Bone Cancer and Metastatic Disease

Question 1

T/F: The potential for cancer rehabilitation is not separate from the prognosis for disease improvement.

Answer 1

False: Is separate

Question 2

Q: What is the focus of cancer rehabilitation?

Answer 2

Prolonging survival, not eradicating diease

Question 3

T/F: Patients fear death more than functional decline and uncontrolled symptoms.

Answer 3

False: flip it

Question 4

T/F: Caretaker burden is strongly linked to requested euthanasia.

Answer 4

True

Question 5

T/F: Threats to functional decline are isolated in nature.

Answer 5

False: Multiple fronts: sx, tx toxicity, metastatic disease, psychosocial adjustment, etc

Question 6

Q: Approach cancer rehabilitation with an ______________ and _________________ stance.

Answer 6

anticipatory, preventative

Question 7

Content: Phases of Therapeutic Intervention for Cancer (4)

Answer 7

1. Preventative
2. Restorative
3. Supportive
4. Palliative

Question 8

Content: Preventative Phase Description (2)

Answer 8

1. Lessens impact of anticipated disability through education and training
2. Condition programs

Question 9

Content: Restorative Phase Description (2)

Answer 9

1. Aims to restore physcial integrity
2. Mobility training and exercise

Question 10

Content: Supportive Phase Description (2)

Answer 10

1. Interventions to cope with/accomodate a disability
2. Potentially orthotics

Question 11

Content: Palliative Phase Description (4)

Answer 11

1. Provide comfort or assistance when recovery is not expected
2. Pain management
3. Family training
4. Discharge to home

Question 12

Q: Primary Bone Malignancies are relatively ______, 1 in _________. Secondary bone disease is ____x more likley to occur.

Answer 12

rare, 100,000, 35

Question 13

Content: Osteosarcoma (4)

Answer 13

1. Unknown etiology (linked to radiation - think Chernoble)
2. < 20 yo or > 60 yo (assoc. w/Paget’s)
3. Distal femur or proximal tibia
4. Tends to metastasize to the lungs and other bones

Question 14

Content: Medical Management of Osteosarcoma (4)

Answer 14

1. Imaging to define extent and biopsy tumor
2. Chemotherapy pre/post operatively
3. Surgical excision of affected bone (80% excised w/o amputation)
4. 70% long term survival even with metastatic disease

Question 15

Content: Ewing’s Sarcome (4)

Answer 15

1. > 3yo < 25 yo
2. 60% of tumors in LE/Pelvic girdle
3. Tends to metastatize to lungs and other bones
4. 1st presents as pain, low grade fever, anemia, limp (not something kids do for fun)

Question 16

Content: Medical Managment of Ewing’s Sarcoma

Answer 16

1. Imaging to define extent, will see “onion skin” appear of cortical bone
2. several course of pre-op multi drug chemo as well as post-op chemo
3. Surgical resection
4. 50-75% survival of 5 years

Question 17

Content: Chondrasarcoma (4)

Answer 17

1. > 40 yo; M > W
2. Central skeleton, esp. pelvis
3. Majority low grade/difficult to distinguish from benign cartilage disease
4. Charactertics radiographic features

Question 18

Content: Medical Management of Chondrosarcoma (3)

Answer 18

1. Managed surgically
2. Chemo is reserved for progression of disease
3. Excellent prognosis with low grade disease

Question 19

In the 1970s, 90% of radioresistance malignant bone tumors were treated with _____________, by 2000, 80-90% of radioresistant malignant bone tumors were treated with __________________.

Answer 19

amputation, limb salvage

Question 20

Content: Types of Limb Salvage (6)

Answer 20

1. Allograft replacement (same species transplant)
2. Endoprosthetic insertion (An artificial replacement of a body part that is placed internally.
3. Allograft-prosthetic reconstructions
4. Vascularized bone graft
5. Arthrodesis
6. Rotationplasty

Question 21

Content: Complication of Limb Salvage (4)

Answer 21

1. Infection
2. Non-union or delayed union
3. OA
4. Joint instability

Question 22

Content: Acute PT Intervention (5)

Answer 22

1. Mobility training: bed mobility, transfers
2. Strengthening within precautions
3. ROM within precautions
4. Gait training with protective WBing
5. Endurance activities

Question 23

Content: Late PT Invervention (3)

Answer 23

1. Joint function
2. Strengthening
3. Quality, effectiveness, and efficiency of gait

Question 24

Content: Metastatic Disease in Bone (5)

