
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Doses for ca cervix is limited by
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tolerance of surrounding organs such as rectum, bladder and small intestine
-sigmoid most susceptible |
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In general brachytherapy _____ application gives best results
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short, high
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In brachy ____ ___ may be used between sources to produce better geometry of dose
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plastic spacers
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