I

② Henri
Becquerel
-

radioactivity
① Pierre
/ Marie Lurie -

physiologic
radium
effects of
rays

④ Emil Grabbe

first to use
way for cancer
-

treatment came n' can )

recurrent
µ w/
- carcinoma

of
the
left breast

⑤ Henri Coutant
kegnud
Claudius
/
fractionated / protractedhead
-

radiation
therapy of
neck
/ cancers

④ William David
Coolidge
tube
x
ray
-

① Ernest
Rutherford
Historical
tlevelopments structure
of
atom
-

era
depends on the
penetration
④ Clarence Skinner
Era curative treatment
Discovery 1st using
-

the atom radiation

-

discovery of ,
various
ionizing
subatomic
particles / electro
magne
-
-
woman w/ malignant fibro sarcoma
tic
particle
① Withem Conrad
discovered
Roentgen
tray
-

-
Nov .
8 ,
1895
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RHA (mRNA ) severe visible chromosome abevra
i
messenger
.
.
,

lions be detected
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12nA
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radiosensitive
DHA
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damaged without
-
-
-

attached to each is one visible chromosome aberration

of
-

( reversible but lead to

4
nitrogenous organic
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death )
i adenine
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.

1 .
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i.
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:÷:÷÷÷÷÷:
result is the reduction
of
-
a

molecule into
long single ,

smaller molecules each

many
which
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phases of cell
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of
still he macromolecular
.

may O
I M mitosis
-

. .

division
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-

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a .

linking
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Sparlin side 4 sub
phases of
mitosis
-

that extend the main chain

of
i.
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nucleus swells
Point lesions link
/ the becomes
i.

result
disruption of single
in
prominent /
-

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,
begins
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to take

form
 .fi
metaphase chromosomes
/ Interphase portion
the cell
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-

appear
i

of mitotic
- -

are lined along between events

up
the the
equator of
nucleus
period of growth of cell
-

mitosis can be slipped between division

-

chromosomes are not visible

chromosomes
/ can be studied

lawfully under the microscope ① 61 -

Growth
between
my
cell
Yap
in
growth
-

tradition induced chromosome

damage can he analyzed pre DHA
synthesis phase
-
.

during metaphase

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" " " ""
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chromatids
structure
w/ four
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poles
to a centromere

spindle fibers -

fibers ④ 62 -

post
-

DHA
synthesis gap of
cell
growth
4.
telophase disappearance of structural
-

chromosomes into a mass

/
the
MA closing
of the nuclear
off of
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at the same time ,

cytoplasm
-

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characterized
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each
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phases are
by
the the structure chromosomes W/o
accompanies one
of of
.

new nuclei contain the pH

meiosis
-

process
in
w/o genetic cells
reduction
undergo division

cells
-

genetic begin w/ the same

number chromosomes as somatic

cells
of (46 chromosomes
- 23
pairs )
that has
completed the 62
phase
cell then the
progresses through
-

phases of mitosis into two

daughter
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cells each
, containing chromosomes
two chromatids each
of level
tissue
Organ
/
- "" h
of
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when bound
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these tissues
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each
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-

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-

units
w/ specific functional
-

each
parent has
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responsibilities
division resulted in
,
4
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-

an overall
integrated organization
known
during second division chromo as
organ system
.

,
some

Gomal material is
exchanged among
radio determined
chromatids
through a
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called
-

sensitivity is
by
functionrate of the in the
crossing over organ
cell
-
results in
change , in
body ,
at
w/o mature
inherent radio
genetic
constitution
/ changes / sensitivity of
the bell
in inheritable traits
type
.
 I
stochastic
delayedEffectseffects
a.

Roentgen 1895
-

,
way
Becquerel 1896 radioactivity malignancies
-

expressed after latency a

/ Nagasaki
epidemiological
be
Hiroshima 1945
period I detectable
may
-

ly in a

Radiation
population
effects
:

assumed to
place we
take

range of doses
the entire
threshold level
w/o a

Deterministic
i.
effects due
large dose
hereditary effects have to
-
-

reddening of radiation
the been
hauler
exposure
-

detected
skin
statistically in other
the dose exceeds
ounce
if mammalian
population
-

a threshold level
-
random

result various
of processes
-

cell death
mainly or

caused
Basic Framework
of
Radiation Protection

delayed cell division ,

levels
by radiation
exposure
to
high based on KRP
-

of
- a
practice should
only be
adopted
yields sufficient benefit
it
if individuals
can
impair function of
tr the
exposed to
-

