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Radio Therapy Syllabus of TNPSC

Updated on: Feb 26, 2013
Radio Therapy - (Code - 130)
Paper I
Paper II


Paper - I

I. Cancer Biology
Cell Cycle
Growth of human tumours
Polypeptide and neuropeptide growth factors
Chemical Carcinogenesis
Chromosomes and cancer- Chromosomal abnormalities -myeloid leukaemia,malignant diseases affecting lymphocytes.
Physical Carcinogenesis- Ionizing radiation-Ionizing radiation and Cancer - Physical factors-Ultraviolet radiation and Carcinogenesis.
Genetics and familial Cancer
Pathogenesis of metastasis (Mechamisml)
Tumour Immunology- Tumour Associated Antigens, immuno Competence and Human Cancer.
II. Cancer Epidemology ; Aetiology and prevention of Cancer
Cell and Molecular Mechanisms with Chemical Carcinogenesis
viral Carcinogenesis
Cellular andMolecular mechanisms in radiation Carcinogenesis
Cancer Registry organaisation and function
Prospects for tumour chemoprevention
Practical application of new Cancer genetics
Evaluation of Screening for Cancer
Cancer Epidemiology and prevention
III Diagnostic and Investigative Procedure
Histopathological Classificationand typing of solid tumours
New techniques on pathology and their application in diagnosis and studies of tumour biology.
Cytology
Clinical approaches to pre Cancerous states.
Role of radiological imaging
Positron Emission Tomography
Magnetic resonance in Oncology.
Interventional Radiology- Percutaneous Tissue sampling
Ultrasonic scanning
IV Specialised Techniques of diagnosis
Endoscopy - Peritoneoscopy -Colonoscopy- Oesophaposcopy- UGI endoscopy -Bronchoscopy- Mediastinoscopy -Thoracoscopy- Intra Operative Scopy
V Tumour Markers

VI Nuclear Medicine Procedure

VII Principles of Surgical Oncology
Role of surgery in Prevention Diagnosis and treatment of Cancer.
VIII Principles of Radiation Therapy - Physical Considerations:-

A. Electromagnetic radiation
Roentgen
Gamma
B. Radiation Techniques
Teletherapy ( Including conformational Therapy)
Brachy Therapy
a. interstitial
b. intracavitary
IX Beam Modifying devices

X Biologic Considerations - Interaction of radiation with Biologic Materials, Cell Survival considerations. Survival Curves, Repair of Radiation damage, Oxygen Enhancement ratio (OER) Variation of radiation response during the division cycle Linear energy transfer Relative biologic Effectiveness Adverse effects of radiation Acute and late Normal Tissue Effects. Fractionation Definition of Radio sensitivity, Radio responsiveness Radiocurability Total Body radiation Hemi Body irradiation Intra operative radiotherapy Particle radio therapy Targeted radio therapy

