SD0000021 SUDAN UNIVERSITY OF SCIENCES A complementary project for B.Sc. degree in Radiation Therapy Technology THE AFFECT OF MEASUREMENT OF ANGLES AND DlAMENTION : : IN • THE TREATMENT OF CARCINOMA OF THE BREAST USING COBALT-60 TEL-THERAPY MACHINE SUPPERVISEDBY: Mr. Mohamed El Fadil Department of Radiation therapy Technology College of Medical Radiological Sciences PERPARED BY: Saeed Mohamed Ibrahim Bafarag Fourth Year (Therapy Section) 31-18 I dedicate this research to the staff of radiotherapy who help and assistant me to succeed and fullfil what I hope to do, Also I pay my own thanks to everyone who apply help to me particularly MR MOHAMED EL FADIL whose played a major role in building and formation of this issue. Contents: Chapter One: Research plan 1 Chapter Two: Anatomy of the breast 7 Physiology of the breast 23 Pathology of the breast 25 Etiology of the breast . 28 Planning of the breast 34 TN pre 'treatment clinical classification 38 Evaluation of treatment 52 Chapter Three: Data Presentation 55 Chapter Four: Analysis and result 81 Chapter Five: Conclusion and recomendation 97 Reference 99 Index . loo Chapter One First topic: ResQarch plan Title: Measurement of dimensions and angles and its affect on cancer of breast treatment Preface: Of course cancer is a very harmful word which make people whom attacted by this diseas in bad situation and so their relation. Breast cancer is a common universal tragedy, maligninant and monstrously destructive of women in their prime of life. It is an ancient an elusive diseas which has claimed its many victims throughout the world and form time immemorial. By the way we must know that, the trends which are of major significence from a practical point of view in the present day management of breast cancer are the following: 1- Early diagnosis as a result of public education., mammography, sonography, nuclear magretic resonance, self examination technique and other reliable methodes of cancer delection. 2- Pathologic recognition of minimal and very early (subclinical) breast cancer, 3- Trend tov/ard more concerative breast surgeny combined with effective radiotherapy. 4- Chemotherapy as an adjuvant to surgery and radiotherapy in the treatment of primary breast cancer improved programs for post operative care and rehabilitation. (1) Problem: of the study: Breast cancer is the most common famale malignancy of midlife and is aleading cause of death amongwomen, that makes it a subject of considerable interest to all concerned. It is the commenest disease which can be detected early by women, so that can improved treatment methodes such as advances in surgery, radiotherapy, chemotherapy, immunetherapy and hormonetherapy as well as prognosis and rehabilitation. This research give an information about the experience of the RICK* IN treatment and control of cancer of the breast, Inaddition to that it trys to found an answer and result for the following tobies: - Evaluation of ca breast* treatment in RICK during year 1989. - To find out the important of demareation the ideal angle of tangential field. - To find out the important of dimensions of treatment region. •5 - To find out the danger of missing the wright angle and distance durina treatment the tangest field. * Satiation i Isotop centre of Khartoum * Cancer of breast . (2) .Reasons of problem selection: - Because of heinous of cancer of the breast and its greates damage in human society, in addition to:- 1- Increment of the cancer of breast among Sudanease women. 2- Increment of recurrence among Ca. breast patients. 3~ Carelessness of fields angles and diamention in treatment sheet. 4- Defferential in tangential field treatmed because of dependence in breast shadow sitvation. All the previous points and others motivate me to cast round for the importance of demarcation angles and dimension in treatment cancer of the breast and to find out its connection with the result of treatment as a fact of success or goff at half cock of the treatment and I have left the other factors as an odds for others studies. Aim of the study: The hypothesis which I put it on for this study is that, the use of worg angles and dimension of tangential fields in the treatment of Ca breast lead to; 1- Eccentricity in the entrance and exit of beam. 2~ Missing of homogenous distribution of the radiation in the treatment volume. 3~ Un neccessary irradiation for accessory tissue which may induced certian problem. 4- Increment the possibilities of recurrent, Objective of the study: To clear out the importance od demarcation the ideal angles of the tangestial field, To show the necessity of measuring the requA-r-emnt dimension. To test out type of the problem arising from the absence of angles demarcation in the treatment sheet. (3) Previous studies: 1- Ca. Breast & self examination techniques Aims and objective of the study: - To find out the ratio of incidence in Sudan and other contries. -Give a general idea about anatomy and physiolog of the breast. - Build a certain mechanism for self examination. Study assumption: The absence of self examination practice lead to late detection of the disease. Results: Complete absence of self examination technique practice duto the absence of health education. Un pleasent feeling caused by the result of detection the disease. 