Adult Oncology Flashcards
Most common forms of cancer
Prostate
Breast
Lung/bronchus
Oncogene
Genes that cause growth
Tumor suppressor gene
Genes that stop growth
Example: BRCA gene in breast cancer
Modifiable Risk Factors
Tobacco
Alcohol
Radiation Exposure
Infectious Organisms
Non-Modifiable Risk Factors
Gene mutations Hormones Immune conditions Age Family history Downs Syndrome Chemotherapy and radiation
In situ cancer
Starting to break through the basal membrane and gets its own circulatory system
Metastases
Cancer cells travel to a remote area
Via blood vessels, lymph vessels
NOT the same thing as secondary primary cancer
Distal representation of original cancer cell
Sedentary lifestyle risk factors
Much higher incidence of certain types of cancer (colorectal)
Screening
Colonoscopy
Mammogram
Pap smears
Stage I or II can have up to 85% EFS
Difference between benign and malignant
Basal membrane break through
Whether or not it’s encapsulated
Lymphoma
Immune system
Sarcoma
Connective tissue and bone
Leukemia
Hematopoietic cells
Carcinoma
Soft tissue
TMN Staging
Tumor size and extent
Lymph node involvement
Distant metastasis
Cancer signs and symptoms
Pallor Easy bruising Pain that wakes from sleeping Lymphadenopathy Fatigue Unintentional weight loss
Why pallor?
Poor circulation
RBC levels
Low Hb
Why easy bruising?
Low platelets
Imaging
CT scan PET scan Xray US MRI
Needle biopsy
FNA - fluid
Core - punch out a core
Surgical biopsy
Excisional - they take the whole thing out and then test for cancer
Incisional - they’re not taking out the whole thing
Lymph node biopsy
Sentinel node
Dissection
Cancers that have highest risk for lymphedema
Breast cancer
Gynecologic cancer
- Uterine
- Ovarian
- Cervical
Breast cancer
Metastases to bone and brain
Axillary lymph node dissection
Flexion restrictions
Cording/axillary web syndrome
Cording/Axillary Web Syndrome
Cording from axilla all the way to the medial elbow
Gynecologic Cancers
Retroperitoneal Lymph Node Dissection (RPLND) often performed
Head and Neck Cancers
Restrictions in neck ROM post-op
Trismus
Trismus
Inability to open your mouth
G-tube
Radiation fibrosis
3-finger rule - if they can fit three fingers between top teeth and bottom teeth
Lung Cancer
Metastasizes to bone and brain
Pulmonary health
Oxygen saturation levels
Positioning - chest PT!
“Bone METS? Have they seen ortho or physiatry? In WB, they are at an extremely high risk of pathological fracture”
Leukemia and Lymphoma
Perpetually low blood counts…
No resistive exercise
No manual therapy
No high impact
ONLY functional mobility
Stem cell transplant and prolonged isolation
Avascular necrosis
Low Hb
Dizziness
Confusion
Pallor
Tachy
Low Platelets
Monitor for safety
Pediatric Cancer
Developmental delay
Parent education is extremely important
Primary bone tumors
Peaks at growth spurts
Metastasizes to lung
Limb salvage vs amputation
Brain tumors
May be inoperable (brainstem)
Level of function changes very quickly
Ommaya reservoir
Steroids and anti-convulsants
Ommaya reservoir
Tiny hole drilled into the skull
Balloon subcutaneously in scalp
They can do whatever except for WB on the Ommaya reservoir (headstand)
Prostate
Most men die WITH prostate cancer, not FROM it
Colorectal, Pancreatic, GI Cancer
Large scale surgeries needed
Early mobilization is KEY
Pancreatic cancer the most aggressive
The “Big 3”
Chemotherapy
Surgery
Radiation
Additional cancer treatments
Stem cell transplant
Steroids
Clinical trials
Mediports
Subcutaneous venous access, typical subclavian
Restrictions…
Placement - none
Removal - avoid excessive stretch and WB for 2 weeks
If your patient is ACTIVELY getting chemotherapy, DON’T SEE THE PATIENT
Chemotherapy
Targets rapidly dividing cells
General SE…
Nausea
Mucositis (mouth sores)
Low blood counts
Neutropenia
Chemo and target
This makes it very difficult for the patient to make any strength gains
mm mass growth = rapidly dividing cells
Chemo agents
Vinca-Alkaloyds
Antrhacycline antibiotics
Alkylating Agent
Platinum Based
Vinca-Alkaloyds
Vins
Peripheral neuropathy a dosage limiting factor
Long finger flexors and dorsiflexors Diminished reflexes Mm cramping Pain/hypersensitivity Paralysis
