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DPT 682 - Pathophysiology > Cancer > Flashcards

Cancer Flashcards

1
Q

“disease in which abnormal cells divide without control and can invade nearby tissues and to the other parts of the tissues through blood and lymphatic system” = ?

Cancer

A

Cancer: “disease in which abnormal cells divide without control and can invade nearby tissues and to the other parts of the tissues through blood and lymphatic system” - CDC

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2
Q

Top 3 most common cancers in US = ?

Cancer

A
  1. Lung and bronchus
  2. Female breast
  3. Prostate
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3
Q

Hallmarks of Cancer = ?

Cancer

A

Hallmarks of Cancer:

  1. Self-sufficiency in growth signals
  2. Insensitivity to anti-growth signals
  3. Tissue invasion & metastasis
  4. Limitless replicative potential
  5. Sustained angiogenesis
  6. Evading apoptosis
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4
Q

Types of tumors include = ?

Cancer

A

Types of Tumors:

(1) Benign tumors stays confined to its original location.

(2) Malignant tumors are capable of invading surrounding tissue or invading the entire body.

  • Lymphatic system
  • Blood vessel
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5
Q

The spread of cancer cells from the place where they first formed to another part of the body = ?

Cancer

A

Metastasis: The spread of cancer cells from the place where they first formed to another part of the body.

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6
Q

Most common site for metastasis = ?

Cancer

A

Common Sites of Metastasis:

(a) Bone, Liver, Lung: most common site for metastasis

  • Most people have multiple sites of metastasis and not all of which presents at any one time.
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7
Q

Anatomic Site Classification:

  • Benign tumor = ?
  • Malignant tumors = ?
  • Leukemias and lymphomas= ?

Cancer

A

Anatomic Site Classification:

(a) Named according to the tissues from which they originated:

(i) Benign tumor (suffix “oma”) and non-malignant in nature.

  • Chondroma
  • Adenoma (“adeno-” means gland-like)
  • Lipoma (“lipo-” means fat)

(ii) Malignant tumors (carcinoma or sarcoma) invasive and malignant in nature

  • Carcinomas: are cancers of epithelial cells (constitute 85-90% of cancers)
  • Sarcomas: are cancers of connective tissues (connective tissue, cartilage, muscle, bone etc.)

(iii) Leukemias and lymphomas: are cancer of blood forming cells (bone marrow and blood) and immune system (T and B cells) respectively (constitute 8% of tumors).

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8
Q

Cell proliferation = ?
Cell differentiation = ?

Cancer

A

(a) Cell proliferation:

  • Increase in cell number by mitotic cell division

(b) Cell differentiation:

  • Proliferating cells become progressively more specialized cell types
  • Results in fully differentiated adult cell that has specific set of structural and functional properties

(c) Notes:

  • Cancer is a disorder of altered cell differentiation and growth
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9
Q

Benign and malignant neoplasm are distinguished by = ?

Cancer

A

(a) Benign and malignant neoplasm are distinguished by the following:

  • Cell characteristics
  • Rate of growth
  • Manner of growth
  • Capacity to invade and metastasize

  • Neoplasm = An abnormal mass of tissue that forms when cells grow and divide more than they should or do not die when they should.
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10
Q

Benign vs. Malignant:

  • Cell characteristics = ?
  • Rate of growth = ?
  • Mode of growth = ?
  • Metastasis = ?

Cancer

A

Benign vs. Malignant:

Benign:

(-) Cell characteristics = Well differentiated that resemble cells in the tissue of origin

(-) Rate of growth = Usually progressive and slow, may come to standstill / regress.

(-) Mode of growth = Grows by expansion without evading the surrounding tissue, usually encapsulated.

(-) Metastasis = Does not spread by metastasis.

Malignant:

(-) Cell characteristics = Cells are undifferentiated with anaplasia and atypical structures that often bears little resembles to the cells in the tissue of origin

(-) Rate of growth = Variable; more undifferentiated the cells more rapid the rate of growth

(-) Mode of growth = Grows by invasion, sending out process that infiltrate the surrounding tissue.

