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Lifespan > Adult Oncology > Flashcards

Adult Oncology Flashcards

1
Q

Three most common cancers in children?

A

leukemia, CNS tumors, lymphoma

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2
Q

Three most common cancers in adults?

A

Breast, prostate, lung

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3
Q

Genetic pathophysiology? (3)

A

Gene mutations
Proto-oncogene vs. Oncogene
Tumor suppressor gene

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4
Q

Gene mutations - vast are? Some?

A

Vast majority are acquired

Some inherited

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5
Q

What’s an oncogene? What suppresses it? What happens in cancer btwn these two?

A
  • gene that causes growth
  • tumor suppressors stop it
  • Nice balance btwn the two in a healthy individual, in cancer you have that either the tumor suppressing gene isn’t working well enough or oncogene is overactive
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6
Q

Modifiable cancer risk factors? (4)

A

Tobacco
Alcohol
Radiation Exposure
Infectious Organisms

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7
Q

Non- Modifiable cancer risk factors? (7)

A 
Gene mutations
Hormones
Immune conditions
Age
Family history
Downs Syndrome
Chemotherapy and radiation
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8
Q

Sequence of errors in cell division that lead to cancer?

A

hyperplasia (bundle of cells) -> dysplasia (bundle of non recognizable cells, atypical and disorganized) -> in situ CA (breaks through the membrane) -> Invasive CA (breaks into circulatory system and can travel anywhere)

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9
Q

What is metastases? Travel how? (2) Not the same as? What is it?

A
  • Cancer cells travel to a remote area
  • Blood vessels
  • Lymph vessels
  • Not the same thing as a second primary: not a cause and effect, just another primary cancer
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10
Q

CA prevention? (5)

A 
Tobacco and alcohol use
Viruses and infection
Sedentary lifestyle 1
UV Exposure
Screening
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11
Q

What is the difference between benign and malignant?

A

All tumors are considered cancers, but it could be malignant (has ability to mestasize) or benign (position or size could be problematic)

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12
Q

CA types and their locations - lymphoma? Sarcoma? Leukemia? Carcinoma?

A
  • immune system
  • connective tissue and bone
  • hematopoietic cells
  • soft tissue
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13
Q

How do you name the stages?

A

T - 1° tumor size & extent
N - Lymph node involvement
M - Distant metastasis

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14
Q

Signs and Symptoms? (6)

A
  • Pallor - low CBC, low hemoglobin and platelets
  • Easy bruising - low platelet levels, less clotting. Bruising is subcutaneous bleeding
  • Pain that wakes from sleeping
  • Lymphadenopathy
  • Fatigue
  • Unintentional weight loss
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15
Q

Diagnoses? (3)

A
  • imaging
  • blood tests
  • biopsy
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16
Q

What types of imaging are done? (5)

A 
CT Scan
PET Scan
X-Ray
Ultrasound
MRI
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17
Q

What types of blood tests are done?

A

CBC

Peripheral blood smear

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18
Q

What types of biopsies are done? (2) Subtypes under each? (2)

A 
- Needle
FNA
Core
- Surgical
Excisional (take whole thing out)
Incisional (take small piece out)
- Lymphnodes
Sentinel node
Dissection
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19
Q

Breast cancer concerns? (4)

A
  • Metastases to bone and brain: may present like stroke, confusion, personality change
  • Axillary lymph node dissection bc breast tissue is really close to lymph nodes
  • Flexion restrictions after surgery
  • Cording/Axillary Web Syndrome
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20
Q

What’s often performed with gynecologic CA?

A

Retroperitoneal Lymph Node Dissection (RPLND) often performed

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21
Q

Head and Neck concerns? (2) 3 things pertaining to the second concern?

A
  • Restrictions in neck ROM post-op: guardian stitch, head stitched to neck
  • Trismus: inability to open mouth due to radiation to side of face
    » G-tube
    » Radiation fibrosis
    » 3 finger rule - able to get them btwn teeth = typical mouth open size
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22
Q

Lung CA concerns? (4)

A
  • Metastasizes to bone and brain
  • Pulmonary health
  • Oxygen saturation levels
  • Positioning
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23
Q

Leukemia & Lymphoma concerns? (5) PT precautions?

