Cancer Flashcards
Lymphedema
a buildup of lymph fluid in the fatty tissues under the skin that causes swelling; it is often a sequela to surgery and/or radiation that involves one or more lymph nodes and remains a lifetime risk for people living with cancer.
Metastasis
occurs when cancer cells migrate into the bloodstream or lymph system, travel to other parts of the body, and form new tumors.
Palliative care:
an approach that aims to improve quality of life for families and patients facing life-threatening illness. It provides relief from pain and other distressing symptoms, support to help patients live as actively as possible, and coping and bereavement assistance.
Peripheral neuropathy:
refers to numbness, tingling, and/or pain caused by nerve damage.
Survivorship:
the cancer journey phase that begins as patients complete medical treatment and continues throughout the remainder of the patients’ lives.
Cancer survivors face long-term side effects and health risks as a result of
both treatment and ongoing fear of recurrence.These challenges may interfere with activity and role performance, necessitating the services of occupational therapists.
The term cancer refers to a
group of diseases in which abnormal cells divide without control, can invade nearby tissues, and travel through the blood and lymph systems to other body parts.
Staging is the process of
determining the severity of a person’s cancer based on the degree to which a cancer has spread4
Common elements in most staging systems consider
the primary tumor site, tumor size and number, spread into lymph nodes, and the presence or absence of metastasis
Stage 0
Abnormal cells are present but have not spread to other tissues. This stage is typically highly curable.
Stage I
Cancer that is the next least advanced; patients often have good prognosis. This is referred to as early-stage cancer because a small cancer or tumor hasn’t spread to lymph nodes or other body parts.
Stage II-III
Cancer involving more extensive disease as indicated by greater tumor size and/or cancer spread to nearby lymph nodes, but not to other body parts.
Stage IV
Cancer that has spread to other organs or body parts. This is referred to as advanced or metastatic cancer.
Problems that may interfere with occupational performance with - Breast Cancer
weakness, fatigue, body image issues, pain, lymphedema, limited ROM, brachial plexus injury, cognitive inneficiencies
Problems that may interfere with occupational performance with - lung Cancer
fatigue, dyspnea, weakness, limited ROM, limited endurance
Problems that may interfere with occupational performance with - Brain Cancer
cognitive problems, impaired vision and balance, decreased sensation, dysphasia, hemiparesis, impaired coordination, personality changes
Problems that may interfere with occupational performance with - Sarcoma
Possible amputation or issues associated with limb salvage, body image issues, peripheral neuropathy, pain, fatigue, edema
Problems that may interfere with occupational performance with - colorectal
Gastrointestinal problems (diarrhea, constipation, incontinence, bowel obstruction), physical and psychosocial challenges associated with managing an ostomy
Cancer-related fatigue (CRF)
defined as an upsetting and enduring sense of physical, emotional, and/or cognitive exhaustion that impedes functioning and is inconsistent with recent activity levels.
Cancer-related fatigue (CRF) involves what concurrent symptoms.
CRF involves concurrent symptoms such as pain, stress, low red blood cell count, and difficulty sleeping.
What does the The National Comprehensive Cancer Network (NCCN) recommends for cancer related fatigue
referral to occupational therapy for nonpharmacological CRF intervention.
What is cancer-related cognitive dysfunction (CRCD; sometimes called chemobrain)?
CRCD involves mild but disruptive changes in memory, executive functions, attention, and processing speed
Chemotherapy-induced peripheral neuropathy (CIPN)
describes sensory impairment of the peripheral nerves caused by neurotoxicity associated with many commonly used chemotherapy drugs.
proto-oncogene is a
normal gene that has the potential to become more active or mutate into a cancer-causing oncogene.
Oncogenes allow
cells to grow and survive when they normally would not.
Benign tumors
do not spread into or invade nearby tissues, although they can still cause damage to the body.
Malignant tumors can
destroy normal cells and invade other tissues. As a tumor grows, some cancer cells can break off, traveling in the bloodstream or the lymphatic system to other body parts.
metastasis
When cancer cells can break off, traveling in the bloodstream or the lymphatic system to other body parts. This process is known as
Hyperplasia
occurs when cells divide faster than normal, and there is a buildup of extra cells or an increase in cell mass.
Intrinsic risk factors are those over which the individual has
no control
Dysplasia is
a buildup of cells that appear abnormal microscopically, and there are differences from normal cells noted in cell organization, size, and shape.
extrinsic risk factors may be
modifiable and and thus preventable.
examples of intrinsic risk factors for cancer
age, heredity, hormones, immune system competence, and metabolic abnormalities.
Five main categories of cancer In situ:
In Situ, localized, regional, distant, unknown
In situ:
Abnormal cells are present only in the layer of cells in which they developed.
Localized:
Cancer is limited to the organ in which it began no evidence of spread.
Regional:
Cancer has spread beyond the primary site to nearby lymph nodes, tissues, or organs.
Distant:
Cancer has spread from the primary site to distant tissues or organs or to distant lymph nodes.
Unknown:
There is not enough information to determine the stage.
survivorship
long term impact of cancer after cancer is gone.