MEDICAL PHYSICS RELATED TO RADIATION ONCOLOGY
Basic concepts - Units - Fundamental units - derived units - Electrical units - Atoms - Nucleus - Atomic Number - Mass numbers - Isotopes - Nuclear Structure - Binding Energy levels - Electromagnetic radiation - Radiation energy from an atom.
Nuclear Physics - Radioactivity - Units of activity - decay - Half life - Transfermation Constant-Disintegration - Electron Capture - Internal Conversion - Fission - fusion-NuclearReactors-ActivationofIsotopes.
Interaction of radiation with matter - Absorption of Energy linear Attenuation co-efficient-Half value layer - Mass, electronic and atomic attenuation co-efficient-energy transfer and absorption - Photoelectric absorption Compton Scattering-Pairproduction-Total attenuationco-efficient-relative importance of different types interaction - Photon interaction (ii) particle interaction- Electron interaction -Ionisational losses- Bremsstrahlung losses - Range of electrons - LET particles in Radiotherapy.
Production of Xrays
High Energy machines-Isotope Machines - 60Cobalt unit sources Housing- Beam Commission- Penumbra- 137 Caesium- Betatron- Linear Accelarator- Microtron.
Radiation Dosimetry
Beam therapy - Phantoms - % Depth dose- Tissue air- ratio- Back-Scatter factor-Tissue Phantom ratio-isodose Curves- Comparision of Isodose curves of 60 Cobalt with high energy beam- Wedge filters-integraldose - choice of radiation beam.
Treatment Planning - patient dose calculation -Treatment time calculation - SSA and SAD techniques -Body Contours - Contours-Corrections for tissue in homogenities - Corrections for Surface Obliqueties-Tissue Compensators. Dose distribution -Opposing pairs of Beams-Three field Techniques -Rotation therapy-Wedge pairs Open and Wedge field Combination. Preparation of Mould- Shielding blocks-Styrofoam cutting machines-simulator and its applications - role of CT and ultrasound in planning.
Brachy therapy Sources- Radium 226, Caesium 137, Cobalt 60. Iridium 192, gold 198, Iodine 125, - Physical Characteristics, Production Storage and Transport facility.

Implant technique- types of implant- paterson parker system- Paterson parker tables-Determination of implant area - radio graphic examination of implant - Orthogonal imaging method- Stereo shift method-After loading techniques iridium 192, implant- permanent implant Examples of dose calculation.

Intracavitary paris technique-stockholm techniques, Manchester technique-Dose specification - Point A and Point B- Loading arrangement -Applications- Manual after loading system - computer dosemetry, Examples of dose calculation - Recent developments in Brachy therapy.
Radiation Protection Biologic Effect of radiation - Somatic and genetic effects, intermediate and late effects - evaluation of radiation hazards - personnel monitoring - films badge pocket dosi meter - TLD - Area monitoring survey meter - survey procedure - Quality assurance in radiotherapy . Maxiamum permissible dose - Radiation Protection rules in India - ICRP reconmmendation - Dose equalent limits - Quality factor.

Planning of radiotherapy department - workload - Occupancy and use factor - Protection from primaruy radiation and leakage radiation and scattered ratiation - Design consideration for accelarator facility. Guideline for safe work and recent development in radiation protection.
TOTAL BODY IRRADIATION - ACUTE EFFECTS - Prodromal radiation synxdrome Central nervous system cardiovascular syndrome - Gastro - intestinal syndraome, hematopoietic syndrome - Mean Lethal dose - Treatment of radition accidents.

LATE EFFECTS - Non specific life shortening

CARCINOGENESIS - Latent period - Dose Response curve in animals - leukaemia - Breast cancer - Thyroid cancer - Bone cancer - skin cancer - lung cancer - other tumours - malignancies in prenatally exposed children. Mechanisms of radiation carcinogenesis.

RADIATION EFFECTS IN THE DEVELOPING EMBRYO AND FETUS - Intrauterine death - congenital abnormalities including neonatal death - growth retardation - Dependence of the above facts on gestation stage, dose, dose-rate. - Carcinogenesis followings in utero exposure. - Pregnant women exposed to therapeutic doses - Occupational exposure of potentially pregnant women. - Elective booking of 10 day rule. - Practical threshold for theraeutic abortion. Effects of radiation on the skin , on Bones & Cartilage , On Kidneys.

Principles of Chemotherapy
General aspects of Chemotherapy
New Drug
developments
Antimetabolites
Alkylating agents
Anti tumour antibiotics
Plant alkaloids
Cis Platin and analogues
New and Miscellaneous anti Cancer drugsNew and Miscellaneous anti Cancer drugs
Drug resistance
High dose Chemotherapy and Autologous, bone marrow rescue
Clinical Uses of Haematopoitic growth factors
Basis of Harmonal therapy of Cancer
Combined Chemotherapy and radiotherapy
Hyperthermia, Photodyanamic therapy, Lasers In Oncology

