Case study four
Susan, a 65-year-old female presents
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Breast cancer |
Lymphoedema may occur in the arm following treatment for breast cancer but may also affect other sites |
The risk of lymphoedema is estimated prior to treatment of lymphatics |
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with PR bleeding, on a background of prior melanoma excision, hypertension, dyslipidaemia and eczema. Colonoscopy demonstrates a large non-obstructive mass in the distal rectum up to the dentate line.
Biopsy demonstrates a moderately differentiated adenocarcinoma. MRI pelvis reports a 7.1cm tumour, 3.6cm from the anal verge( see figure 12A). The tumour involves the circumferential margin and there is a 0.3cm extension into perirectal fat. A CT of the chest, abdomen and pelvis does not demonstrate any metastatic dis-
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The rectum directly or from an incidental dose received by the rectum during prostate radiotherapy
Pelvic area
Pelvic area
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Change in bowel habits may result following treatment
This may occur transiently shortly following radiotherapy or may be a permanent change
Irritation of the bladder may occur from pelvic treatments and can manifest with symptoms similar to a urinary tract infection
Urinary incontinence as a late effect is rare, with incidence increasing following surgery
Fertility issues are particularly important with younger patients and gonad sensitivity to radiation
Even a small, scattered dose of radiation to the pelvis may affect fertility
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Management may include antimotility agents or review by dietitian for dietary modification
Bladder irritation can be managed with medication or with ablation of neovascularisation in the long term, if there is evidence of bleeding from radiation cystitis
Urinary incontinence is largely managed with pelvic floor exercises or operative intervention by a urologist
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ease. An FDG PET scan reports uptake in the primary lesion, but no uptake elsewhere. Susan is managed with |
Impotence in men is an important consideration when treating prostate cancer with radiotherapy |
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Figure 10. Single metastasis in the right lung treated with palliative radiotherapy( 8Gy / 1f) to prevent haemoptysis. |
Figure 11. A cT4N0M0 squamous cell carcinoma of the oesophagus treated with definitive chemoradiotherapy( 50Gy / 25f). |