NY state most common occurring cancer
Prostate
Breast (female)
Lung & bronchus
Areas of occupation most frequently impacted by cancer
Bathing/showering; dressing; eating/feeding
areas of body function most frequently impacted by cancer
Attention; memory; physical energy & endurance
performance skills most impacted by cancer
Bending; reaching; coordinating body movements
T =
N =
M =
Tumor, Node, Metastasis
Tumor 1-4
Indicates growth of tumor
T1= smaller tumor
T4= larger tumor that has grown into another organ
Nodes
0-2
Shows if cancer has grown to lymph nodes
N0 = no lymph no growth
N1 = cancer spread to 1-3 nodes
N2 = cancer spread to 4 or more nodes
Metastasis
0-1
Shows if cancer has spread to other distant parts of the body
M0= cancer has not spread
M1= cancer has spread
Common Metastasis Sites
Bone
Brain
Lungs
Liver
Lymph nodes
87% of patients with cancer have what kind of needs?
rehabilitation needs
qualifying conditions with cancer for OT
ADL/IADL
Debility, fatigue
Neuropathy
Lymphedema
Cognitive decline
UE impairment
Balance issues
Pain
Falls
How does an OT intervene with cancer patient for Preventative
Care
talk to them about post surgery and how to manage and keep things from getting worse.
Restorative care with patients with cancer
how to get back to normal level of function
Supportive role for OTs in cancer care
keeping them as strong as possible to maintain strength and keep them indipendent in their own home.
palliative care is
looking at quality of life. looking at balance between function and comfort.
what is the challenge for palliative care
healthcare doesn’t pay for palliative care.
what would OT intervene with in Acute Care:
general mobility, endurance, cognitive stim, positioning, self care
what would OT intervene with in Rehab/Subacute:
Restore function, strengthening, energy conservation, ADLs
what would OT intervene with in Home Care:
Restore daily ADLs, equipment, compensatory strategies, caregiver training, progress indep
what would OT intervene with in Outpatient:
improve ROM, strength, endurance for function
Assessments areas for cancer
- ADL/IADL - BI, AMPAC
- Fatigue - Cancer Fatigue Scale
- Neuropathy - Sensation
- Lymphedema - Circumferential measurements
- Cognitive decline - TFLS, CPT, MMSE, MoCA
- UE Impairment - DASH, ROM, MMT, Dynamometer, pinch meter, goniometer, sensation,
- Balance - Berg, TUG, 5XSST,
- Falls - Functional React Test, TIS
- Pain - Pain Analog Scale
What are the type of treatments a person with cancer may have all at the same time
Surgery
Chemotherapy
Radiation
Hormone
Alternative Approaches
debulking-
remove part of malignant tumor to enhance effectiveness of chemo/radiation TX
types of surgery
Mastectomy or lumpectomy
Ovarian (bilateral salpingo-oophorectomy)
Cystectomy - removal of part of bladder.
with anytime of abnominal surgery what type of bed mobility are we doing
log rolling
post surgery what the weight lifting precautions?
no more than 5lbs with affected side no more than 10 with both.
abdominal surgery precautions
Log roll
No lift > 5-10 lbs
Avoid strain
Binder
Body mechanics
Back protection
What are some things to be cautious of for someone who’s had surgery after cancer
Drains & lines
Glad press & seal to cover in shower
Check BP first bf shower
Transfers
Side effects of chemotherapy
Nausea
Vomiting
Mouth Ulcers
Hair Loss
Fatigue
Decreased WBC
oral hygiene and chemo
chemo can cause bleeding in gums. offer a soft brush and being very careful with flossing.
a person receiving chemo is considered to be what kind of risk?
immunocompromised. it lowers white count and makes them more at risk for infection.
radiation therapy
- Shrinks tumor via gamma or x-ray
- May occur prior to surgery or along with other therapies
- can cause a burn on the skin.
Gliomas (Supportive Tissue)
Astrocytoma Brain or SC
Cerebrum
Glioblastoma Multiforme (GBM)
Young adults affected
Neurological presentation may be cognitive, sensory, motor
secondary brain tumors
Cancer cells originate elsewhere & spreads through metastasis
Multiple Myeloma:
Cancer of plasma cells of bone marrow (check weight bearing status, pathological FX)
Vital Organ cancers:
Kidney, liver, lung, pancreas, or stomach
Reproductive Organ cancers:
Uterine, ovarian, fallopian tubes, prostate
platelet more tha 5000
May be on bedrest
platelets more than 10000
No ex. but can walk in room or bathroom if steady
platelets between 10 and 19,000
AROM & Cardio ok without strain or signs of bleeding (no PROM)
20,000 & 49, 000 platelets
Strength & cardio of if no bleeding but without strain. NO massage
50,000 - 100,000 platelet count.
Cardiovasc ex and strengthening w/ resistance ok – if no bleeding
Hematocrit (HCT): must be
> than 25% for any form of exercise
25 light ex, shower
30-32 resistive ex as tolerated
Hemoglobin (HB): must be
> than 8.5 for any form of exercise
8-10 light exercise
10 resistive exercise
Precautions of working with a patient with cancer
Blood levels - but OT’s don’t need to know that but they nurses may weigh in.
Mucositis: side effect of chemo mouth ulcers or painful swallow
Steroid Myopathy: weakness of prox to distal ms . weakness of hands and hips.
hand to foot syndrome - looks like they have sunburn on hands and feet.
With hand and foot syndrome why does it happen , how to modify
side effect of chemo. be cautious of textures, transfers, no friction on skin. water temp is mild. Make sure gate belt doesn’t go directly on skin.
what consideration would use to choose assessment
type of cancer and what symptoms the cancer is created. consider what setting you are in. are they post-op, outpatient, etc.
