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Benkovich 1

Stephanie Benkovich
Knowledge Assessment

1. Anatomy and Physiology:

2. Clinical Presentation of Disease:

3. Lymphatic Drainage:

4. Typical Routes of Spread:

5. Common Sites of Distant Metastasis, list the 4 most common:

6. Epidemiology:

7. Etiology:

8. Clinical Detection and Diagnostic Procedures:

9. Histopathology, list the 4 most common:



Stephanie Benkovich

Knowledge Assessment

Removes the tumor so that it does not cause any more harm. Used for invasive cancers. Removes only a portion of the bladder. Knowledge Assessment . Removes the entire bladder and nearby lymph nodes to prevent spread of the cancer. Used if the cancer is not very large.Benkovich 2 Stage T N M Stag e 0a Stag e 0is Stag eI Stag e II Ta N0 Tis N0 T1 N0 T2a N0 T2b N0 T3a N0 T3b N0 T4a N0 T4b N0 Any T N13 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 M 0 Any T Any N M 1 Stag e III Stag e IV Treatment Surgery Y Y Details Type Transurethral Cystectomy Partial Cystectomy Stephanie Benkovich Rationale Used for early stage and superficial cancers.

Small dose of radiation put directly into the cancer. Provides a way for the urine to leave the body. Chemotherapy. Immunother Y apy 11. Causes the immune cells to be attracted to the bladder and activated by the BCG. Used to shrink tumor before surgery or used to kill any remaining cancer cells after surgery. Done in the event the entire bladder is removed. Radiation Therapy. Electrons Chemothera Y py Intravesical Systemic Used for stage 0 or stage 1 cancers. LDR. Can attack cancer cells that have already spread from the bladder.Benkovich 3 Urinary Diversion so the bladder can still be functional. describe two ways and include all set-up devices: Stephanie Benkovich Knowledge Assessment . Cryo surgery Laser surgery Radiation Therapy Y Photons 10MV or greater Can be used alone or with surgery and/or chemotherapy. Can limit some of the side effects of external radiation therapy such as skin irritation. Brachytherapy (HDR. Typical Patient Position and Rationale. Bacillus CalmetteGuerin(BCG) Used in treating low-stage cancer. 12. Interstitial) and Immunotherapy.Treatment and Rationale: Surgery. Limits the unwanted side effects by keeping the drugs from spreading throughout the body. which then affects the bladder cancer cells. Brachythera Y py HDR LDR Interstitial Source Source Used for T1-T3a lesions less than 5cm.

Hands can be folded on upper abdomen. Can be used to immobilize legs. Can be customized and used to help recreate initial position. Can be used to relieve pressure on back while lying supine.Benkovich 4 Position Plan A Supine Plan B Rationale The supine position is the most comfortable for the patient while allowing consistent recreation for treatment. can help support upper body at an angle making it easier to breath. Can be used with elastic or Velcro around feet to stabilize hips. Bladder must be empty. Beam Angles used and Rationale: 14. Leg immobilizer Alpha Cradle 13. Special Blocking and Rationale: Stephanie Benkovich Knowledge Assessment . Prone pillow Bellyboard Ankle roll A-Foam/head holder Wing board Knee cushion Used to support patients head to insure their comfort. Can be used to immobilize legs or if patient has orthopnea. Prone Lateral recumbent Device Aqua-plast mask Vac-loc Rationale Can be customized and used to help recreate initial position. If bowels need to be out of field of treatment.

used to monitor prostate in real time while treatment is being given Organs at Risk.500 61 60 60 52 52 52 Bladde r Rectu m Femor al head and neck Stephanie Benkovich 65 50/5 1/3 50/ 5 2/3 50/ 5 3/3 100 cm2 7.00 0 80 100 cm2 5.Benkovich 5 Blocking Blocks Electron cutout Dynamic MLC’s Y Rationale Y To shape the beam and spare healthy tissue while targeting cancer cells Other 15. Y Y Rationale Calypso. Accessory Devices and Rationale (ex: wedges. TD 5/5 and TD 50/5. make a chart: Organ 5/5 1/3 5/5 2/3 5/5 3/3 Skin 10 cm2 7. bolus): Accessory device Wedges Bolus Electron cone Other 16.00 0 Selected Endpoint Necrosis/ulceration Symptomatic contracture. volume loss Severe proctitis/necrosis/ stenosis/fistula necrosis Knowledge Assessment .00 0 93 30 cm2 6.

lateral borders): Lateral Border Superior Inferior Anterior Posterior AP Border Superior Inferior Medial Lateral 18.8 Gy Re-Eval Dose 45-50 Gy 1. creamy peanut and seeds . beans. nuts boneless fish. medial. Total Dose: Treatment Radiation only Radiation Type Photons Radiation then surgery Photons Radiation. eggs. Re-Eval Dose. tofu Stephanie Benkovich Knowledge Assessment . draw a diagram and make a chart (superior. discuss site specific side effects from radiation therapy: FOOD TYPE Meat and protein RECOMMENDED NOT RECOMMENDED Tender beef chicken and turkey. posterior.Benkovich 6 17. Surgery and Chemotherapy Photons Ener gy 6-MV to 20MV 6-MV to 20MV 6-MV to 20MV Daily Dose 1. Details Radiation Type.8 Gy Total Dose 65-70 Gy 45-50 Gy 40 Gy 65 Gy 19. anterior. Tough or fibrous meat. inferior. Energy.8 Gy 1. Daily Dose. Dietary Needs. Treatment Borders. crunchy peanut butter butter.

