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Lifespan > Adult Oncology > Flashcards

Adult Oncology Flashcards

1
Q

Most common forms of cancer

A

Prostate
Breast
Lung/bronchus

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2
Q

Oncogene

A

Genes that cause growth

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3
Q

Tumor suppressor gene

A

Genes that stop growth

Example: BRCA gene in breast cancer

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4
Q

Modifiable Risk Factors

A

Tobacco
Alcohol
Radiation Exposure
Infectious Organisms

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5
Q

Non-Modifiable Risk Factors

A 
Gene mutations
Hormones
Immune conditions
Age
Family history
Downs Syndrome
Chemotherapy and radiation
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6
Q

In situ cancer

A

Starting to break through the basal membrane and gets its own circulatory system

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7
Q

Metastases

A

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

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8
Q

Sedentary lifestyle risk factors

A

Much higher incidence of certain types of cancer (colorectal)

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9
Q

Screening

A

Colonoscopy
Mammogram
Pap smears
Stage I or II can have up to 85% EFS

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10
Q

Difference between benign and malignant

A

Basal membrane break through

Whether or not it’s encapsulated

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11
Q

Lymphoma

A

Immune system

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12
Q

Sarcoma

A

Connective tissue and bone

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13
Q

Leukemia

A

Hematopoietic cells

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14
Q

Carcinoma

A

Soft tissue

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15
Q

TMN Staging

A

Tumor size and extent

Lymph node involvement

Distant metastasis

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16
Q

Cancer signs and symptoms

A 
Pallor
Easy bruising
Pain that wakes from sleeping
Lymphadenopathy
Fatigue
Unintentional weight loss
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17
Q

Why pallor?

A

Poor circulation
RBC levels
Low Hb

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18
Q

Why easy bruising?

A

Low platelets

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19
Q

Imaging

A 
CT scan
PET scan
Xray
US
MRI
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20
Q

Needle biopsy

A

FNA - fluid

Core - punch out a core

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21
Q

Surgical biopsy

A

Excisional - they take the whole thing out and then test for cancer

Incisional - they’re not taking out the whole thing

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22
Q

Lymph node biopsy

A

Sentinel node

Dissection

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23
Q

Cancers that have highest risk for lymphedema

A

Breast cancer

Gynecologic cancer

  • Uterine
  • Ovarian
  • Cervical
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24
Q

Breast cancer

A

Metastases to bone and brain

Axillary lymph node dissection

Flexion restrictions

Cording/axillary web syndrome

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25
Q

Cording/Axillary Web Syndrome

A

Cording from axilla all the way to the medial elbow

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26
Q

Gynecologic Cancers

A

Retroperitoneal Lymph Node Dissection (RPLND) often performed

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27
Q

Head and Neck Cancers

A

Restrictions in neck ROM post-op

Trismus

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28
Q

Trismus

A

Inability to open your mouth

G-tube

Radiation fibrosis

3-finger rule - if they can fit three fingers between top teeth and bottom teeth

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29
Q

Lung Cancer

A

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”

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30
Q

Leukemia and Lymphoma

A

Perpetually low blood counts…

No resistive exercise
No manual therapy
No high impact
ONLY functional mobility

Stem cell transplant and prolonged isolation

Avascular necrosis

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31
Q

Low Hb

A

Dizziness
Confusion
Pallor
Tachy

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32
Q

Low Platelets

A

Monitor for safety

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33
Q

Pediatric Cancer

A

Developmental delay

Parent education is extremely important

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34
Q

Primary bone tumors

A

Peaks at growth spurts

Metastasizes to lung

Limb salvage vs amputation

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35
Q

Brain tumors

A

May be inoperable (brainstem)

Level of function changes very quickly

Ommaya reservoir

Steroids and anti-convulsants

36
Q

Ommaya reservoir

A

Tiny hole drilled into the skull

Balloon subcutaneously in scalp

They can do whatever except for WB on the Ommaya reservoir (headstand)

37
Q

Prostate

A

Most men die WITH prostate cancer, not FROM it

38
Q

Colorectal, Pancreatic, GI Cancer

A

Large scale surgeries needed

Early mobilization is KEY

Pancreatic cancer the most aggressive

39
Q

The “Big 3”