(-) Metastasis = Gains access to blood, lymph channels to metastasize to other parts of body.

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11
Q

Cancer:

Diagnostic methods include = ?

Cancer

A

Diagnostic methods:

  • Blood tests for tumor markers
  • Cytological studies and tissue biopsy
  • Endoscopic examination
  • Ultrasonography
  • X ray studies
  • MRI
  • CT
  • PET
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12
Q

Grading of Cancer:

  • Grade #1 = ?
  • Grade #2 = ?
  • Grade #3 = ?
  • Grade #4 = ?

Cancer

A

Histologic Analysis Classification:

(a) Based on cellular appearance and differentiation

  • Grade 1: Differ slightly from normal; well differentiated
  • Grade 2: More abnormal; moderately differentiated
  • Grade 3: Poorly differentiated
  • Grade 4: Immature, primitive and undifferentiated cells; difficult to determine cell of origin.
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13
Q

Clinical Staging:

  • 0 = ?
  • 1 = ?
  • 2 = ?
  • 3 = ?
  • 4 = ?

Cancer

A

Clinical Staging:

  • 0: Cancer small and in situ (situ means in it’s original space)
  • 1: Tumor limited to tissue of origin
  • 2: Limited local spread
  • 3: Extensive local and regional spread
  • 4: Metastasis
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14
Q

Tumor Markers:

  • Tumor cell markers (biologic markers) are = ?
  • Screening includes = ?

Cancer

A

Tumor Markers:

(a) Tumor cell markers (biologic markers) are antigens expressed on the surface of tumor cells or substances produced by cancer cells or normal cells in response to presence of tumor

(b) Screening, establishing prognosis, monitoring treatment and detecting recurrent disease

  • Hormones
  • Enzymes
  • Genes (B-Rraf, K-Ras etc)
  • Antigens (PSA – in blood, prostate cancer)
  • Antibodies
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15
Q

Process of Cancer Development = ?

3 stages

Cancer

A

Process of Cancer Development:

  • Exposure of cells to carcinogenic agents that causes them to be vulnerable to cancer transformation.
  • Growth of cells
  • Tumor cells acquire malignant phenotypic changes
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16
Q

Risk factor:

  • Modifiable = ?
  • Non modifiable = ?

Cancer

A

Risk factor:

(a) Modifiable:

  • Smoking, tobacco use
  • Chemical exposure like paint, dye, rubber, asbestos, radon, ionizing radiations, herbicides, pesticides
  • Alcohol consumption (> 1-2 drinks/ day)
  • Sedentary lifestyle
  • Obesity
  • Diet
  • Radiations
  • STDs/ viruses
  • Vitamin B12 deficiency
  • Lack of access to use of health care and screening tests

(b) Non modifiable:

  • Age
  • Previous cancer
  • Ethnicity
  • Gender
  • Heredity / genetics
  • Congenital diseases / immunodeficiency
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17
Q

Seven Warning Signs of Cancer = ?

CAUTION

Cancer

A

Seven Warning Signs of Cancer:

  • Change in bowel or bladder habits
  • A sore throat that does not heal
  • Unusual bleeding or discharge from body orifice
  • Thickening or lump in breast or elsewhere
  • Indigestion or difficulty in swallowing
  • Obvious change in wart or mole
  • Nagging cough or hoarseness
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18
Q

Clinical Manifestations of Cancer = ?

Cancer

A

Clinical Manifestations of Cancer:

  • Cancer in earliest stages are asymptomatic.
  • As cancer progresses, symptoms characteristic of involved organ / tissue start to develop.
  • Rapid growth encroaches healthy tissue- destruction, necrosis, hemorrhage.
  • Continued spread- GI, vascular obstruction, brain, neurologic, MSK, hepatic, pulmonary, integumentary.
  • Cancer pain
  • Cancer related fatigue
  • Paraneoplastic syndromes
  • Cancer related anorexia / cachexia
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19
Q

Cancer - Signs and Symptoms:

  • Integumentary = ?

