Eyad Alsaeed , MD,FRCPCConsultant Radiation OncologyPSHOCKFMC

HistoryPhysical Examination

PathologyGenetics

Tumor MarkersRadiological imaging

Blood work

History of present illnessPast Hx (Past Cancer,Sx,CTx,Rx)

Contra indications of radiationFamily history

Gynacological historySocial history

CancerSymptoms

CNSHA,Motor & Sensor dysfunction,Seizure,cognitive dysfunction,Ataxia,gait

BreastLump, Nipple discharge, Axillary lump

LungChest pain, cough, Haemoptysis, SOB

ColorectalPain, constipation, Diarrhea, Bleeding

GastricPain, Haematemesis, Vomitting

EsophagusDysphagia, odynophagai, cough

cervixVaginal bleeding, pain ,

Nasopharynx

Hearing loss, Neck mass, nasal obstruction, Epistaxis

larynx Hoarseness, Sore throat, Otalgia, pain,SOB,

BladderHaematuria, dysuria, Urgency

Lymphoma

Lump, fatigue, Itching (B symptoms, Fever, Weight loss, sweating)

General ( weight , vital sign , appearance , skin, sign of anaemia )

Lymphatic systemBreast

Respiratory systemCVS

GYN systemRECTAL

CNSHead & Neck

CBCCa , Mg , Ph , .. ) ) Eletrolyte

RFT LFT

HormonesVirology Titer

Tumor MarkerPrimary TumorOther TumorsBenign conditions

AFPHepatocellular Carcenoma, nonseminomatous germ cell tumors(Yolk sac tumorsand embryonal cell carcinoma)

Gastric, biliary, and pancreatic

Cirrhosis, Viral hepatitis , pregnancy

B-2Microglobulin

Multiple myeloma

Other B Cell neoplasms, lung, hepatoma, breast

Ankylosing spondylitis, Reiters syndrome

CA125ovarianEndometrial, Fallopian tube, breast, lung, esophageal, gastric, hepatic, pancreatic

Menstruation, pregnancy, fibroid, ovarian cysts, pelvic inflammation, cirrhosis, ascites, pleural, and pericardial effusions, endometriosis

CA15-3BreastOvary, lung, prostate

Benign breast or ovarian disease, endometriosis, pelvic inflammatory disease , hepatitis, pregnancy , lactation

CA19-9Pancreatic, biliary tract

Colon, esophageal, hepatic

Pancreatitis, biliary disease, cirrhosis

CA27.29BreastColon, gastric, hepatic, lung, pancreatic, ovarian, prostate

Breast, liver, kidney disorders, ovarian cysts

CalcitoninMedullaryThyroid

Metastatic breast, lung, pancreas, hepatoma, renal cell, carcinoid

Zollinger-Ellision syndrome, pernicious anemia,chronic renal failure,cirrhosis, paget’s disease , pregnancy, benign breast or ovarian diseas

CEAcolorectalBreast, lung, gastric, pancreatic, bladder, medullary thiroid , head and neck, cervical, hepatic , lymphoma, melanoma

Smoking, peptic ulcer disease, inflammatory bowel disease , pncreatitis, hypothyroidism, cirrhosis, biliary obstruction

Gamma globulin

Multiple myeloma, macroglobulineemia

LeukemiaChronic infections, hepatic disease, autoimmune disease , collagen disease

Neuron-specific enolase

NeuroblastomaSmall cell lung cancer

Wilms’ tumor, melanoma, thyroid, kidney, testicle, pancreas

Prostatic acid phosphatase

prostateTesticular, leukemia, non-hodgkin’s lymphoma

Paget’s disease , osteoporosis, cirrhosis, pulmonary, embolism, hyperparathyroidism

PSAprostatenoneProstatitis, BPH, prostate trauma, after ejaculation

ThyroglobulinDifferentiated thyroid cancer (not medullary )

Hyperthyroidism, subacute thyroiditis, benign adenoma

B-HCGNon- seminomatous germ cell tumors ( embryonal cell carcinoma , choriocarcinoma) gestational, trophoblastic disease

Rarely, gastrointestinal tumors, seminoma

(occasional minimal)

Hypogonadal statesMarijuana use

Chromosomal changesHuman cancer

Deletion (1), Gene amplificationNeuroblastoma

Translocation (1-8) , (8-22)Burkitt’s lymphoma

Deletion (5)Acute nonlymphocytic Leukemia

Deletion (11)Sarcoma

Translocation (8-14)B-Cell Lymphoma

Translocation (3-8)Parotid Cancer

Translocation (6-14)Carcinoma

Gene amplificationBreast Cancer

a = anterior cerebral artery m = middle cerebral artery fh = frontal horn - lateral ventricleph = posterior horn - lateral ventriclecc = corpus callosum

lp = lateral pterygoid musclem = masseter musclet = temporalis muscle

p = prevertebral musclemx = maxillary sinus

h = hyoid bonesm = submandibular gland

s = sternocleidomastoid musclec = internal carotid artery

j = internal jugular veinv = valleculae = epiglottis

arrow = platysma muscle

1 = descending aorta 2 =right lower lobe bronchus3 = left lower lobe bronchus 4 = root of aorta

5 = pulmonary outflow 6 = right atrium 7 = left atrium 8 = right pulmonary vein

1 = left lobe of liver2 = fissure for the

ligamentum venosum3 = quadrate lobe of liver

4 = right lobe of liver5 = inferior vena cava

6 = aorta7 = stomach

8 = spleen

1 = prostate 2 = rectum 3 = obturator internus 4 = ischium5 = body of pubis6.= pubic symphysis7 = femoral artery8 = femoral vein

6 cm right posterior parietal lesion

Irregular margins, infiltrating tumour

Rim-enhancing, central necrosis

Mass effect / edemaBeware corpus

callosum involvement

24

81 yo female with headache,

confusion, ? History of fever

referred for radiation without

biopsylabelled WBC scan+ diagnosis = abscessresected/drained -

well 2 years later

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