Figure 8. Linear accelerator which delivers external beam radiotherapy. |
Figure 9. A cT2N0M0 squamous cell carcinoma of the anal canal. Treated with definitive chemoradiotherapy( 50.4Gy / 28f). |
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epidemiological data from nuclear |
Local side effects are more likely |
discussion of treatment side effects, |
swelling of the spinal cord or cauda |
( 5.8cm in size) involving the lateral |
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weapon and fallout disasters. It is |
to be experienced at the target site( see |
facilitate discussion of admission to |
equina, which is dependent on the |
wall of the anal canal. This extends |
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estimated that the risk of develop- |
table 1). |
hospital, where indicated, and in the |
level of the involved vertebral body. |
into the left ischiorectal fossa, |
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ing a cancer many years after treatment with radiotherapy may be in the order of 0.1-1 %, although it is difficult to accurately quantify. 9 Note that this is a cumulative risk, increasing with the number of years following |
ROLE OF THE GP
THE multidisciplinary approach to
radiotherapy includes the integral role of general practice. The GP is generally involved in the initial diagnosis,
|
palliative setting to optimise end of life care.
When to make an urgent referral
Malignant spinal cord compression
|
Symptoms of MSCC include bone pain and neurological deficits, including loss of bladder or bowel control. Prompt referral to a cancer specialist, including a radiation oncologist, is important, as |
extending into the perineal body but without vaginal invasion. There is a suspicious left inguinal left node. FDG PET scan demonstrates the avid primary lesion in the anal canal and faint uptake in the suspi- |
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radiotherapy. This low risk therefore |
may play a role in patient management |
( MSCC) is an important diagnosis |
the chance of the patient remain- |
cious lymph node( see figure 9A). |
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becomes increasingly significant in |
during treatment and in surveillance |
that requires prompt evaluation. This |
ing ambulant is related to the time |
Examination under anaesthe- |
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paediatric patients treated at a young |
post-radiotherapy together with survi- |
condition occurs when a cancer has |
of onset of symptoms. Treatment of |
sia demonstrates an ulcerated anal |
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age. These patients require moni- |
vorship. Patients who live in regional |
metastasised to a vertebral body. The |
MSCC with radiotherapy is simple |
mass involving the sphincters. A |
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toring at an appropriate late effects |
or rural areas receive their radiother- |
mass destroys the bone, and a soft tis- |
and can be performed more quickly |
biopsy shows a moderately differen- |
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clinic for potential early detection of |
apy and then return home follow- |
sue component can impinge on the |
than other more complex radiother- |
tiated squamous cell carcinoma and |
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malignancy. |
ing treatment. Their local GP will be |
spinal cord / cauda equina. This may |
apy plans. The aim is to alleviate |
is p16 +. Michelle’ s case is discussed |
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|
Management of side effects
Managing radiotherapy-related side
|
involved in the management of some acute side effects.
It is important that both the GP
|
also occur in haematological malignancies such as multiple myeloma. This condition requires urgent man- |
pain, which is successful in about 80 % of cases, and to prevent further progression of any neurologi- |
at the MDT meeting, and definitive chemoradiotherapy is recommended. Figure 9B is her FDG PET |
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effects is fortunately fairly straight- |
and patient are fully informed regard- |
agement, which may include surgi- |
cal deficit. |
after treatment. |
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forward. The severity of side effects is dependent on the dose of radiotherapy delivered, concurrent treatments such as chemotherapy, and comorbidities. |
ing the potential role of radiotherapy in the management of the patient’ s cancer. A referral to a radiation oncologist can facilitate an informed deci- |
cal decompression, a combination of decompression and radiotherapy, or radiotherapy alone in patients not suitable for surgical resection. Radi- |
CASE STUDIES
Case study one
MICHELLE, a 60-year-old female,
|
Case study two
Nick, a 44-year-old male presents
with haemoptysis on a background
|
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The only generalised side effect of |
sion-making process by exploring all |
otherapy is favoured in haematologi- |
presents with faecal incontinence |
of metastatic renal cell carcinoma |
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radiotherapy is fatigue; this is highly |
treatment options. |
cal malignancies, given the predicted |
and an anal canal mass on a back- |
and hypertension. A CT pulmonary |
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variable from patient to patient, and |
Communication between GPs and |
high response rate, obviating the need |
ground of migraines, depression, |
angiogram demonstrates multiple |
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usually improves following completion |
radiation oncologists is important to |
for surgical intervention. Manage- |
anxiety, tonsillectomy and vertebral |
lung metastases. A right lower lobe |
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of radiotherapy. Always think of other |
maintain the clarity of the patient’ s |
ment of MSCC also generally includes |
fusion. |
metastasis is encircling the lower |
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reversible causes, such as anaemia. |
management plan, promote the |
the use of dexamethasone to reduce |
MRI pelvis reports a large mass |
lobe bronchus, with possible erosion |