***Your patients won’t report this because they think their chemo is getting cut back
Antrhacycline Antibiotics
Rubicins
Cardiotoxicity…
Cardiomyopathy and CHF
Monitor HR closely, asymptomatic
Alkylating Agent
Busulfan
Pulmonary fibrosis…
Low O2 sat
DO NOT USE SUPPLEMENTAL O2
***Their new normal is the lower O2 sat; it will make the PF worse
Platinum Based
Platins
High frequency hearing loss
Questionable Vestibular involvement
–Might destroy hair cells that sense motion of the endolymph
Peripheral neuropathy
Develops at any phase of treatment
Cast as soon as you see these impairments
Total Contact Custom Molded Foam Lined Solid Ankle AFOs
–No hinge bc they’ll just collapse at their forefoot
Loss of Achilles tendon reflex Sensory impairments (N+P) Weakness/mm atrophy --Lose of fine motor skills --Gait disturbance with tripping and falls
Progression of Peripheral Neuropathy
Cramping Pain Weakness Numbness Paralysis
“Chemo Brain”
Mental cloudiness
Typically rapid onset
Can be ST or LT
Exact cause is unknown
“Chemo Brain” possible causes
Disease Treatment Low blood counts Sleep problems Tiredness Hormone changes Nutritional deficiencies Depression, stress, anxiety, worry, or other emotional pressure
Incidence of Cancer in Adults
1 in 2 men
1 in 3 women
Typical Cycle of Chemo
Chemo week
Neutropenic week
Counts return/week of rest
Chemo week
Anti-emetics given
Typically feel reasonably well
Neutropenic week
Chemo is taking effect
Mouth sores, nausea, low counts/energy
Will be admitted if febrile
Not the most productive time to use PT services
Counts return/week of rest
Energy returns
Radiation types
Intensity Modulated
External Beam
Intra-operative
Brachytherapy
Intensity Modulated Radiation (IMRT)
Only modulates if it becomes intense enough to have an effect on the tissues
External beam (XRT)
Typical large swath of radiation
Intra-operative (IORT)
Radiation therapy in the OR
Brachytherapy
Common in prostate cancer
Patient energy after radiation
Exhausted
Radiation effects
Up to 10 years after treatment
Fibrosis
Skin - lack of glands and follicles; altered sensation; pliability decreased
Organs
Bone Marrow Transplant
Subset of stem cell transplant
Diseased cells are killed off with chemotherapy and radiation
Hematopoietic stem cells are replaced with new ones from a donor - peripheral blood, umbilical blood
Stem Cell Transplant Types
Autogenic
Allogenic
Syngenic
Stem Cell Transplant Sources
Peripheral blood
Cord blood
Bone marrow
Matching for SCT
HLA typing
Stages of HSCT
Admission Cytoreduction Day of Rest Transplant Engraftment D/C
Engraftment
Dangerous part where they are stuck in a room and cannot leave
Graft v Host Disease
Graft - transplanted immune system
Host - pt
Systems affected - skin, liver, gout
Acute? Goes away within first 100 days of transplant
Chronic? Does not go away
Steroids
Prevents increased ICP
Myopathy
Cushingoid symptoms
Blood Counts
G-CSF
Hb
Platelets
Transfusions
ACSM guidelines often do not apply here
G-CSF
Counting a protein that stimulates bone marrow to produce granulocytes and stem cells
Bone Pain
Platelets and HgB produced in bone marrow
Activity has no effect
No risk of fracture damage
Osteoporosis causes
Chemo Radiation Inactivity Steroids Hormone therapy
Higher risk for osteoporosis
Breast cancer
Prostate cancer
Multiple myeloma
Pathological fractures
EMERGENCY
Ortho or physiatry consult if metastatic disease is present
Tumor Lysis Syndrome
Fracture through tumor
EMERGENCY
Cancer Related Fatigue (CRF)
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
Reasons for referral to PT
Diagnosis Active treatment Survivorship Palliative care Pulmonary Integumentary Neurological Cardiovascular Muscuoloskeletal
When to proceed
LE DVT c IVC filter
Platelets > 20, HgB >8
Bone pain from increasing counts
Hydration prior to or following chemotherapy
When to modify
Platelets 10-20, HgB 7-8 with special orders
Symptomatic
External VP shunt
When to delay
Active chemotherapy infusion
Active blood or platelet transfusion
A-Line
When to hold
Following radiation
Following dialysis
DVT
PEG-asparaginase (when monitored every 15 minutes)
