Bone Malignancies and Rehabilitation

Question 1

Phases of Therapeutic Interventions (4)

Answer 1

1. Preventative: lessens impact of anticipated disability
2. Restorative: aims to restore physical integrity
3. Supportive: cope w/ or accomodate a disability
4. Palliative: provide comfort or assistance when recovery is not expected

Question 2

Primary bone Malignancies (3)

Answer 2

osteosarcoma, ewing’s sarcoma, chondrosarcoma

Question 3

Osteosarcoma

• typical patient age
• typical site
• medical management
• prognosis

Answer 3

age: less than 20 or greater than 60 but can occur at any age

• usually at the distal femur or proximal tibia
• unknown etiology but linked to radiation exposure

Medical management:

• diagnosis: xray, MRI, CT, biopsy
• pre-operative chemo –> surgical excision –> post-surgical chemo

Prognosis: 70% long term survival

Question 4

Ewing’s Sarcoma

• typical patient age
• site
• medical management
• prognosis

Answer 4

Age: greater than 3 or less than 12

Site: LE and pelvic girdle most common
-first symptom of pain and may have low grade fever

Medical management:

• diagnosis: x-ray, CT, MRI, bone scan; cortical bone will have “onionskin” appearance
• preop chemo –> surgical resection –> post op chemo approx 1 year

50-75% survival rate of 5 years

Question 5

Chondrosarcoma

• typical patient age
• site
• medical management
• prognosis

Answer 5

age: >40; men more than women
site: central portions of the skeleton, especially of the pelvis

Medical management:

• diagnosis: x-ray
• surgical resection, chemo and/or radiation reserved for progression of disease

excellent prognosis if low grade disease

Question 6

Primary Malignancies that metastasize to bone

Answer 6

P.T. Barnum Loves Kids

P = prostate
T = thyroid
B = breast
L = lungs
K = kidney

Question 7

Types of metastatic disease lesions (2) & definitions

Answer 7

osteolytic vs. osteoblastic

Osteolytic = destruction of new bone growth by stimulated bone resorption (bone appears washed out)

Osteoblastic = dense, new bone growth w/ likely lytic processes and compromised bone quality (bone appears white and dense)

Can have a combo of both lesions in the same patient

Question 8

Whose at risk for a pathologic fracture?

-CPR & other characteristics

Answer 8

Mirel’s Rating System (CPR) - 4 variables in assigning fracture risk

1. site (UE, LE, peritrochanteric)
2. nature (blastic, lytic, mixed)
3. size (2/3)
4. pain (mild,mod,functional)

Other characteristics: younger, greater number of sites involved, presence of 2 or more pathologic fractures

Question 9

Multiple Myeloma

• type of cancer
• pathophys

Answer 9

Pathophys:
B-lymphocytes transform into malignant cells resembling plasma cells which leads to monoclonal proliferation of plasma cells –> abnormal cells accumulate causing tumor –> chemicals secreted by plasma cells stimulate osteoblastic activity creating lytic bone lesions

Hematologic cancer - begins in the immune system but affects the bones

Question 10

Sequelae of Multiple Myeloma

Answer 10

1. myeloma cells increase in number and damage/weaken bone
   * *fracture is often the first sign of the disease
2. damaged bones lead to release of Ca causing hypercalcemia –> muscle weakness, restlessness and confusion
3. bone marrow prevented from forming normal plasma cells and other WBC compromising immunity
4. prevent growth of RBC causing anemia
5. excess antibody proteins and Ca can prevent kidneys from filtering and cleaning the blood properly

Question 11

Diagnosis & Medical management of Multiple myeloma

Answer 11

Diagnosis: CT & x-ray, lab tests (high levels of antibody proteins) and bone marrow biopsy

Medical management:
highly treatable, but NOT curable
- chemo and radiation
- usually has neutropenic precautions (low immunity)
- dialysis
- orthotics (common to see compression fx)

Prognosis: 24-30 months,

Question 12

PT Considerations

Answer 12

back pain and compression fractures are common
-spinal orthotics

AROM

Maintain ambulation activities