Cancer Flashcards
What is Cancer?
- A general term used for the abnormal, uncontrolled growth of cells
Cancer cells don’t respond to the normal restraints on proliferation
Once growth has commenced, these cells divide in an uncontrolled way
“Tumour” and “neoplasm” are terms used to describe these new growths
Neoplasms fuel their growth by using the nutrients and blood supply of their hosts
Not all tumours are a concern
Benign tumour is an encapsulated growth comprised of slowly proliferating cells and are not considered serious unless they compress vital structures
Malignant tumours is a type that can destroy other tissues
Malignant tumours have two important qualities: they are invasive without an encapsulated structure and they spread into neighbouring tissue - they are able to move to new sites
Referred to as “metastasizing”, the movement of cancer cells to other areas of the body occurs by way of the circulatory system or the lymphatic system
Naming Types of Cancer
The suffix “oma” is used to designate a tumour and is added to the name of the tissue type from which the tumour originated
Ex. osteoma (a benign tumour of the bone)
Ex. glioma (a malignant tumour of the glial nerve cells)
Carcinoma is a term used for a malignant tumour that originates in epithelial tissue
Ex. squamous cell carcinoma (malignant cancer of the skin)
Sarcoma is the term used for a tumour that develops in connective tissue such as cartilage, bone, muscle and fat. Often highly malignant but not common
Ex. osteosarcoma (malignant bone cancer)
Causes of Cancer
For many cancers, the cause is unknown and for any specific cancer there is not one single cause
Carcinogens are chemical and environmental agents known to cause cancer, these include:
- Cigarette smoke
- Radiation from UV rays of sunlight
- Certain drugs and hormones such as some immunosuppressors and estrogen
- Industrial agents or toxic substances such as asbestos, chromium, coal tar, benzene, cadmium, radon, uranium and nickel
- Excesses or deficiencies in diet, particularly low fibre and high fat
Heredity plays a role with some types of cancers
Medical Treatment of Cancer
- Surgery:
Is primarily used to excise localized tumours
To optimize success in removing the cancer, other forms of treatment are frequently used in conjunction with surgery
Most cancers will metastasize into neighbouring tissues so surgery will be used to partially remove the cancer and another therapy used to treat the remaining cancer
Side effects:
Theses are the same for any surgical procedure including risks from anesthesia use, respiratory complications, bleeding, DVT, infection, pain and fatigue
- Chemotherapy:
The use of chemical agents to destroy the cancer cells
The drugs are administered orally, by injection or intravenously and they travel through the bloodstream and affect the entire body
The drugs interfere with the cancer cells’ ability to reproduce and thereby prevent the development of a new tumor
Because there drugs target rapidly dividing cells, it results in the destruction of healthy, quickly growing non-cancerous cells such as hair, blood and skin cells
Side effects:
Most common is nausea and vomiting
Chronically, hair loss, mouth sores, nausea, diarrhea or constipation and low blood counts can occur
- Radiation:
Frequently used to destroy localized cancer
It is also used to shrink tumours to give relief from symptoms during palliation
General side effects:
Fatigue is common, especially if a large area is treated
Skin reactions are usually temporary and appear similar to a sunburn
Localized side effects:
Head, face and neck radiation may result in irritation of the mucosa of the mouth and dry mouth. Taste can be affected and hair loss can occur
Chest radiation may cause irritation of the esophageal lining resulting in heartburn-like symptoms, difficulty swallowing or chewing and coughing
Radiation-related fibrosis is extensive scarring which may occur from 9 months to 2 years post-treatment
- Biological Therapy:
Destroys cancer cells by exploiting the immune system and its ability to eliminate and destroy foreign substances in the body
It involves highly purified proteins that help activate or generally enhance the immune system
Massage and Cancer
A diagnosis of cancer has a tremendous emotional impact on people
There is fear of the disease and of the treatments and their side effects
Support systems and relaxation strategies are recommended to promote psychological wellness
Massage cannot treat cancer, but can reduce some of the symptoms such as pain and tension. It can also aid in relaxation and stress reduction
There is no evidence that massage can promote metastasizing of cancer but is suggested that the therapist inform the client regarding uncertainty about massage increasing the risk of metastasizing the cancer
Warning Signs of Cancer
Changes in bowel movements or flow of urination
Healing time of injuries increases (if the cut doesn’t heal for a long time, talk to them to get it check out)
Unusual bleeding
Any thickening or lump
Changes in digestion
Difficulty swallowing or eating
Chronic coughing
Changes in size, shape or colour in a wart or mole
Unexplained sudden loss of weight such as 10-15lbs in two weeks
Unusual headaches or changes in vision
Noticeable proximal muscle weakness for no apparent cause
Contraindications
- Post-surgical massage is CI’d locally and their physician should be contacted before proceeding
- Radiation frequently creates burns so creams, oils, etc should not be used over the affected area during the radiation period
- All massage is CI’d on the affected tissue for a few days after treatment
- Chemotherapy and radiation can often result in nausea so massage may or may not be tolerated by the client
- Lymphatic drainage is CI’d with untreated or metastasizing neoplasms
- Hot hydrotherapy applications are CI’d with lymphedema
- Heavy pressure techniques should be avoided at the scar and distal to not provoke a lymphedema from occurring
- Vigorous or stimulating techniques or treatments of long duration are CI’d for debilitated clients
Health History Questions (after diagnosis)
- When was the diagnosis? How has it progressed? Do you know the location of the tumour(s) and the risk of metastasis??