butter. cream of rice. prune juice. peppers. fruit juices with no pulp. mayonnaise. yogurt without seeds or skins. dried fruit bars. Typical Lab Tests (CBC-state normal blood values and cutoffs). low-fat. buttermilk. bran. pasta. roles(white). pasta Bagel without seeds or raisins. plain gravy’s Fried /greasy food Desserts/snacks Plain ice cream. potato chips 20. onions. plum Vegetables Very small servings of vegetables Broccoli. cabbage Fats Margarine. and powdered). plain cheese. whole grain pasta. melon Avocado. list most common for the area being treated with radiation: Test Frequenc y Intervention Rationale CBC Weekly See chart below See below Weigh -In Weekly Nutritionist. custard. Frequency. ice cream with coconut or nuts.Benkovich 7 Milk and dairy Milk(skim. jams with skin or seeds. cottage cheese Bread. cereals with more than 2 grams of fiber per serving Fruit Cooked or peeled fruit without seeds. dried fruit. granola. berries. noodles. rice. cereals with less than 2 grams of fiber per serving Breads/rolls made with whole grains/seeds/nuts/dried fruits. Physician must be notified To ensure that patient does not lose or gain more or less than 5% 10% of their body weight Stephanie Benkovich Knowledge Assessment . oatmeal. salad oils. corn. refined bread . cereal. Fruit yogurts with seeds or skins evaporated. peas. crackers. white rice. pudding . popcorn. brown rice. plain cakes/cookies Oatmeal cookies. potato skins. English muffins(white). canned fruit. banana. sherbets. Intervention and Rationale. grits.

21. 21. 21.16 Hematoc rit Hemoglo bin Interventi on Rationale Epogen Procrit Erythropoie tin Epoetin alfa Darbepoeti n Restore RBC Gets sick easily Neupogen Neulasta Leukine Restore RBC Neumega. Chemotherapy. 21. 21. 21. 21. 21.00 0 37% 47% <100. 21. what type of chemotherapy. 21. 21.0 Platelets 150. 21. 21.0 00 12 . 21. 21. 21. Typical Side Effects for Radiation Therapy (Acute and Chronic) and state the Medical Intervention for each. Blood transfusion Restore platelet count <30% Excessi ve bleedin g anemia Cease Treatment Allow body to restore Hct <10% anemia Cease Treatment Allow body to restore Hemoglobin State 3 for each: Complications associated with surgery and immunotherapy agents.00 0– 300. 21.010. 21. 21. 21. 21. 21. 21. Surgery Complications Immunotherapy complications 22. .Benkovich 8 Blood cell Erythroc ytes Norma Blood Proble l cutoffs m Blood Values 3.0 <2.2 Leukocyt es 4. 21. side effects and Medical Intervention for each: Stephanie Benkovich Knowledge Assessment 21. 21.8 – fatigue 5. 21. 21.

such as Zofran or Reglan.Benkovich 9 Radiation Side Effect Fatigue Acute/ Chroni c Acute Skin redness/ pain/irritation Acute Decrease in blood counts Acute Acute Nausea/ Vomiting Acute Diarrhea Medical Intervention Make sure eating and drinking well. Megace or Marinol Make sure eating and drinking well. moisturizer. Knowledge Assessment . or Marinol Polyuria Acute/ chronic Medications such as Vesicare. exercise Use mild soap. Kaopectate or Pepto-Bismol Loss of appetite Acute Medications such as Megace. Compozene or Zofran Medications such as Imodium. Medications such as Procrit or Aranesp. protect from sun. Reglan. medications such as Remeron. RBC transfusion Medications such as Reglan. Neupogen for WBC. and a prescription is also given for use after. are given before the infusion. and Neumega for platlets Baking soda rinse Refer to dietician. and avoid extreme temperatures. take rests as needed. wear loose clothing. Hydration and in severe cases hemodialysis Erythropoietin to increase RBC. Toviaz or Detrol Dysuria Acute/ chronic Medications such as Phenazopyridine Infertility Chronic Development of new cancer Chronic Chemother apy Drug Type Cisplatin Alkylatin g Most Common Side effects Nausea/ Vomiting Kidney toxicity Low Blood counts Mitomycin antitumo r antibiotic Mouth sores Poor Appetite Fatigue Stephanie Benkovich Medical intervention Anti-nausea medications.

Benkovich 10 Interferon alfa cytokine Flu like syndrome Fatigue Low Blood counts 23. exercise Acetaminophen to treat fever and aches and pains. exercise Erythropoietin to increase RBC. Prevention: 25. Lomotil for diarrhea Make sure eating and drinking well. References: Portal Design in Radiation Therapy Principles and Practices of Radiation Therapy Mosby’s Radiation Therapy Study Guide and Exam Review Stephanie Benkovich Knowledge Assessment . Megace or Reglan to stimulate appetite. and Neumega for platelets Prognosis. Neupogen for WBC. List 5-year survival by stage or Grade: Stage Relative 5year Survival Rate 0 I II III IV 24. Zofran for nausea. take rests as needed. take rests as needed. meperidine or hydromorphone to stop severe chills.