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:

10.

Staging/Grading:

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Knowledge Assessment

Benkovich 2

Stage

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. Removes the tumor so that it
does not cause any more harm.
Used for invasive cancers. Removes the
entire bladder and nearby lymph nodes
to prevent spread of the cancer.
Used if the cancer is not very large.
Removes only a portion of the bladder,
Knowledge Assessment

Benkovich 3

Urinary
Diversion

so the bladder can still be functional.

Done in the event the entire bladder is
removed. Provides a way for the urine to
leave the body.

Cryo surgery
Laser surgery
Radiation
Therapy

Y
Photons
10MV or
greater

Can be used alone or with surgery and/or

chemotherapy. Used to shrink tumor
before surgery or used to kill any
remaining cancer cells after surgery.

Electrons
Chemothera Y
py
Intravesical

Systemic

Used for stage 0 or stage 1 cancers.

Limits the unwanted side effects by
keeping the drugs from spreading
throughout the body.
Can attack cancer cells that have already
spread from the bladder.

Brachythera Y
py
HDR
LDR
Interstitial

Source
Source
Used for T1-T3a lesions less than 5cm.
Small dose of radiation put directly into
the cancer. Can limit some of the side
effects of external radiation therapy such
as skin irritation.

Bacillus
CalmetteGuerin(BCG)

Used in treating low-stage cancer.

Causes the immune cells to be attracted
to the bladder and activated by the BCG,
which then affects the bladder cancer
cells.

Immunother Y
apy

11.Treatment and Rationale: Surgery, Radiation Therapy,

Chemotherapy, Brachytherapy (HDR, LDR, Interstitial) and
Immunotherapy.

12.
Typical Patient Position and Rationale, describe two ways and
include all set-up devices:
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Knowledge Assessment

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. Hands can be folded on upper
abdomen. Bladder must be empty.
If bowels need to be out of field of treatment.

Prone
Lateral
recumbent
Device
Aqua-plast
mask
Vac-loc

Rationale

Can be customized and used to help recreate

initial position. Can be used to immobilize legs or if
patient has orthopnea, can help support upper
body at an angle making it easier to breath.

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 relieve pressure on back while
lying supine.
Can be used with elastic or Velcro around feet to
stabilize hips.
Can be customized and used to help recreate
initial position. Can be used to immobilize legs.

Leg
immobilizer
Alpha Cradle

13.

Beam Angles used and Rationale:

14.

Special Blocking and Rationale:

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Knowledge Assessment

Benkovich 5

Blocking
Blocks
Electron
cutout
Dynamic
MLCs

Rationale

Y To shape the beam and spare healthy tissue while

targeting cancer cells

Other
15.

Accessory Devices and Rationale (ex: wedges, bolus):

Accessory
device
Wedges
Bolus
Electron
cone
Other

16.

Rationale

Calypso- used to monitor prostate in real time while

treatment is being given

Organs at Risk, 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
7,00
0
93

30
cm2
6,00
0
80

100
cm2
5,500

61

60

60

52

52

52

Bladde
r
Rectu
m
Femor
al
head
and
neck

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65

50/5
1/3

50/
5
2/3

50/
5
3/3
100
cm2
7,00
0

Selected Endpoint

Necrosis/ulceration

Symptomatic
contracture, volume loss
Severe
proctitis/necrosis/
stenosis/fistula
necrosis

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Benkovich 6
17.
Treatment Borders, draw a diagram and make a chart
(superior, inferior, anterior, posterior, medial, lateral borders):

Lateral
Border
Superior
Inferior
Anterior
Posterior
AP Border
Superior
Inferior
Medial
Lateral
18.