What symptoms are you experiencing from the cancer? - Did you have surgery? What was removed?
- Is further treatment currently being received? What is the treatment and schedule?
- What side effects are you experiencing?
If treatment is finished, when was your last treatment? - What is the prognosis?
- Are you experiencing any pain? What is the location, quality, duration and frequency of pain?
- Are you taking any medication, prescribed or over-the-counter? Are there any side effects being experienced?
- Is there any edema present? If so, where?
- Is your physician aware you are seeking massage?
- Do you consent to the therapist contacting your physician?
- Are you exercising regularly or are generally active?
- Have any restrictions been placed on the you by yourself or your physician?
Observation & Palpation
Redness and warmth may be noticed after radiation treatments
Tissue wasting and disuse atrophy may be present if the client is bedridden or in later stages of terminal cancer
Edema due to local lymphatic obstruction or removal
Scars from surgery should be noted and secondary fascial restrictions are very likely
Tenderness and pain may be present post-surgery
Massage During Medical Treatment
Relaxation massage can be beneficial for clients with cancer
Pain relief and symptom relief are achieved through the decrease of SNS firing
Full body massage may not be possible due to tumour sites, new surgical sites and recently radiated sites as they should be avoided
Diaphragmatic breathing and positive visualization are encouraged
Massage After Medical Treatment
Stress reduction massage is continued
Treatment of edema, scar tissue and fascial restrictions are appropriate if requested or consented to by the client
Edema may be present local to a surgical site
Treating secondary fascial restrictions surrounding the affected areas to regain joint movement and reduce postural imbalances
Swedish techniques to address scar tissue can be applied (work toward to scar)
The therapist should observe for emotional responses to the treatment
Palliative Care (try to keep them pain free as much as posible)
This involves providing the best emotional and physical quality of life for a terminally ill person
Frequently the role of the therapist goes beyond providing touch but to include passive listening and acknowledgement of the client’s feelings
It is important that the client not be pushed to talk about their experience if they choose not to
A relaxation massage is given with extra focus on those areas the client requests
The client’s tissues and organ systems will be deteriorating đang xấu đi and fragile so the treatment approach should be modified accordingly
Self-care
Referral for nutrition counselling by a naturopath or nutritionist is recommended for building the immune system secondary to receiving treatment
Relaxation strategies such as ongoing massage, meditation and diaphragmatic breathing are encouraged
Some form of exercise such as regular walking is encouraged
Clients with lymphedema may also be referred to a MLD specialist
Support groups are encouraged
Breast Cancer
I. Causes and Contributing Factors:
There are associated factors which increase risk:
- A familial or personal history of breast cancer before menopause
- A woman’s hormonal history
- A familial history of cervical, uterine or colon cancer
Increasing age - A high fat diet and sedentary lifestyle
II. Symptom Picture:
- Breast lumps are palpated. They may feel hard and have an irregular shape. Sometimes a thickening of breast tissue is palpated which generally feels different from the rest of the breast tissue
- Enlarged lymph nodes may be palpated in the axilla
- Pain is more common with benign lumps but should be investigated
- Changes in the nipple or breast appearance may be observed
- The skin of the breast may appear irregular or retracted in an area
- Sometimes due to metastasizing, pain or swelling may be present in other areas
III. Medical Treatment:
- Surgery may involve a lumpectomy or a mastectomy
- A lumpectomy removes the lump and a small amount of normal tissue. Removal of the axillary lymph nodes is also performed
- A modified radical mastectomy is the removal of the entire breast and lymph nodes of the axilla
- Radiation therapy is used with surgery
- Chemotherapy is usually used with cancer that is thought to have metastasized
- Hormonal therapy is used
- Post-treatment complications
- Obstruction of the lymphatic flow may occur because of surgical removal of the lymph nodes, radiation treatment or scarring secondary to mastectomy
- Obstruction of the lymphatics in the upper limb leads to a retention of plasma proteins which in turn attracts more fluid. This chronic edema is called lymphedema
- With lymphedema resulting from surgery, there may be a latent period following the operation where the tissue appears to return to normal. Weeks or years after the surgery, a apparently insignificant injury may provoke lymphedema to occur
Colorectal Cancer
- Causes & Contributing Factors:
Cause is unknown
Diet appears to play a role-too much fat, especially saturated fats
Preventative factors are an adequate intake of fibre, fruits and vegetables as well as vitamin C & E
- Symptom Picture:
Early symptoms include changes in bowel habits lasting over two weeks such as increasing constipation or alternating constipation and diarrhea
Polyps, benign tumours are precursors to cancer
Crampy abdominal pain and swelling may be present
A tumour in the rectum may be indicated by an ongoing desire to have a bowel movement with with little success at passing stool
- Medical Treatment:
Surgery is more commonly used to remove the localized cancer of the colon or rectum. Because the colon’s function is primarily to convert waste to solid stool, with colon cancer, large sections can be removed with little change in function
Rectal cancer requires rectal surgery often involving the removal of the sphincters along with the anal canal
Radiation therapy if used, is give in combination with surgery or chemotherapy