A
  • Perpetually low blood counts
  • Stem cell transplant and prolonged isolation
  • Avascular Necrosis
  • Tachycardia
  • Low platelets - monitor for falls
  • No high impact, manual therapy, or resistance
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24
Q

Concern in peds? What’s important?

A
  • Developmental delay

- Parent education is extremely important

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25
Q

Primary Bone Tumors - peak at? Mestasizes to? Two options?

A
  • Peaks at growth spurts
  • Metastasizes to: lung
  • Limb salvage vs. amputation
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26
Q

Brain tumors may be? What changes quickly? Treatments? (3) Any PT restrictions?

A
  • May be inoperable
  • Level of function changes very quickly
  • Ommaya reservoir: bubble underneath scalp bc blood brain barrier keeps big molecules out. Pour chemo into it. No PT restrictions.
  • Steroids and anti-convulsant
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27
Q

Prostate CA - most men die how? Colorectal, Pancreatic, and GI CA - what’s needed?

A
  • Most men die with prostate cancer, not from it
  • Large scale surgeries needed, early mobilization is key
    » Zero survival rate
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28
Q

What are the big 3 in terms of types of tx? Additional tx? (3)

A

Chemotherapy
Surgery
Radiation

Stem cell transplant
Steroids
Clinical trials

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29
Q

What are mediports? Restrictions? Removal?

A
  • Subcutaneous venous access

Restrictions

  • Placement: None
  • Removal: avoid excessive stretch and weight bearing for 2 weeks
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30
Q

Chemo targets? SE? (4)

A

Targets rapidly dividing cells

Nausea
Mucositis (“mouth sores”)
Low blood counts
Neutropenia

31
Q

Vinca-alkaloyd types? (3) Causes? (6) What is CIPN? Pts often?

A

Vincristine
Vinblastine
Vinorelibine

  • Peripheral Neuropathy
  • Long finger flexors and dorsiflexors
  • Diminished reflexes
  • Muscle cramping
  • Pain/hypersensitivity
  • Paralysis
  • CIPN: chemo-induced peripheral neuropathy: pts will under report bc it’s a dosage limiter
32
Q

Antrhacycline Antibiotics types? (4) Can cause? (3) Dangerous why? Responds well to?

A

Doxorubicin
Danorubicin
Epirubicin
Idarubicin

  • Cardiotoxicity
  • Cardiomyopathy and CHF
  • Monitor HR closely, asymptomatic
  • Responds well to training
33
Q

Alkylating Agent? Causes? (3) What should you avoid giving them?

A
  • Busulfan
  • Pulmonary Fibrosis
  • Low O2 Sat
  • Do not use supplemental oxygen
34
Q

Platinum Based agents? (3) Cause? (2)

A

Cisplatin
Carboplatin
Nedaplatin

Hearing Loss, Vestibular Involvement

35
Q

Peripheral Neuropathy - develops when? Causes? (7)

A
  • Develops at any phase of treatment
  • Loss of Achilles tendon reflex
  • Sensory impairments
  • Numbness
  • Parasthesia
  • Weakness/muscle atrophy
  • Loss of fine motor skills
  • Gait disturbance with tripping and falls
36
Q

What should you do immediately upon first signs of symptoms? Prognosis?

A
  • cast it immediately to create custom molded, foam-lined SFOs to avoid skin breakdown
  • resolves over time
37
Q

Progression of Peripheral Neuropathy? (5)

A

cramping -> pain -> weakness -> numbness -> paralysis

38
Q

What is chemo brain? Symptoms? (5) What kind of onset? How long does it last?