Answer 24

1. Highly prevalent complication of cancer
2. 70-85% of pts. who die of cancer have bone metastasis
3. Combination of lesions (osteolytic/blastic) can occur in the same pt.
4. Risk of hypercalcemia, pathologic fx, pain, spinal cord compressoin
5. Relatively long clinical course

Question 25

Content: Most common sites of cancer bone metastasis (5)

Answer 25

PT Barnum Loves Kids Prostate Thyroid Breast Lung Kidney - If you see these it should be on your rada that the cancer came from metastatic disease

Question 26

Defn: Osteolytic

Answer 26

Destruction of bone by stimulated bone resorption

Question 27

Defn: Osteoblastic

Answer 27

Dense, new bone growth with likely lytic processes and compromised bone quality

Question 28

Content: Pathologic Fx (4)

Answer 28

1. Severe complication of osseous metastatic disease 2. Incidence in patient with bone mets = 9.5% 3. Protective unweighting prescription 4. Prophylactic repair is controversial due to uncertainty in determining fracture risk

Question 29

Content: Predicting Pathologic Fx (3)

Answer 29

1. Primarily uses x-ray and bone scans. x-rays allow quantitative measure of cortical involvement. 2. Studies support determining fracture risk and intervention based on % of cortex involved 3. Another significant study used pain aggravated with functional activity as predictor

Question 30

Diagram: CPR for Pathologic Fx

Answer 30

Question 31

T/F: Bedrest is the best method to prevent pathologic fractures.

Answer 31

False: Study of 54 patients indicated that few patients (1) fracture with direct therapy activities. More fractures occurred (6) while the patient was in bed which is consistent with the cause of the fracture primarily from erosive disease

Question 32

Content: Characteristics of Pt. more likely to have pathologic fx (3)

Answer 32

1. Younger (~59 yo) 2. Greater number of sites involved with bony metastases 3. Presence of 2+ pathologic fx

Question 33

Content: Rehab with Risk of Pathologic Fx (3)

Answer 33

1. Active pain free AROM, NO resistive/PROM 2. Limit MMT of uninvolved extremities 3. Inform pt. of risks/risks of bedrest

Question 34

Content: Multiple Myeloma (4)

Answer 34

1. Acquired **injury to the DNA** of a cell in the lymphocyte development sequence 2. **B-lymphocytes transform into** malignant cells resembling plasma celss resulting in a monoclonal proliferation of **plasma cells** 3. Abnormal cells **accumulate in bone marrow** causing a tumor 4. Chemical secreted by plasma cells **stimulate osteoblastic activity** creating lytic bone lesions

Question 35

Content: Multiple Myeloma Sequelae

Answer 35

1. Myeloma cells increase in number \> damage and weaken bone 2. Damaged bones release calcium \> hypercalcemia (muscle weakness, restlessness, and confusion) 3. Myeloma cells prevent bone marrow from forming normal plasma cells and WBC \> compromises immunity 4. Cancer may prevent RBC growth \> anemia 5. Excess antiboy proteins and calcium \> prevent kidneys from filtering/cleaning blood

Question 36

Content: Diagnosis of Multiple Myeloma (3)

Answer 36

1. Imaging to specify extent of lytic lesions 2. Blood and urine tests for high antibody proteins 3. Bone marrow biopsy and/or bone marrow aspiration

Question 37

Content: Medical Management of Multiple Myeloma (4)

Answer 37

1. Systemtic chemotherapy 2. Local XRT 3. Neutropenic precaustions, dialysis 4. Highly treatable, rarely curable, 24-30 mo prognosis, \< 3% of 10 yr survival

Question 38

Content: PT Considerations in Multiple Myeloma (5)

Answer 38

1. Back pain and compression fx are common 2. Considerations as with metastatic compression fx 3. Spinal orthtoics 4. AROM 5. Maintain ambulation abilities

Question 39

Q: Who was the founder of hospice?

Answer 39

Dame Cicely Saunders

Question 40

Content: Conserations for Pathologic Fx (3)

Answer 40

1. Amount of cortical involvement limited in long bones 2. Dynamic process in metastatic lesion 3. Treatments change the nature of lesions

Question 41

T/F: There is a no fall tolerance with hip, pelvis, and LE pathologic fx.

Answer 41

True

Question 42

Q: What type of cancer is multiple myeloma?

Answer 42

A primary leukemia/hematologic cancer

Question 43

Q: What type of cancer does multiple myeloma look like?

Answer 43

Metastatic disease