tissues or to
society outweigh
the

radiation detriment it causes

-
should not exceed dose limits

for occupational / public exposure

not medical
applicable to exposure
-
 should

I
radiation installations
/
-
sources

be
provided w/ the best available
the
protection / circumstances
safety
under measures

that the
prevailing so ,

/ likelihoodindividuals
magnitude numbers I
of exposures
ybe
the
of exposed
social
A- LARA .
economic

into
/ factors
taken
being account

Diagnostic medical
exposure
optimization of protectionthe
-

achieved
is
by keeping
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medical
therapeutic exposureis
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-

optimization by
normal
keeping exposure of
tissue ALHKA consistent to

deliver H

Volume Lptv )
planning target
 :/
short distance
therapythe
- o

Greek word which means

"
short "
from
-

"
"
short distance
therapy
-
-

to endo
referred therapy
"
-

as curie or -

therapy
"
curie

in w/o
refersradiationradiotherapy
- to sources

close
or are
placed at

at
proximity to .
or
directly the
target
volume

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the radioactive
isotope is encased

small metal structure dose distributions

wlin
therefore
a ,
-
, are

usually
tubes that
titanium or

welded
stainless
shut
steel
inherently inhomogeneous
are at the
treatment
ends external beam minimize
hotspot
-

brachytherapy increase
hotspot
-

- dose is delivered continuously .

either

Innovia dal
over a shout
period of time ctemporavy a
very high
dose is
-

lifetime
the while the
implants ) or over
give sparing surrounding
of
the source to a
complete decay tissue

(
pennant implants ) used adjuvant
monotherapy
-

as ur

external beam
therapy to boost

therapy
 :÷ ÷
Source
specification Brachytherapy applications
the amount radiation emitted in terms duration
-

of
L
major type ,

of
from
a source is
directly proportional
to the absorbed dose around it ① Pennant
Brachytherapy small radioactive
placement of
-

activity defined the the

-

source -
as sources directly in
targeted
of disintegration per
number time where
they are
left to

unit time
for a
particular decay
source

-
deliver the due to the
radioactive
-

activity
of any
tumor
during a
period of
source
changes w/ time several weeks or months
as source
decays
most common Ute is
for
-

prostate cancers

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'

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.
3.7 x 10 Bg =
I Li
th terms method
hard to
of of placement
activity
sources is

ofbecause
-

measure some emitted ① Interstitial

Brachytherapy
radiation interact source
places radioactive sources
directly
w/
-

material
/ encapsulation into a tumor or tumor bed

amount rigid needles

strength
tubes
source
of
or
flexible
- - -

radiation in the be used in the actual

exposure air
may
unit U placement the
-
is
of sources

U and commonly used treatment

I I cbylh in
of
= -

neck ,
breast ,
prostate / soft tissue

sarcomas
 :i ÷ ÷ i÷ ÷
Dose Rates in
Brachytherapy
① rate
brachytherapy
Low
dyeh
②
lntracavitary Brachytherapy by Ihr

placed wfin a
body cavity extreme
hyper fractionto
-

normal tissue
treatment relatively sparing
-

but continuous
an
applicator is
placed in low
-
-

shortens treatment
the
cavity / the radiation overall
-

then inserted into reduce

opportunity for tumor
-

sources are

treatment
the
applicator repopulation after
used in
used permanent
gynecological
-

-
in

cases cervical cancer

up .

② Medium dose nite

brachytherapy
Ihr Ihr
-

h 6g to 12
by
" "

÷ i÷ ÷ ÷ ÷ ÷ ÷ ÷ :*
:÷÷÷÷÷
④ Intravascular
Brachytherapy
.
duration cell
-

placed w/ in the blood vessels

/
rate
of proliferation
stents
-

drug alluding
treatment
Delivery
① surface Brachytherapy
i. Hot
loading
-

place radioactive sound on

-

applicator is
preloaded
the area to be contains radioactive sources
top of
-

time
treated at
into
the
the
of placement
pt
-

non -
melanoma skin cancer
.

oral cavity ,
nasal
cavity ,

hard
palate / orbital cavity
after loading
I .

applicator
-

radioactive
is
source
placedloadedfirstlater
,
 1
capsule of brachytherapy
radioactivity
-
contain the

provide source
rigidity
-

-
ghouls
any radiation
produced
through the sound
decay

Disadvantages of brachytherapy
alive to
1 .