A
  • Mental “cloudiness”
  • Lapses in memory
  • “spacing out” and difficulty concentrating
  • Multitasking becomes difficult
  • Increased processing time
  • Word recall
  • Typically rapid onset
  • Can be short term or long term
39
Q

Chemo brain etiology? (9)

A
  • Exact cause is unknown
  • Disease
  • Treatment
  • Low blood counts
  • Sleep problems
  • Tiredness (fatigue)
  • Hormone changes or hormone treatments
  • Nutritional deficiencies
  • Depression, stress, anxiety, worry, or other emotional pressure
40
Q

Typical “Cycle”? (3)

A

chemo week
neutropenic week
counts return/week of rest

41
Q

What happens during chemo week? (2) Neutropenic week? (3) Counts return week? (1)

A 
- Chemo week
>> Anti-emetics given
>> Typically feel reasonably well
- Neutropenic week
>> Chemo is taking effect
>> Mouth sores, nausea, low counts/energy bc rapidly dividing cells aren't dividing and low immune system
- Will be admitted if febrile (feverish)
- Counts return/week of rest
Energy returns
42
Q

Might not be worth seeing patients during what week?

A

Neutropenic

43
Q

Radiation types? Describe each

A
  • Intensity Modulated (IMRT): radiation comes from all different angles, only overlaps and becomes intense enough where the tumor is
  • External Beam (XRT): typical large swatch of radiation, whole body
  • Intra-operative (IORT): radiation in Or (open and exposed)
  • Brachytherapy- radiative pieces of metal
44
Q

How long does radiation stay in our system? Causes? Of? What does it do to the first? (3)

A
  • Up to 10 years after treatment
  • Fibrosis
    » Skin
    Lack of glands and follicles
    Altered sensation
    Pliability
    » Organs
45
Q

What is a “bone marrow transplant?” (2) BMT is a subset of? Donors can come from? (2) Pts are? Why?

A
  • Diseased cells are killed off with chemotherapy, radiation
  • Hematopoietic stem cells are replaced with new ones from a donor
  • BMT is a subset of stem cell transplant
  • They can come from peripheral blood, umbilical cord
  • Pts are sequestered bc you’re killing their immune system
46
Q

Stem Cell Transplant types? (3) Source? (3) Matching?

A 
- Types
Autogenic
Allogenic
Syngenic
- Source
Peripheral Blood
Cord Blood
Bone Marrow
- Matching
HLA Typing
47
Q

Stages of HSCT (hematopoetic stem cell transplant)? (6)

A

admission -> cytoreduction (kill off immune system) -> day of rest -> transplant -> engraftment (stuck in room and can’t leave) -> d/c

48
Q

What is graft vs host disease? Systems affected? (3)

A
  • host attacking immune system; rejecting graft
  • Skin
    Liver
    Gut
49
Q

Steroids prevent? Causes? (2)

A
  • Prevents increased ICP
  • Myopathy
  • cushingoid symptoms
50
Q

When should you be on bed rest?

A

Platelets below 20 and Hgb below 8

51
Q

Bone pain can be caused by? (2) Restrictions? (2)

A
  • Platelets and HgB are produced in the bone marrow
  • Small medullary canal, large bone thikness - pain 2/2 counts coming back
  • Activity has no effect
  • No risk of fracture or damage
52
Q

Osteoporosis can be caused by? (5) Who’s at a higher risk? (3)

A 
Causes
Chemo
Radiation
Inactivity
Steroids
Hormone Therapy

Higher risk
Breast cancer
Prostate cancer
Multiple myeloma

53
Q

Pathological fx is a? What’s needed?

A

EMERGENCY

Ortho or Physiatry consult if metastatic disease is present

54
Q

What is Cancer Related Fatigue (CRF)?

A

Distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.

