Cancer therapy

• site • spread • stage • histology • patient’s general condition • sensitivity of tumour • patient preference • resources

• radical / palliative • sole treatment modality • part of a combined therapy • adjuvant therapy • neo-adjuvant • prophylactic therapy

• management of primary tumour • management of regional lymph nodes • palliative surgery

• tissue biopsy to establish diagnosis • removal of malignant disease w a clear margin of normal tissue • repair, recon + restoration of normal function

• axillary nodes - breast cancer • radical neck dissection - head & neck • inguinal node dissection - vulva, anal, penile

• relief of obstructive symptoms • control of haemorrhage • tumour fungation • fracture fixation

• treatment of malignant disease w/ high energy x-rays or gamma • radical + palliative approaches • used in few benign situs • can be used as a single treatment option or as part of combo • wide range of tumour sites • external beam - particle therapy • internal radiotherapy - brachytherapy

• 360 movements -> access to any part of body • laser system + imaging system • range of high energy photons + electrons allow a range of tumours to be treated from superficial skin lesions to deep seated pelvic tumours

• tumour volume • critical structures • isodose curves • wedges • homogenous distribution

• multileaf collimators • increase dose to tumour • decrease dose to surrounding normal structures

• CT plan • volume definition • identification of organs at risk • dose calculation

• PET/CT fusion • functional imaging can also be used to define the tumour priot to radiotherapy • PET demonstrates metabolically active tissue

• skin rxn • hair loss • GI disturbance • tissue fibrosis

• adjuvant therapy • high sensitivity: leukaemia, lymphoma, germ cell tumours, small cell lung cancer • modest sensitivity: breast, colorectal, bladder, ovary, cervix • low sensitivity: prostate, kidney, primary brain tumours, melanoma • combination drugs

• breast - tamoxifen • prostate - zoladex