Paper - II

I Cancer of the Head and Neck - Epidemiology, Anatomy Pathology, Natural history, Methods and diagnosis treatment, principle of Treatment , General principles of Surgery radiation therapy, Chemotherapy and Combined Modalities Oral Cavity, Oropharynx, larynx, Hypopharynx, Nasopharynx, Nasal Cavity, Nasal vestibule, Paranasal sinuses, Major and minor salivary Glands. Tumours of external auditory meatus and middle ear. Uncommon Tumours of Head and Neck.Management of Cervical nodes Skin Cancers other than Melanoma Cutaneous melanoma Eye and OrbitChemotherapy with radiotherapy and or sugery

II Carcinoma lung - Pathology, Natural History, Screening studies for early diagnosis staging Surgery or Radiotherapy, Curative intention. Radiotherapy Treatment - Non small cell lung Cancer.Small Cell Carcinoma lung. Mesothelioma Thymic Tumours with Myasthenia Gravis/ Bone Marrow Dyscrasias Other ThymicTumours Neurogenic tumour, Mesenchymal Tumours Sugery- Pulmonary Metastases Uncommon intathoracic tumours.

III Cancer of Oesophagus - Epidemiology Oetiology, Pathalogy, Pathalogic variants Anatomic considerations of Clinical significant Squamous Cell Carcinoma of Oesophagus Adeno Carcinoma of Oesophagus. Cancer Stomach Pathalogy , anatomic Relationships of Stomach Natural History Clinica presentation staging, Prognosis, Diagnosis and Treatment Cancer of Pancreas Cancer Hepatobiliary system Cancer of the small Intestines Colo-rectal Cancer Treatment of rectal Cancers- Special problems in Management Diagnosis of recurrent Colorectal Cancers Cancer of Anal regionEpidemiology- Anatomy, Pathology, Natural History, Diagnosis - Assessment of prognosis-Staging-Treatment Cancer of Kidney and Ureters Renal AdenoCarcinoma - Chemotherapy of Hyper Nephroma,- Carcinoma of Renal Pelvis- Carcinoma of Ureters Cancer of the BladderEpidemiology, Pathology - Clinical Presentation, Staging- Treatment.

IV Cancer of the Prostate - Epidemiology, Anatomy, History, and rpoutes of spread- Pathology- Clinical Features- Staging- prognostic factors - radiotherapy - survival- Sequelae of Radio therapy and Surgery - Hormonal Therapy - Chemotherapy

V Carcinoma Urethra and Penis - Carcinoma Penis - Carcinoma of Female and Male Urethra

VI Cancer of Testes - Anatomy - Etiology, Histology, Physical diagnosis, lab investigation, Staging (Radio graphic Investigation ) - Surgery - Seminoma - Non Seminomatous tumours - Radio therapy following Surgery - Adjuvant Chemotherapy - CNS Metastases - chemotherapy of disseminated diseases

VII Carcinoma Cervix - Epidemiology, Staging, pathology, diagnosis staging- Treatment of Carcinoma Cervix (Surgery, Radiotherapy, Chemotherapy)
- Carcinoma Cervix and Pregnancy
- Carcinoma of Cervical Stump
- Carcinoma of endometrium
- Carcinoma of Vagina, Vulva
- Trophoblastic Tumours

VIII Cancer of the Ovary - Epidemiology pathogenesis - pathology, Diagnosis, Staging - Stromal and Germ Cell tumours- management of mInimal residual disease after surgery - management of Stromal and Germinal ovarian Tumours Cancer of Endocrine Glands Thyroid Glands, Adrenal Glands, Endocrine pancreas, Carcinoid, tumours, Multiple endocrine Neoplasia syndromes.

IX Soft Tissue Sarcoma - Incidence Epidemiology, sites, pathologic classification, Benign and Malignant Tumours, Diagnosis, Staging, Unique features of individual Histologic types of Soft tissue Sarcoma- Treatment.

