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Bladder Cancer - Coggle Diagram
Bladder Cancer
CT simulation
Supine
Knee cushion and ankle stock/footfix
Empty Bladder
No fluids 30 mins prior
IV contrast
L3/L4 to 5cm below ischial tuberosities
Hand on chest
Psychosocial Effect
Erectile Dysfunction
Ostomy bag - feeling disfigured, affect sexual function
Vaginal dryness/tightening - pain during sex
Fear of reoccurence
Money issues - having to take time off work
Transport issues
Increased need for family/peer support
Dose and fractionation
52.2- 55Gy/20# over 4 weeks
60-64Gy / 30-32# over 6-6.5 weeks
Palliative: 21Gy/3# OR 30-36Gy/5-6#
Toxicities
Late
Cystitis
Sexual dysfunction
Urinary Incontinence
Bladder or rectal fistulae
Radiation Induced small bowel obstruction (rare)
Secondary Malignancy
Acute
Noturia
Increased urinary frequency and urgency
Fatigue
Cystitis
Dysuria
Retention
Rectal urgency
Bleeding
Proctitis
Chemotherapy
Nausea and vomiting
Hairloss
Loss of appetite
Increased risk of infection
Mouth sores
Site Specific Issues
Bladder filling and daily variability
Patient's hydration levels may vary on chemo days
Rectal content may cause artifact
Treatment verification imaging
CBCT as minimum for first 3# to identify and correct for systematic errors (offline protocol)
Daily CBCT is reccomended