Details

Radiation Type, Energy, Daily Dose, Re-Eval Dose, Total Dose:

Treatment
Radiation only

Radiation
Type
Photons

Radiation then
surgery

Photons

Radiation,
Surgery and
Chemotherapy

Photons

Ener
gy
6-MV
to
20MV
6-MV
to
20MV
6-MV
to
20MV

Daily
Dose
1.8 Gy

Re-Eval
Dose
45-50 Gy

1.8 Gy

1.8 Gy

Total
Dose
65-70 Gy

45-50 Gy

40 Gy

65 Gy

19.
Dietary Needs, discuss site specific side effects from radiation
therapy:

FOOD TYPE
Meat and
protein

RECOMMENDED

NOT RECOMMENDED

Tender beef chicken and turkey,

Tough or fibrous meat, beans, nuts
boneless fish, eggs, creamy peanut and seeds , crunchy peanut butter
butter, tofu

Stephanie Benkovich

Knowledge Assessment

Benkovich 7
Milk and dairy

Milk(skim, low-fat, buttermilk,

Fruit yogurts with seeds or skins
evaporated, and powdered), yogurt
without seeds or skins, plain
cheese, cottage cheese

Bread, cereal,
rice, pasta

Bagel without seeds or raisins,

refined bread , crackers,
roles(white), English
muffins(white), pasta, noodles,
white rice, cream of rice, cereals
with less than 2 grams of fiber per
serving

Breads/rolls made with whole

grains/seeds/nuts/dried fruits,
whole grain pasta, brown rice,
popcorn, oatmeal, granola, grits,
bran, cereals with more than 2
grams of fiber per serving

Fruit

Cooked or peeled fruit without

seeds, banana, canned fruit, fruit
juices with no pulp, melon

Avocado, berries, dried fruit, jams

with skin or seeds, prune juice,
plum

Vegetables

Very small servings of vegetables

Broccoli, corn, peas, peppers,

potato skins, onions, cabbage

Fats

Margarine, salad oils, butter,

mayonnaise, plain gravys

Fried /greasy food

Desserts/snacks Plain ice cream, sherbets, custard,

pudding , plain cakes/cookies

Oatmeal cookies, ice cream with

coconut or nuts, dried fruit bars,
potato chips

20.
Typical Lab Tests (CBC-state normal blood values and cutoffs),
Frequency, Intervention and Rationale, 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,
Physician must be
notified

To ensure that patient

does not lose or gain
more or less than 5% 10% of their body
weight

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Knowledge Assessment

Benkovich 8

Blood
cell

Erythroc
ytes

Norma Blood
Proble
l
cutoffs
m
Blood
Values
3.8
fatigue
5.2

Leukocyt
es

4.010.0

<2.0

Platelets

150,00
0
300,00
0
37% 47%

<100,0
00

12 - 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,
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.
Surgery Complications

Immunotherapy complications

22.
Typical Side Effects for Radiation Therapy (Acute and Chronic)
and state the Medical Intervention for each. Chemotherapy, what
type of chemotherapy, side effects and Medical Intervention for
each:

Stephanie Benkovich

Knowledge Assessment

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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, take rests

as needed, exercise
Use mild soap, moisturizer, protect from sun,
wear loose clothing, and avoid extreme
temperatures.
Medications such as Procrit or Aranesp, RBC
transfusion
Medications such as Reglan, Compozene or
Zofran
Medications such as Imodium, Kaopectate or
Pepto-Bismol

Loss of appetite

Acute

Medications such as Megace, Reglan, or Marinol

Polyuria

Acute/
chronic

Medications such as Vesicare, 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, such as

Zofran or Reglan, are given before the
infusion, and a prescription is also
given for use after.
Hydration and in severe cases
hemodialysis
Erythropoietin to increase RBC,
Neupogen for WBC, and Neumega for
platlets
Baking soda rinse

Refer to dietician, medications such as

Remeron, Megace or Marinol
Make sure eating and drinking well,
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Benkovich 10

Interferon
alfa

cytokine

Flu like
syndrome

Fatigue
Low Blood
counts

23.

take rests as needed, exercise

Acetaminophen to treat fever and
aches and pains, meperidine or
hydromorphone to stop severe chills,
Megace or Reglan to stimulate
appetite, Zofran for nausea, Lomotil
for diarrhea
Make sure eating and drinking well,
take rests as needed, exercise
Erythropoietin to increase RBC,
Neupogen for WBC, and Neumega for
platelets

Prognosis, List 5-year survival by stage or Grade:

Stage

Relative 5year Survival Rate

0
I
II
III
IV

24.

Prevention:

25.
References:
Portal Design in Radiation Therapy
Principles and Practices of Radiation Therapy
Mosbys Radiation Therapy Study Guide and Exam Review

Stephanie Benkovich

Knowledge Assessment