Opa
nature access
④ Vaginal cylinder
the tumor
acrylic cylinders having
a
variety
-

diameters drilled
skilled
of f huommudak
axially
i.
requirement for personnel
holes to
tandem
a stainless
steel
radiation
i.

needed
protection measures
to
protect ix. staff
/ gen
.

public

Used
Common
Equipment
① Remote after
loader
loader contains
HIM remote
after a
-

single
source
if high activity

④ Rectal
applicator
acrylic cylinders of diff diameters
.
-

tumor rectum
of
-

selective used
shielding is to
spare
-

normal tissue

Fletcher
① suit or Fletcher suit Dildos
-

used
gynecological malignancies
-
in

side
f pelvic
uterus cervix
ofwalls ,
⑤ Intra luminal catheter
-

treat intra luminal disease

such a ,
endo bronchial

carcinoma

④ nasopharyngeal applicators
nasopharyngeal tumors w/
-

HDR

-
Includes tracheal tube , catheter
connector
/ nasopharyngeal

① Interstitial
-
Implants stainless
hollow ,
steel are

implanted into the tumor

standard
brachytherapy
following
of implant
rules

-
doled ended catheters are

inserted to accommodate the

HMI source wire
 out
④ sends

:÷f ÷ :÷
the
Grows
periphery /
as

begins when infiltrate / destroy

abnormal cell that
is
processes
-

mutation
transformed by
the
genetic surrounding tissues
the cellular 17nA
of
growth / depends
variable
① Rate
of
is

on the level
of differentiation ,

forms
a done
/ begins to
pro life
more
anaplastic faster growth
-
-

rate
abnormally ignoring growth ,

regulated signals in the environment to

anaplastic failure
=

of organ
characteristics
of malignant
cells be
differentiated
① contain
proteins called tumor
④ caused
generalized effect
such as

loss
/
Weakness
specific antigens
anemia .
weight
-

proteins w/o distinguish

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.in:*
:*
.

. not blood
I do adhere to
lymph f vessels how it
spreads
-
-

mechanism
adjacent cells
readily key
-

③ nuclei
of
cancer cells are
large 1.
lymphatic spread
/ irregularly shaped (
pleomorphism ) through lymphatic
-
circulation
-
most ummm

enter
④ mitosis occurs
frequently
tumor emboli
lymph
-

channels interstitial
by way of
⑤ cells are
undifferentiated / often fluid w/o communicates
w/ lymphatic
bear little resemblance to the normal
fluid
cells the tissue
of from they awk
 Hematogenous spread

:/
2.

bloodstream
sample viruses

through
-

related ④ Epstein-Barr virus

directlythe to the vascularity
-

tumor burkitt
of lymphomacancers
-

few malignant cells can survive

nasopharyngeal
-
-

's
the turbulence
of
arterial circulation , non
lymphoma
hodgkindisease
-
-

/ hodgkin
destruction
insufficient oxygenation or 's

of
the
body 's immune system
④ Herpes simplex ,

cytvmeyalovivm
/ HPV
-
cervical canoe
u

①
HepatitisliverB/c
- cancer

④ Human
lymphotropio
t cell
-
virus

lymphocytic leukemia
lymphoma
-

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""

:
"

.
factor ( VEGF ) -

exposure
to
sunlight
-
chronic irritation or

inflammation
tobacco
Etiology use
-

④ Viruses
/ When
Bacteria ① chemical agents
clusters related
-
cancers
appear
in -

751 .
are to
viruses themselves environment
incorporate
-

the death
in the
genetic structure of 301 of
cancer
- .

cell , altering future cell are tobacco smoke

population
-

smoking :

lung pancreas
-
-

head neck cervix

f
- -

bladder
esophagus
-
-
 familial disposition

.µ:÷ ÷ ÷:
oval to
chewing tobacco due
cavity
cancer
51
-
-
.
-

Hallmarks
chemicals
of families
:

suspected carcinogenic
.

I .
aromatic amines
/
aniline
dyes i. Lancer
w/ 2 or more relatives
Pesticides lanier than
/ formaldehyde
50
ylo
i. s 2.

arsenic Same
younger in several members
type
3. n .

Sort taus than

4.

5.
/
asbestos
i. More
Race
one
type of Lancel

type
5.

6. Ben hehe

Betel
/ lime with
familial
inheritance
7. nut :

8. Cadmium

9. Chromium Retinoblastoma
compounds
'

nephwblastoma

:÷ ÷ :÷ ÷ :÷ ÷ ÷ ÷
i
-

:* .

/ Kidneys
lung because mostly lung
are
liver
-
.
-
,

affected they detoxify

chemicals ⑤ Dietary factors
be
carcinogenic colarcino
-
can or .