Cancer

A

Signs and Symptoms - Integumentary:

  • Any skin lesions or observable/ palpable skin changes
  • Any observable palpable changes in nail bed
  • Unusual mole (ABCDE) method
  • Bleeding/ discharge from mole, skin lesion, scar or nipple
  • Tenderness or soreness around a moleMusculoskeletal
20
Q

Cancer - Signs and Symptoms:

  • Musculoskeletal = ?

Cancer

A

Signs and Symptoms - Musculoskeletal:

  • Asymptomatic soft tissue mass, soft tissue swelling
  • Bone pain (does not respond to physical agents)
  • Pathologic fractures
  • Hypercalcemia
  • Back pain/ rib pain
21
Q

Cancer - Signs and Symptoms:

  • Neurologic = ?

Cancer

A

Signs and Symptoms - Neurologic:

  • Drowsiness, lethargy, headache, nausea, vomiting
  • Depression, irritability, personality change, confusion, memory loss, vision changes like blurring, vision loss.
  • Numbness, tingling, balance, coordination problems, changes in DTR’s change in bladder bowel function, myotomal weakness pattern.
22
Q

Cancer - Signs and Symptoms:

  • Pulmonary = ?

Cancer

A

Signs and Symptoms - Pulmonary:

  • Pleural pain, dyspnea, new onset of wheezing, productive cough with rust, green, or yellow tinged sputum.
23
Q

Cancer - Signs and Symptoms:

  • Hepatic = ?

Cancer

A

Signs and Symptoms - Hepatic:

  • Abdominal pain, tenderness, jaundice, ascites, distended abdomen, dilated upper abdominal veins, peripheral edema, general malaise and fatigue, bilateral carpal tunnel/ tarsal tunnel syndrome, asterisks, palmar erythema, spider angiomas, right shoulder pain.
24
Q

Risk factor Assessment for Skin Lesions = ?

Cancer

A

Risk factor Assessment for Skin Lesions:

(a) When a suspicious skin lesions is noted:

  • How long have you had this area of skin discoloration/mole/spot
  • Had it changed in past 6 weeks to 6 months
  • Has your physician examined this area
25
Q

ABCD of Skin Lesion:

  • A = ?
  • B = ?
  • C = ?
  • D = ?
  • E = ?
    • Warning sign for Melanoma = ?

Cancer

A

ABCD of Skin Lesion - Signs of melanoma:

(i) “A” stands for asymmetrical.

  • Does the mole or spot have an irregular shape with two parts that look very different?

(ii) “B” stands for border.

  • Is the border irregular or jagged?

(iii) “C” is for color.

  • Is the color uneven?

(iV) “D” is for diameter.

  • Is the mole or spot larger than the size of a pea?

(v) “E” is for evolving.

  • Has the mole or spot changed during the past few weeks or months?

(vi) Warning sign for Melanoma:

  • Flat, growing, irregularly shaped lesion, light brown to black color, it may turn various shades of red, blue, white, crust on the surface and bleed.
26
Q

Cancer Pain:

  • Causes = ?

There are ALOT!

Cancer

A

Cancer Pain:

(a) Causes:

(i) Pressure on nerves / Infiltration if Nerves:

  • Continuous, sharp, stabbing pain following the pattern of nerve distribution
    (ii) Visceral obstruction:
  • Severe colicky cramp like or diffuse dull boring
  • Throbbing pain from interference with blood supply

(iii) Bone metastasis:

  • Bone pain, pathologic fractures
  • Inflammation, infection and necrosis can cause pain
  • Immobility/ inflammation can also lead to pain

(iv) Superficial / Mild to Moderate Pain:

  • Sympathetic response- hypertension, tachycardia, tachypnea (rapid shallow breathing)

(v) Visceral pain / severe:

  • Parasympathetic response = Hypotension, bradycardia, nausea, vomiting, tachypnea, weakness, faintness
  • Anxiety / depression increases the client’s perception of pain

(vi) Pharmacological management:

  • Opioids, non opioids

(vii) Non pharmacological management:

  • Acupuncture, cryotherapy, biofeedback, relaxation techniques.