2. Care of cancer's patient; Aims and objective of the study: To study the care of patient and the psychology of cancer's patient in RICK and the treatment circle which he came across it and his reception in virous units and how to face sign, symbtom and complication, in addition to the relation ship between the team work and the patient. Result; There is no a certain system for care of cancer's patient. (4) Different between this study and others;- In this study I aw trying to find the relation between non ideal angles and dimansions in the treatment of Ca. breast and outcame of the treatment. Research Methodology: Resources of information:- From information available sources:- - Text books & reference. - Specialist in the field. - Technician/Technologist. - Observation. Location of research: Radiation and Isotope centre of Khartoum (RICK) where ionizing radiation is used to treat cancers. Period of research: Four monthes from September 1995 to December 1995. Sampling: The method of sampling is the random method, that means ages of the patients, social status and level of education are different of the different cases. Second topic: Articles of Knowlege Gathering: I have followed the following steps: 1- Observation: Of course I have used scientific observation in which I followed the behaviour of treatment patient in the treatment room in RICK and during this I registered the angles of tangential field which occure duto the shadow of the breast and variety appear clearly between this one and the ideal one later on. (5) 2- Interview: It is an oral talk between two person in confrontation manner where the interview tries to extractsome information or gestures from the person whom the regearch is concerning. In this research I used open interview by preparing questions, 3- Avialable resources: These include all text books., reference journals .... etc. Research dividing: Chapter One: First topic- Research plan Second topic: Articles of knowlege gathering Chapter two: Literature Review Chapter three: Presentation of data Chapter Four: Data analysis and result Chapter Five: Conclusion and recomendation Reference Index (6) Chapter Two Anatomy of the Breast J*) Form: The human breast has adistinctive and unique protuberant concial form. This conical form is most marked in younger nulliparovs women with advancing age the breast usually become some what flattened and pendulous and less firm. Obesity is the most important factorconcerned with variation in the size, shape and density of the breasts. As women gain weight their breasts become more massive and pendulous. They become so firm and dense that it is much more difficult to detect disease in examining them. Extent: The upper edge of the protuberant breast is usully at the level of the second or third rib and its lower edge is at the level of the sixth or seventh costal cartillage. Medial border is at the edge of the sternum. Lateral border at the anterior axillary line. The actval extent of the mamary tissue is considerably greater. It is spread out as a thin layer that often reaches the lower edge of the clavicle above. The mid line of the sternum medially and the anterior edge of the latissimus dorsi muscle laterally. The upper outer sector contains more breast tissue than the remainder of the breast. The mamary tissue is also extends into the axilla to avariable degree. Size: There is some different in the size of the two breasts. If it is slight it may not be have been noticed by the women because she does not have as good a view of her breasts as a care full examiner. (*) C.D. Haagensen, M.D - Diseas of the Breast -P. (1-2) - Third edition - WB; Saunders Company, Philadephia London Turanto - Mexico City Rioclejaneiro Sydney - Tokyo Hong Kong. (7) Anomalies!*): Abnormal in form or number or position or the absence of normal breast, should be classified as anomalous. Differences in size of entirelly normal breasts or extention of breast tissue into the axilla or so frequant that they can hardly be classified as anomalies. The anomalies of the human breast include the following:- - absences of the breast - rudimentary - definitely abnormal - accessory breasts or nipples. The absence or in complete development of breast is the result of complete or imperfect suppression of the breast anlagen in the embryo. Accessory breast or nupple represent reversion to a mor primitive type of mammary arrangement in which more than a single pair of breast anlagen persist, Amastia(*) Complete absence of one or both breast.