④ Gene"
I. Yinka! .vn/:smin. .
"
"
genic
term
long ingestion
-

due to shared
genetics environment,
-

cultural or
lifestyle factors or
Dietary substances
chance alone 1. Fats
1. alcohol
abnormalities
with
underlying genetic salt cured smoke meats
: g - -
or

i. nitrate
/
nitrite
containing foods
- Burkitt
lymphoma
chronic leukemia
myelogenous bbesitu
tea dome trial
-

hleningiomas cancer
-

postmenopausal
-
acute leukemia -
breast cancer
-

Retinoblastoma '
-

Winn 's tumor

Skin cancer
malignant melanoma
-
<
 Hormonal
⑥ agents -
T
,
-

Ty
-

increasing sine
/ the
or

disturbance in hormonal local extent

of primary
-

balance tumor
-
either
endogenous / exogenous
hormone '
② Regional lymph
nodes

nodes
Diethyl stilbestrol ( NES )
Regional lymph
*
Ny
-
-

cannot be assessed
-

vaginal caucinomg

No no
regional lymph
-
-

node metastasis
oral
contraceptives f prolonged
*

estrogen replacement therapy

hepatocellular h ng increasing involvement
- - -

]
-

in !:adf.metn.nl of regional lymph

increase

nodes

ovarian cancer
-
decrease

:÷÷÷÷÷:÷:÷:÷÷:÷÷÷÷ ÷ ÷ :÷ ÷ ÷:÷ ÷ :÷:÷

"""
""

"

i
. :
extent the tumor
T -

of primary
node involvement
n
lymph staying provides convenient
-

a
-

M extent metastasis shorthand notation that condense

of
,
-

lengthy description into

manageable
classification system treatment
/
"
terms
for prognoses
① comparison
Primary H
tumor
tumor cannot
Primary
- -

be assessed
I
TO
stage small
no evidence cancer
of primary
- -

tumor -

w/ in organ it started
-
carcinoma in situ
-

tis -
carcinoma in situ
 h
stage

÷ ÷ :÷i :÷ ÷
stage Grade N
larger than
-

tumor 1

yet spread
-

not into the .

do not resemble the tissue

surrounding tissue
of origin
alreadynodesspread poorly differentiated
-
sometimes -
or

lymph undifferentiated
in the close
to tumor
localised more
aggressive
-

] undifferentiated
-

- less
responsive
3
stage
large cancer
-

spread into the

surrounding Biopsu
ldefinih
-

nodes
tissue
/ lymph advanced / confirmatory tent
've
for
-

determination
-

early locally the or

diagnosis of
cancer

"
"

" ""
Malachi
-

define
frication
tissue
of based
tumor

on
cells
its
:÷ ÷ ÷ :÷ ÷:÷ :i
tract
tract
/ upper respiratory
.

origin what
,
to
degree tumor

characteristics /
cells retain
functional entire
removes
surgeon
-

histological of
tumor
/ surrounding
tissue
of origin marginal tissues

-
l -
IV -
decrease chance
of
the tumor
seeding
Grade I 2. Incision at
Biopsy
:
well
differentiated tumors tumor man is too
large
-
-

be removed
closely resemble the to
tissue
origin -

wedge of tissue is

removed
for analysis
 :÷ ÷ i÷ ÷:
needle
Biopsy
b. a .
Ct scan

sample suspicious
masses
neurologic
-

that are
easily accessible
pewit
-

abdominal
such as breast ,
thyroid
-

thoracic
/ kidney
liver
lung
-

skeletal
X Ct Utd MRI
ray
-
-
.
,
,

guided
Fluoroscopy
d.

skeletal
-

aid detect lung

Diagnostic to cancer -

growththe / gastrointestinal
-

used to locate -

malignancies throughout body

5. Ultrasound

÷÷÷÷÷÷÷÷÷
"
"" -

Abdominal

:*:÷ .

/ prostate opening
testis

Bronchial 61
/
-

7. Nuclear Medicine
-
Bone
-
liver
-

kidney
spleen
-

-
Brain
-

thyroid

2. MRI
-

neurologic
-
pelvic
-

abdominal
<
Thoracic
 I
Emission
8. Positron
tomography
use tracer
of
a
-

provides black
color coded /
white or

images of
biologic activity of a

particular area

lung
-
colon
-
liver

pancreas
'

head neck
/
-

hodgkin 's / non

hodgkin 's
-
-

lymphoma
-

melanoma

9.
kadioimmunocojuyates -

monoclonal antibodies are

labeled
w/ isotopes /
into
injected IV
px
antibodies
aggregate the
-

tumor site

-
aolorectnl
-

breast

bunny
-

head
Inuk
-

lymphoma
'

< melanoma