(b) Notes:

  • 50-70% clients in early stages
  • 60-90% clients in late stages
27
Q

Systemic and Musculoskeletal Pain:

  • Course/ duration = ?
  • Aggravating factors = ?
  • Relieving factors = ?
  • Quality = ?

Cancer

A

Systemic and Musculoskeletal Pain:

(a) Systemic:

- Course/ duration:

  • Constant or cyclic, progressive, awakens at night

- Aggravating factors:

  • Cannot alter, alleviate or eliminate with movement, organ dependent: esophagus- eating swallowing, heart- cold, exertion, stress

- Relieving factors:

  • Usually none, organ dependent; gallbladder: leaning forward; kidneys: leaning to the affected side; pancreas: sitting upright or leaning forward

- Quality:

  • Unilateral or bilateral; deep aching throbbing, diffuse or waves/ spasm

(b) Musculoskeletal:

- Course/ duration:

  • Usually intermittent/ can be modified with rest or change in position.

- Aggravating factors:

  • Altered by movement, may become worse with movement.

- Relieving factors:

  • Rest, change in support, heat/cold; stretching.

- Quality:

  • Usually unilateral, sharp, local tenderness, stiffness.
28
Q

Cancer Related Fatigue (CRF):

  • Factors contributing to CRF include = ?
  • Fatigue management includes = ?

Cancer

A

Cancer Related Fatigue (CRF):

(a) CRF is distressing, persistent, and subjective sense of tiredness, or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning

  • Fatigue present in nearly all people receiving chemo, radiotherapy, biologic response modifiers, bone marrow transplant

(b) Factors contributing include:

  • Anemia
  • Poor nutrition
  • Infection
  • Depression
  • Pain
  • Medications

(c) Fatigue should be screened at initial visit at regular intervals, during and after cancer treatment, as when clinically indicated, assessed, managed:

  • Activity pacing
  • Structured daily routine with one activity at a time.
  • Aerobic exercise, nutrition
  • Exercise at lower intensity, progress at slower pace.
29
Q

Systemic signs and symptoms that are not the direct effects of either the tumor or its metastases = ?

Cancer

A

Paraneoplastic Syndromes:

  • Systemic signs and symptoms that are not the direct effects of either the tumor or its metastases.
  • When tumors produce signs and symptoms at a site distant from the tumor or its metastasized sites.
  • Many of these syndromes involve ectopic hormone production by tumor cells, or the secretion of biochemically active substances.
  • Small cell carcinoma of lung - produce ACTH - Cushing’s syndrome
30
Q

Cancer Related Cachexia:

  • What is it = ?
  • Mechanisms include = ?

Cancer

A

Cancer Related Cachexia:

(a) Most severe form of malnutrition

  • Cause of morbidity and mortality in 50-80% of cancer patients with advanced cancer.
  • Hyper-metabolic state and altered nutrient metabolism.
  • Loss from both muscular and skeletal compartment

(b) Includes:

  • Anorexia, weight loss, anemia, and altered protein, lipid metabolism

(c) Mechanisms:

  • Tumor use large amounts of glucose - lot of ATP is used
  • Use of fat and proteins
  • Persistent inflammatory response, suppresses the satiety center in hypothalamus.
31
Q

Referral to physician when = ?

signs and symptoms

Cancer

A

Physician Referral:

Important for PTs esp in patients with family history of cancer or previous history of cancer.

  • Changes in DTRs (hyper reflexive/ hypo reflexive)
  • A myotomal weakness pattern
  • Changes in bladder/ bowel function
  • Pain that is unrelieved by rest or change in position, does not respond to treatment ,unremitting, at night
  • Recently discovered lumps / nodules
  • Changes in lymph nodes (hard, immovable, non- tender)
  • Idiopathic proximal muscle weakness
32
Q

Cancer Treatment:

  • Local = ?
  • Local Regional = ?
  • Systemic = ?

Cancer

A

Cancer Treatment:

  • Local = Surgery
  • Local Regional = Radiotherapy
  • Systemic =
    • Chemotherapy
    • Immunotherapy
    • Hormones
    • Biologic therapy
33
Q

Administer medications systematically to interrupt tumor growth or kill tumor cells = ?