55
Q

CRF contributing factors? (4)

A

Environment
Personal/behavioral
Cultural/family
Tx

56
Q

How does environment contribute to CRF? (4)

A
  • Return or stay in treatment area
  • Long waits
  • Altered schedule and routine
  • High cognitive demand situations
57
Q

How does personal/behavior contribute to CRF? (2)

A
  • Negative belief in ability to perform activity

- Altered sleep patterns

58
Q

How does cultural/family contribute to CRF? (3)

A
  • Adversely affected by others emotions, moods, concerns
  • Restricted activity when not indicated
  • Others push to perform too much activity
59
Q

How does treatment contribute to CRF? (6)

A
  • Exams
  • Not enough recovery time between treatments
  • Metabolic changes
  • Poor nutrition
  • Adverse effects to treatment
  • Stage of treatment
60
Q

How does environment alleviate CRF? (4)

A
  • Rest, sleep patterns
  • Schedule awake and sleep times
  • Shorten clinic visit
  • Decrease stimulation around child
61
Q

How does personal/behavior alleviate CRF? (5)

A
  • Focus on child’s ability
  • Encourage child to voice concerns
  • Allow choices
  • Encourage exercise
  • Allow choices
62
Q

How does cultural/family alleviate CRF? (4)

A
  • Modify family schedule for when child has more energy
  • Quiet and rest periods
  • Create realistic expectations
  • Avoid limiting activities unnecessarily
63
Q

How does treatment alleviate CRF? (3)

A
  • Monitor nutrition and hematologic status
  • Evaluation of interventions
  • Blood products as needed
64
Q

Cancer Treatment Stages and Physical Therapy - pretreatment phase - evaluation? Intervention? (2)

A
  • Baseline
  • Strengthening and conditioning
  • Education on potential treatment related activity and participation limitations
65
Q

Cancer Treatment Stages and Physical Therapy - active care - evaluation? Intervention? (2)

A
  • Address specific impairments, - episodes of care inpatient and outpatient
66
Q

Cancer Treatment Stages and Physical Therapy - Post care/

Maintenence - evaluation? Intervention? (2)

A
  • tx effects
  • Address specific impairments and conditioning.
  • Return to activity and participation based on patient’s goals.
67
Q

Cancer Treatment Stages and Physical Therapy - palliation - evaluation? Intervention? (4)

A
  • Driven by patient’s goals
  • Focus on patient/family goals. - Improve quality of life.
  • Maximize functional skills.
  • Durable medical equipment needs
68
Q

Reasons for Referral - diagnosis? Active tx? (5)

A
  • Patient and family education
  • Post-surgical rehabilitation
  • Peripheral neuropathy
  • Deconditioning
  • Neurological deficits
  • Steroid myopathy
69
Q

Reasons for Referral - survivorship? Palliative care? (2)

A
  • Long term effects of treatment
  • Quality of life
  • Comfort
70
Q

Reasons for Referral - pulmonary? (4) Integumentary? (2) Neurological? (7)

A

Post-op
Pulmonary metastases
Infection
Pulmonary fibrosis

Radiation fibrosis
Axillary web syndrome

Primary tumor
>> Brain tumor
>> Nerve sheath tumors
>> Cord compression 
Peripheral neuropathy
Encephalopathy
Sensory processing
71
Q

Reasons for Referral - cardiovascular? (6) Musculoskeletal? (6)

A 
Decreased Endurance
Prolonged isolation
Post-op activity limitations
Chemo Induced
Cardiomyopathy
CHF
Decreased strength
Postural deviation
Altered weight bearing
Post-op Rehabilitation 
Steroid myopathy
Avascular necrosis
72
Q

Scheduling Treatment Sessions - when to proceed? (4) When to modify? (3)

A
  • Lower extremity DVT with IVC filter
  • Platelets > 20, HgB > 8
  • Bone pain from increasing counts
  • Hydration prior to or following chemotherapy
  • Platelets 10-20, HgB 7-8 with special orders
  • Symptomatic
  • External VP shunt
73
Q

Scheduling Treatment Sessions - when to delay? (3) When to hold? (4)

A

Active chemotherapy infusion
Active blood or platelet transfusion
A-Line

Following radiation
Following dialysis
DVT UE or no filter
PEG-asparaginase

Lifespan (3 decks)

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