9-26a Cancer Flashcards
What is cancer?
Rapid uncontrollable growth of cells
Define neoplasm
(tumor) new tissue growth
spectrum of disease characterized by abnormal growth of cells resulting in distorted tissue architecture
What is a malignant tumor?
cancerous tumor
capable of invasion and spread (metastasis)
fast growing
invasive
anaplastic, undifferentiated, immature cells
What is a benign tumor?
non-cancerous growth
non-invasive, do not spread, slow growing, encapsulated, well-differentiated cells
What is the classification system for a tumor?
Malignant or Benign
Tissue of origin and anatomic location
Define dysplastic
abnormal cells that are not cancerous – often precursor to cancerous lesions
Define in situ
neoplasm that has not invaded adjacent structures
How would you classify a benign and malignant tumor of epithelial tissue (skin, glands, GI, reproductive?)
Benign: Adenoma
Malignant: Carcinoma
How would you classify a benign and malignant tumor of connective tissue? (bone, fat, muscle, cartilage)
Benign: tissue type + “oma”
Malignant: sarcoma
How would you classify a benign and malignant tumor of connective tissue? (bone, fat, muscle, cartilage)
Benign: tissue type + “oma”
Malignant: sarcoma
Benign tumor of fat cells
lipoma
Malignant Tumor of squamous cells
squamous cell carcinoma
Malignant tumor of basal cells
basal cell carcinoma
Malignant tumor of breast glandular cells
breast adenocarcinoma
Benign tumor of bone
Malignant tumor of bone
osteoma
osteosarcoma
What are the most common cancers for men? women?
Males: prostate, lung, colorectal
Females: breast, lung, colorectal
what are the necessary components of cell growth?
Recognize DNA damage or errors in replication
Activate checkpoints to stop further/unnecessary replication
Implement corrective measures or induce apoptosis
What are the reasons for loss of control of cell growth?
Genetic
Epigenetic
Abnormal signaling
What is epigenetic?
Chronic inflammation from environment activating genetic predisposition (obesity, smoking, hormones)
What does abnormal signaling consist of in general?
□ Positive and negative feedback for cell growth
Signaling could be from overactivation of ras pathway
What is the most common genetic and epigenetic factors that can lead to tumor formation?
inactivation of tumor suppressor genes (most common)
activation of genetic oncogenes
What genetic and epigenetic factors can lead to tumor formation?
inactivation of tumor suppressor genes (most common)
activation of genetic oncogenes
role of viruses (HPV)
What are abnormal signaling factors that can lead to tumor formation?
hormone effect (hormone replacement therapy) angiogenesis: process where blood vessels form in the new tumor; involves increased proliferation of VEGF
What are the hallmarks of malignant tumors?
Proliferation: grow and divide faster than healthy cells
Invasion: via basement membrane to nearby CT
Metastatic potential: angiogenesis where cells are seeding into the blood stream and travelling and depositing to distant organs
In general, what are common sites of metastases?
bone, liver, brain, lung (and adrenal glands)
What are cancer risk factors?
Weight Genetics Environmental exposures Viruses/prior infections Immunocompromised state Tobacco Nutrition Physical Activity Alcohol Excess sun exposure
What does a diagnosis of cancer involve?
Screening
Genetic testing
Diagnostic imaging
CT, MRI, whole-body PET-CT, etc.
Clinical manifestations/symptoms and systemic effects
Ultimately need biopsy for tissue sample to confirm
At what age should people get colonoscopies? mammograms? pap smear? lung? prostate
50 40-50 21 55 with greater than 30 pack year removal of recommendation, if needed at 50
What are signs and warnings of cancer?
Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharged Thickening or lump (in breast or elsewhere) Inability to swallow food easily Obvious change in a wart or mole Nagging cough or hoarseness Unexplained weight loss Loss of appetite Weakness and fatigue Anemia Pain Organ-specific
What are organ specific warnings of cancer?
Liver: jaundice, ascites Lung: dyspnea, cough Bone: fractures, pain Brain: confusion, loss of coordination Breast: nipple discharge, skin changes Colon: constipation
What is grading of cancer? What are the grades?
how abnormal is the cell?
1: almost normal, well-differentiated
3-5: so undifferentiated and anaplastic, hard to recognize cell of origin
What is staging for cancer?
tumor (size and degree of local invasion), nodes (regional lymph nodes affected), and metastases (TNM) system
0-3 roughly
What are some cancer treatments?
hormone therapy, surgery, bone marrow transplant, chemotherapy, targeted therapy, radiation therapy, immunotherapy
What can we treat for?
curative intent: (5 year disease-free survival)
palliative: improve symptom burden and QOL
Hospice: expected <6 months
PT is an option for all of these phases (gain strength for treatment or home hospice)
What are the roles of PT and cancer?
Prevention, Detection, and Treatment
How does PT prevent cancer?
Anti-inflammatory benefits of physical activity/exercise
Promotion of healthy lifestyle
How does PT detect cancer?
Skin checks
Identification of CAUTION symptoms or concerning pain patterns
How does PT treat cancer?
Quality of life and psychosocial effects (Improved compliance with treatment)
Functional status/ability to receive treatment (Cardiovascular, metabolic and immune function)
patients need an ECOG of 0-2 for chemo
Anti-inflammatory benefits (Improved survival in physically active patients)
What cancer comorbities can PT help treat?
Post-operative deconditioning and mobility
Cancer-related fatigue
Chemotherapy-related cognitive impairment
Lymphedema
Radiation Fibrosis
What are some precautions PT should take when working with patients with cancer? When is it emergent? When is it urgent?
Emergent:
Sudden onset or worsening shortness of breath
Sudden onset of lower extremity/calf swelling or pain
Sudden worsening muscle weakness or neurologic deficit
Unstable vital signs
Urgent: Increase or change in pain New palpable mass Worsening or new lymphedema Worsening mental status Change in continence