Cancer

A

Chemotherapy:

(a) Administer medications systematically to interrupt tumor growth or kill tumor cells

(b) Chemotherapy is cytotoxic to dividing cells selectively by blocking the ability of DNA and RNA to reproduce

  • Can be given orally, IM, IV
  • Rapidly dividing cells are most sensitive (tumor cells, hair, GI, reproductive, & blood cells): cause of most side effects.

(c) Drugs usually given in combination:

  • TC (Taxol/Taxotere + Cytoxan) is gradually replacing
  • AC, the Adriamycin-based “gold standard” of chemo for many years
34
Q

Side Effects of Chemotherapy Drugs = ?

Cancer

A

Side Effects of Chemotherapy Drugs:

(-) Peripheral neuropathy (chemotherapy induced peripheral neuropathy; CIPN)

(-) Fatigue

(-) GI effects: anorexia, nausea, vomiting, diarrhea and constipation

(-) Anxiety/ depression

(-) Fluid electrolyte imbalance

(-) Hepatotoxicity

(-) Hemorrhage

(-) Bone marrow suppression

  • Anemia
    • Fatigue, muscle weakness, dizziness, dyspnea, pallor, tachycardia.
    • RBCs transfusions, injectable Epogen, a recombinant form of human erythropoietin
  • Leucopenia (neutropenia)
    • Opportunistic infections: result in dose reduction, treatment delays, and hospitalizations.
  • Thrombocytopenia

(-) Hair loss

(-) Poor wound healing

35
Q

Cancer:

  • Physical activity assessment incluces = ?

Cancer

A

Cancer - Physical activity assessment incluces:

36
Q

ACSM:

  • Guidelines = ?
  • Considerations = ?

Cancer

A

ACSM:

(a) Guidelines:

(b) Considerations:

(a) Slower progression may be needed compared to healthy adults.

  • FITT principle of Ex Rx should be reduced to a level that is better tolerated.
  • Several short bouts per day rather than a single bout may be useful, particularly during active treatment.

(b) If tolerated without adverse effects of symptoms or side effects, the Ex Rx need not differ from healthy populations.

(c) Bone is a common site of metastases in many cancers.

  • Will require modification of their exercise program (e.g., reduced impact, intensity, volume) given the increased risk of bone fragility and fractures.
37
Q

Symptomatic Precaution During Exercise Testing or Training:

  • Contact physician if = ?

Cancer

A

Symptomatic Precaution During Exercise Testing or Training:

(a) Contact physician if:

  • Night pain
  • Fever
  • Extreme unusual fatigue
  • Unusual muscular weakness
  • Irregular heart beat, chest palpitations and chest pain
  • Sudden onset of dyspnea
  • Leg pain/ cramps
  • Unusual joint pain
  • Recent or new onset back, neck or bone pain
  • Unusual bruising, nosebleeds, or body from any other body opening
  • Sudden onset nausea during exercise
  • Rapid weight gain or weight loss
  • Severe diarrhea/ vomiting
  • Disorientation, confusion, dizziness or lightheadedness
  • Blurred vision or other visual disturbances
  • Unusual skin rash
38
Q

Monitoring the Lab Values:

  • Hematocrit = ?
  • Platelets = ?
  • Hemoglobin = ?
  • WBC’s= ?

Cancer

A

Monitoring the Lab Values:

(a) Hematocrit:

  • Normal = 43-49% male / 38-44% female
  • NO exercise = < 25%

(b) Platelets

  • Normal = 150,000-350,000
  • NO exercise = < 20,000

(c) Hemoglobin

  • Normal = 14.4-16.6 mg/dL male / 12.2-14.7 mg/dL female
  • NO exercise = < 8 mg/dL

(d) WBC’s

  • Normal = 4500-11000 mm^3
  • NO exercise = < 5000 mm^3
39
Q

Using focal ionizing radiation to damage the cell DNA and prevent further replication of proliferating cells = ?