A

Chemotherapy
Surgery
Radiation

40
Q

Additional cancer treatments

A

Stem cell transplant
Steroids
Clinical trials

41
Q

Mediports

A

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

42
Q

Chemotherapy

A

Targets rapidly dividing cells

General SE…

Nausea
Mucositis (mouth sores)
Low blood counts
Neutropenia

43
Q

Chemo and target

A

This makes it very difficult for the patient to make any strength gains

mm mass growth = rapidly dividing cells

44
Q

Chemo agents

A

Vinca-Alkaloyds
Antrhacycline antibiotics
Alkylating Agent
Platinum Based

45
Q

Vinca-Alkaloyds

A

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

46
Q

Antrhacycline Antibiotics

A

Rubicins

Cardiotoxicity…

Cardiomyopathy and CHF
Monitor HR closely, asymptomatic

47
Q

Alkylating Agent

A

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

48
Q

Platinum Based

A

Platins

High frequency hearing loss

Questionable Vestibular involvement
–Might destroy hair cells that sense motion of the endolymph

49
Q

Peripheral neuropathy

A

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
50
Q

Progression of Peripheral Neuropathy

A 
Cramping
Pain
Weakness
Numbness
Paralysis
51
Q

“Chemo Brain”

A

Mental cloudiness
Typically rapid onset
Can be ST or LT
Exact cause is unknown

52
Q

“Chemo Brain” possible causes

A 
Disease
Treatment
Low blood counts
Sleep problems
Tiredness
Hormone changes
Nutritional deficiencies
Depression, stress, anxiety, worry, or other emotional pressure
53
Q

Incidence of Cancer in Adults

A

1 in 2 men

1 in 3 women

54
Q

Typical Cycle of Chemo

A

Chemo week
Neutropenic week
Counts return/week of rest

55
Q

Chemo week

A

Anti-emetics given

Typically feel reasonably well

56
Q

Neutropenic week

A

Chemo is taking effect

Mouth sores, nausea, low counts/energy

Will be admitted if febrile

Not the most productive time to use PT services

57
Q

Counts return/week of rest

A

Energy returns

58
Q

Radiation types

A

Intensity Modulated
External Beam
Intra-operative
Brachytherapy

59
Q

Intensity Modulated Radiation (IMRT)

A

Only modulates if it becomes intense enough to have an effect on the tissues

60
Q

External beam (XRT)

A

Typical large swath of radiation

61
Q

Intra-operative (IORT)

A

Radiation therapy in the OR

62
Q

Brachytherapy

A

Common in prostate cancer

63
Q

Patient energy after radiation

A

Exhausted

64
Q

Radiation effects

A

Up to 10 years after treatment

Fibrosis

Skin - lack of glands and follicles; altered sensation; pliability decreased

Organs

65
Q

Bone Marrow Transplant

A

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

66
Q

Stem Cell Transplant Types

A

Autogenic
Allogenic
Syngenic

67
Q

Stem Cell Transplant Sources

A

Peripheral blood
Cord blood
Bone marrow

68
Q

Matching for SCT

A

HLA typing

69
Q

Stages of HSCT

A 
Admission
Cytoreduction
Day of Rest
Transplant
Engraftment
D/C
70
Q

Engraftment

A

Dangerous part where they are stuck in a room and cannot leave

71
Q

Graft v Host Disease

A

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

72
Q

Steroids

A

Prevents increased ICP
Myopathy
Cushingoid symptoms

73
Q

Blood Counts

A

G-CSF
Hb
Platelets
Transfusions

ACSM guidelines often do not apply here

74
Q

G-CSF

A

Counting a protein that stimulates bone marrow to produce granulocytes and stem cells

75
Q

Bone Pain

A

Platelets and HgB produced in bone marrow

Activity has no effect

No risk of fracture damage

76
Q

Osteoporosis causes

A 
Chemo
Radiation
Inactivity
Steroids
Hormone therapy
77
Q

Higher risk for osteoporosis

A

Breast cancer
Prostate cancer
Multiple myeloma

78
Q

Pathological fractures

A

EMERGENCY

Ortho or physiatry consult if metastatic disease is present

79
Q

Tumor Lysis Syndrome

A

Fracture through tumor

EMERGENCY

80
Q

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

81
Q

Reasons for referral to PT

A 
Diagnosis
Active treatment
Survivorship
Palliative care
Pulmonary
Integumentary
Neurological
Cardiovascular
Muscuoloskeletal
82
Q

When to proceed

A

LE DVT c IVC filter
Platelets > 20, HgB >8
Bone pain from increasing counts
Hydration prior to or following chemotherapy

83
Q

When to modify

A

Platelets 10-20, HgB 7-8 with special orders
Symptomatic
External VP shunt

84
Q

When to delay

A

Active chemotherapy infusion
Active blood or platelet transfusion
A-Line

85
Q

When to hold

A

Following radiation
Following dialysis
DVT
PEG-asparaginase (when monitored every 15 minutes)

Lifespan (18 decks)

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