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In human cancer, the role of genetic mutations, epigenetic alterations, and cellular repair mechanisms are becoming increasingly apparent. Recent studies have elucidated significant variations of the genetic codes that underpin cancer development in a variety of cancer subtypes. Genetic variations provide a backbone upon which cancer cells can adapt to overcome both intrinsic and extrinsic mechanisms designed to limit the growth of abnormal cells. This chapter provides an overview of the types of mutations, various epigenetic modifications, DNA repair mechanisms, and their relationship to the development of cancer, as well as various techniques utilized for the detection of these genetic alterations in cancer. With the development of new, advanced, and sensitive molecular techniques like next-generation sequencing and digital droplet polymerase chain reaction, our understanding of cancer biology is rapidly developing, and a critical appreciation and knowledge of these cancer-associated changes will likely lead to continued development of more effective therapies.
This chapter discusses treatment planning for gastrointestinal radiotherapy. It describes patient setup, immobilization, and planning technique for esophageal cancer external beam radiation therapy (EBRT). The chapter provides patient setup and immobilization, motion management techniques, target delineation, and planning technique for pancreas fractionated EBRT. It explains patient setup and immobilization, motion management techniques, and planning technique for pancreas stereotactic body radiation therapy (SBRT). The chapter presents patient setup and immobilization, motion management techniques and planning technique for rectal cancer EBRT. It describes patient setup and immobilization, and planning technique for anal cancer EBRT. Finally the chapter explores patient setup and immobilization, motion management techniques and planning technique for liver SBRT.
This chapter discusses strategies for radiation therapy treatment planning for thoracic cancer. It provides a brief description of immobilization on 3D and modulated radiation therapy (intensity modulated radiation therapy [IMRT], volumetric modulated arc therapy [VMAT]), and stereotactic body radiation therapy (SBRT). It describes the image acquisition for 3D and modulated radiation therapy (IMRT or VMAT) and SBRT. The chapter discusses the localization for 3D and modulated radiation therapy (IMRT or VMAT) and SBRT. It presents the beam energy requirements for 3D plans, IMRT and VMAT, and SBRT. The chapter also provides treatment planning volumes for beam energy. Finally it describes treatment planning for 3D, IMRT and VMAT, and SBRT.
Intracranial imaging is vital to the initial evaluation, staging and treatment planning, and posttreatment follow-up of brain tumor patients. The modalities used to evaluate the brain are CT and MRI. A familiarity with basic radiologic concepts can enable a provider to better translate the intracranial process to clinical care. This chapter is intended to give the clinician a baseline for interpreting images independently in either the acute or chronic setting. Imaging of the brain using CT and MRI techniques is essential to the evaluation of patients with intracranial malignancy, both in the acute and chronic setting. Knowledge of basic imaging principles related to the presence of an intracranial mass and familiarity with findings unique to certain malignancies are useful tools for the clinician. These skills can be built over time by reviewing patient images independently, utilizing the kinds of fundamentals discussed in this chapter.
Interventional pain procedures are an adjunct to pharmacologic therapy for cancer pain. While pain at the location of the tumor might be the primary cause of pain, cancer patients may also have non-cancer related pain as a result of altered anatomy or biomechanics, for example, myofascial pain. Myofascial pain is pain or autonomic phenomena referred from active trigger points in the muscles, fascia, and tendons. This chapter discusses about the therapies for muscular pain which includes the trigger point, botulinum toxin, acupuncture, therapies for peripheral nerve mediated pain, local blockade, ultrasound guided procedures, sympathetic blocks, complex regional pain syndrome, spinal procedures, epidural steroid injections, neuromodulation, vertebral procedures and facet arthropathy. Kyphoplasty and vertebroplasty not only have been studied most extensively in stabilizing compression fractures from osteoporosis, but have also been used to treat fractures resulting from osteolytic metastasis, myeloma, vertebral osteonecrosis, and hemangioma.
Treatment planning consists of clinical treatment planning and technical treatment planning. Clinical treatment planning refers to the treatment intent, treatment modality, and treatment dose scheme. Technical treatment planning refers to the details of patient positioning, placement of radiation beams, and the aperture shapes of radiation beams designed to achieve highly conformal radiation dose distributions to the treatment target volumes while protecting the critical organs. Treatment plan quality depends on the radiation beam orientation in combination with the treatment couch angles; the number of beams; radiation beam energies; and beam shapes or number of sub shapes. The chapter provides a brief description on: source-to-skin (patient) distance versus source-to-axis (isocenter) distance treatment planning; treatment target volumes and planning margins; treatment plan types; prescription and normalization methods; open field, wedged field, and field-in-field; forward planning versus inverse planning; boost: sequential versus integrated; intensity modulated radiation therapy and volumetric modulated arc therapy delivery methods.
Involvement of neural plexus structures in a patient with cancer may result from direct invasion by tumors originating within nerve tissue, local metastatic extension or distant spread from diseased organs, or compression by adjacent tumor masses. The function of the neural components may also be severely affected by sequelae or complications of surgical intervention or radiation therapy. Clinical history may suggest a possible etiology; however, physical examination may be of limited value in evaluation of plexopathy depending on the structure affected. Conventional radiologic methods are usually nonrevealing, although they may be helpful in advanced disease. As new techniques are introduced, improved resolution and ability to analyze chemical composition of tissues advanced MRI to the method of choice in diagnosis and assessment of treatment response in patients with plexopathy. This chapter discusses the role of conventional and new modalities in evaluation of plexus disease, including indications, current techniques, advantages, and pitfalls.
Gastrointestinal (GI) complications of cancer are significant and can be challenging to manage. Dysphagia, nausea, vomiting, diarrhea, constipation, fecal impaction, bowel obstruction, and infections are just a few of the adverse effects experienced by the cancer patient. This chapter discusses the current strategies for diagnosis and treatment. The treatment of cancer with chemotherapy agents, immunotherapy, and radiotherapy has dramatically improved the prognosis and survival of many patients diagnosed with cancer. However, these interventions may cause significant GI side effects that can limit tolerability of treatment. The prevention and treatment strategies often utilize a combined pharmacological approach and target the receptors located in the chemoreceptor trigger zone and periphery. Cancer rehabilitation includes vigilant monitoring for GI complications of cancer. GI complications resulting from cancer treatment are variable in presentation and often multifactorial. Proper diagnosis of treatment related symptoms and more serious sequelae are imperative.
This chapter provides a brief description on evaluation and treatment of lung and bronchus cancer. An estimated 234,030 cases of lung cancer will occur in 2018, accompanied by an estimated 155,870 deaths from the disease. Lung cancer is the second most common cancer in men and women but is the leading cause of cancer mortality in both. This chapter discusses epidemiology, pathology, screening, diagnosis, and prevention of lung cancer. Paraneoplastic syndromes are a combination of symptoms produced by substances formed by the tumor or produced by the body in response to the tumor. Lung carcinoma is a pathologically heterogeneous tumor. The most important distinction is between small cell carcinoma and non-small cell carcinoma. Treatment for early-stage disease usually involves one or more modalities of treatment, which include surgery, chemotherapy, and radiation therapy. Patients with advanced disease are treated with chemotherapy, immunotherapy, or targeted therapy.