Cancer

A

Radiation Therapy:

(a) Using focal ionizing radiation to damage the cell DNA and prevent further replication of proliferating cells

(i) External radiation

  • X-rays
  • Gamma rays

(ii) Internal radiation

  • Radioactive source is placed close to or directly in the tumor site

(iii) Systemic radiation

  • Radioisotopes are given orally or injected into the tumor site

(b) Can affect normal tissue that is rapidly proliferating like bone marrow

  • Decrease in leukocytes, platelets and red blood cells.
40
Q

Side effects of radiation therapy = ?

Cancer

A

Side effects of radiation therapy:

  • Fatigue
  • Immunosuppression
  • Decreased platelets, bleeding, anemia
  • Decreased WBC’s, infections
  • Infection
  • Fatigue
  • Diarrhea
  • Skin redness, dryness, irritation, itching, burns
  • Edema
  • Hair loss
  • Ulceration; overtime hyperpigmentation and atrophy
  • Delayed wound healing
  • Destruction of lymph tissue
  • Bone necrosis and demineralization (radiation osteonecrosis)
    • Increased likelihood of fractures
41
Q

Exercise and Radiation Therapy:

  • Rx = ?

Cancer

A

Exercise and Radiation Therapy:

  • Moderate intensity exercise (walking for 20-45 minutes), 3-5 times/week at 50-70% of the measured maximum heart rates during 7 weeks of radiation shown to maintain erythrocyte levels.
  • Reduce anxiety, improve mood, reduce stress.
  • Improve QOL
42
Q

Side Effects of Surgery = ?

Cancer

A

Side Effects of Surgery:

  • Fatigue
  • Loss of function
  • Disfigurement
  • Infection
  • Increased pain
  • Deformity
  • Bleeding
  • Scar tissue
  • Fibrosis
43
Q

Chemo-induced peripheral neuropathy (CIPN):

  • Symptoms = ?

Cancer

A

Chemo-induced peripheral neuropathy (CIPN):

(a) Peripheral neuropathy (chemotherapy induced peripheral neuropathy; CIPN)

(b) Symptoms:

  • Glove and stocking
  • Symmetric
  • Tingling
  • Numbness
  • Burning
  • Impaired sensation to touch and vibration
  • Sensitivity to heat and cold
44
Q

Oncology Rehabilitation:

PT signs & symptoms = ?

Cancer

A

Oncology Rehabilitation:

  • Cancer-related fatigue
  • Poor endurance
  • Postural changes
  • Gait abnormality
  • Balance/coordination deficits
  • Joint stiffness
  • Muscle weakness
  • Pain
  • Pelvic floor dysfunction
  • Pre-and post-op teaching
  • Scar tissue restriction
  • Radiation fibrosis
  • Chemo-induced peripheral neuropathy (CIPN)
  • Cognitive changes
  • Lymphedema/Edema
  • Sleep disturbance
  • Body image changes
45
Q

Drugs that can cause CIPN = ?

Cancer

A

Drugs that can cause CIPN:

(a) Platinum - based agents

(b) Taxanes

(c) Vinca Alkaloids:

  • Thalidomide
  • Lenolidamide
  • Methotrexate

(d) Rehabilitation:

  • Balance
  • Mobility
  • Quality of life
  • Strength
46
Q

CIPN Rehabilitation:

  • Phase #1 = ?
  • Phase #2 = ?
  • Phase #3 = ?
  • Outcome measures = ?

Cancer

A

CIPN Rehabilitation:

(a) Phase #1:

  • Balance training
  • Coordination practices

(b) Phase #2:

  • Endurance training
  • Resistance training

(c) Phase #3:

  • Cool down

(d) Outcome measures:

  • neurotoxicity questionnaire
  • balance
  • endurance
  • strength
47
Q

Lymphedema:

  • Phase #1 = ?
  • Phase #2 = ?

Cancer

A

Lymphedema:

  • Complete decongestive therapy
  • Manual lymphatic drainage
  • Compression
  • +Bandaging
  • Exercises

(i) Phase #1 = Decongestion

(ii) Phase #2 = Maintenance

DPT 682 - Pathophysiology (16 decks)

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