X Sarcomas of Bone - Classification and types of Bone Tumours, Radiographic Evaluation and diagnosis- staging- pre operative, evaluation and Biopsy considerations - Surgical Management of Skeletal tumours - Benign and Malignant Bone Tumours- Variants of Classic Osteo Sarcoma - Chondro sarcoma- Giant Cell Tumour of Bone- Malignant fibrous, Histio Cytoma- Fibrosarcoma of Bone- Chordoma- Small round Cell Sarcomas of Bone- principles of Radio therapy

XI Central Nervous System - Epidemiology, - Anatomy - Pathology- Treatment

XII Solid Tumours of Childhood - Etiology- Anatomy- Pathology, Staging and Treatment of Tumours of infants and Children (Wilm's Tumour, Neuroblastoma, Retinoblastoma, primary Hepatic Tumours, Germ Cell Tumours, Histiocytosis X syndromes

XIII Tumours of Children and Adults - Rhabdomyo Sarcoma Ewing's Sarcoma, Gynaecologic Tumours Carcinomas.

XIV Leukaemias & Lymphomas of childhood - Epidemiology - etiology - All, AML, CML, NHL, Burkitt's lymphomas, Hodgkin's diseases.

XV HODGKIN'S & NHL - Etiology, epidemiology, Microscopic anatomy of normal lymphoid tissues - cellular orign - Disease diagnosis, and staging of lymphomas - chemotherapy of NHL - Single agent Chemothraphy for NHL - place of rt in NHL - Combination chemotheraphy for NHL. ALL Etiology, morphology, pathology, Diagnosis, and treatment.
CLL Etology, Pathology, Diagnosis and treatment.

XVI PLASMA CELL NEOPLASM - History , Incidence, pathogenesis, Anatomic consideration, pathology dignasis, Investigication and staging screening , different diagnosis, treatment, Special probelm, Survival and causco of death, special syndromes - Future consideration.

XVII PARANEOPLASTIC SYNDROMES - Etiology, pathogenesis, endocrinologic manifestations of malignancy, neurologic mainfestations, haematologic manifestations, anaemia associated with cancer, thrombocytosis associated with cancer, unexplained thrombocytopenia in cancer, hypercaogulable state with cancer , renal manifestation in cancer paraneoplastic lesions involving the skin, gastro - intestinal paraneoplastic syndromes, miscellaneas Paraneoplastic syndromes.

XVIII CANCER OF THE UNKOWN PRIMARY SITE - Definition- Diagnostic - evaluation - Historical approach - basic screening studies - specific studies treatment.

XIX ONCOLOGIC EMERGENCIES
Superior venacava syndrome
Central Nervous system emergensies spinal cord compression, investigation, treatment, prognosis
Metabolic emergensies Hypercalcaemia, Hyperuraecemia, tumour lysis syndrome, lactic acidosis, adrenal failure
surgical emergencies General aspect - inflmmatory lesion - obstructive disease - haemorrhage - post operative
XX ABDOMINAL PROBELMS - Urologic emergencies Hematuria, obstructive uropathy

SUPPORTIVE CARE OF CANCER PATIENT
Nutritional Support - Etiology of malnutrition,indication of nutritional support,indication for parenteral nutrition - justification for nutritional support - therapeutic traial and efficacy.
Use of blood and blood products.
Management Of Cancer Pain - Epidemiology, types of cancer pain, clinical assessment of pain,management of cancer pain.
Adverse effects of treatment
Hair loss
nausea and vomiting
Oral complication of radiation therapy and chemotheraphy
cardiac and pulmonary toxicity
Gonadal dysfunction due to chemothrapy and radio threaphy
Second cancers (after radiation, chemothearapy and host factors) Special care of terminally ill patients
Treatment of metabolic disease - Brain, lung, liver, bone, malignant pleural effusion, malignant pericardial effusions, malignant ascites.

Rehabilitation of cancer patient.
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