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Clinical Conditions > Cancer > Flashcards

Cancer Flashcards

1
Q

Cancer

A
  • cancer has that hereditary trait
  • 39.5% of individuals will be diagnosed with cancer of any body structure at some point in their lifetime
  • 2019 = 16 million people living with cancer in the U.S.
  • cancer can sometimes be fatal but more often leads to survival (immunotherapy = can target genes and target your immune system individually)
  • “new normal” due to side effects and late effects
  • even when someone is cleared of cancer, they still could have some occupational implications because of the treatment
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2
Q

Cancer definition

A

Healthy tissue of the body:
- cells grow, divide, and replace each other
- as new cells are formed, old cells die off
Cancer:
- old or damaged cells to continue to survive
- overabundance of new cells are formed unnecessarily
- lead to abnormal growth and disease (leads to a tumor or a mass)
- cells divide without control or develop abnormally
- too many new cells grow in a cluster = tumor or neoplasm
- the National Cancer Institute defines a tumor as “an abnormal mass of tissue that results when cells divide more than they should or do not die when they should”

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3
Q

Etiology (Causes) of cancer

A
  • use of tobacco products = leading cause of lung, head, and neck cancer
  • excessive exposure to the sun = 5 or more sunburns in a lifetime increases exposure
  • radiation exposure = exposure during treatment increase risk for secondary cancer
  • diet = obesity increases risk for liver cancer
  • viruses
  • infections = liver cancer linked to hepatitis B and C
  • genetic = BRCA1 and BRCA2 (genes that cause cancer) & PTEN and TP53 (if those genes are mutated then they can do their role as a tumor suppressor so you are at a higher risk for tumor growth. Does not mean automatic cancer)
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4
Q

Classifications based on…

A
  • site of origin = the specific or primary location
  • histological (tissue) type
  • stage and grade (or severity) of the cancer
  • most common site of origin = skin, lungs, breasts, prostate, colon, rectum, cervix, and uterus
  • when hearing that they have breast cancer or colon cancer, it means that the cancer started in that organ
    -metastasize = moved to other organs
  • breast cancer most common in women
  • prostate cancer most common in men
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5
Q

Tissue types of cancers

A
  • carcinoma
  • sarcoma
  • myeloma
  • leukemia
  • lymphoma
  • mixed types
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6
Q

Carcinoma

A
  • tumors that occur in the epithelial tissue such as the skin, blood vessels, and the linings of organs and body cavities
  • 80-90% of the cancers
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7
Q

Sarcoma

A
  • tumors that occur in supportive and connective tissues such as bones, tendons, cartilage, muscle and fat
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8
Q

Myeloma

A
  • cancers that originate in the plasma cells of bone marrow
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9
Q

Leukemia

A
  • cancers of the blood-forming tissues, including the bone marrow and the lymphatic system
  • overproduction of immature white blood cells and poor blood clotting and anemia from red blood cells
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10
Q

Lymphoma

A
  • cancer of the lymphatic system, which is a network of vessels and nodes throughout the body that helps to fight infection
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11
Q

Mixed types

A
  • histological components are from more than one type of cancer
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12
Q

Hematological cancers

A
  • leukemia
  • lymphoma
  • myeloma
  • blood cancers
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13
Q

Stem cells in the bone marrow

A
  • bone marrow has blood stem cells that breaks off into red or white blood cells
  • myeloid stem cell breaks off into red blood cells, platelets, or myeloblast (which then breaks off to granulocytes which are white blood cells)
  • lymphoid stem cell breaks off into lymphoblastic which then turns into B lymphocyte, T lymphocyte, and natural killer cells (white blood cells)
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14
Q

Acute lymphocytic leukemia (ALL)

A
  • acute = happens really fast (very dangerous)
  • originates in the bone marrow
  • too many lymphocytes are made and they overcrowd white blood cells
  • most common type of childhood cancer
  • more common in children ages 3-5 years old
  • adults over age 75
  • risk factors include having a sibling, previous exposure to chemotherapy or radiation for another cancer, exposure to excess radiation, and having a genetic disorder such as Down syndrome
  • bone marrow with leukemia has lots and lots of white blood cells
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15
Q

Acute myeloid leukemia (AML)

A
  • starts in myeloid cells
  • typically would grow into white blood cells, red blood cells, and platelets
  • lowers the number of health blood cells in all three types of blood cells
  • fast progressing disease
  • primarily found in people over the age of 65 and is more common in men
  • risk factors for AML include previous treatment with chemotherapy or radiation for cancer, exposure to toxic chemicals like benzene, a history of smoking, and a diagnosis of another blood disorder
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16
Q

Chronic lymphocytic leukemia (CLL)

A
  • chronic = abnormal cells are there but they’re growing very slowly and takes a long time
  • most common type of leukemia in adults
  • starts from lymphocytes in bone marrow
  • grows slowly
  • many people do not show any symptoms for years after the cancer starts
  • affects people age 70 or older
  • risk factors include having a family history of blood cancer and overexposure to chemicals such as weed killers or insecticides
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17
Q

Chronic myeloid leukemia (CML)

A
  • originates in myeloid cells
  • abnormal cells grow slowly
  • more common in adults, yet children are sometimes affected as well
  • more common in men
  • a major risk factor is high exposure to radiation
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18
Q

Hodgkin lymphoma

A
  • lymph system = immune system (have B and T cells)
  • originates in B lymphocytes (B cells) which are the immune cells
  • B cells make antibodies, which fight off germs
  • have lymphocytes that are larger than normal, known as Reed-Sternberg cells
  • these enlarged lymphocytes are noticeable as lumps in the lymph nodes
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19
Q

Non-Hodgkin lymphoma

A
  • start in B cells or in another immune cell known as T cells
  • Non-Hodgkin lymphoma is more common than Hodgkin lymphoma (doesn’t create the Reed cells from Hodgkin lymphoma, creates lymphocytes that turn into cancer within the lymph system and gets spread throughout)
  • in the U.S., non-Hodgkin lymphoma is the 6th most common cancer
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20
Q

Breast cancer

A
  • most common cancer in women
  • BRCA1 and BRCA2 genes identified as higher risk
  • signs = palpable lump, change in size/shape of breast, skin changes, dimples with orange skin texture
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21
Q

Incidence and prevalence of breast cancer

A
  • mammograms = early detection reduce the risk of breast cancer by 40%
  • 40 = important number
  • 1 in 6 breast cancers occur in women ages 40-49
  • ten year risk for breast cancer in 40 years old is 1 in 69
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22
Q

Pediatric cancer facts

A
  • cancer = #1 cause of disease-related death in children
  • 1 in 285 U.S. children will be diagnosed with cancer by the time they are 20 years old
  • more than 12 types of pediatric cancer and over 100 subtypes
  • as of 2020, only 6 new drugs have been developed for pediatric cancer
  • most standard childhood cancer treatments are decades old
  • 1 in 6 kids with cancer do not survive
  • 95% of survivors have significant health issues by age 45 because of cancer or toxicity of treatments
  • only 4% of federal government’s cancer research budget goes to pediatric cancer research
  • about 50% of all pediatric cancer research is funded by philanthropies supported by private donors, corporations, and foundations
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23
Q

Stats of childhood cancer (diagram slide 22)

A

- leukemia
- CNS tumor
- lymphomas
- soft-tissue sarcomas
- neuroblastoma and other peripheral nervous cell tumors
- renal tumors
- other

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24
Q

Childhood cancer late effects

A
  • health problems that occur months or years after cancer treatments have ended
  • caused by the cancer treatments (weaker immune system, infertility issues as their reproductive organs have been disrupted, and at risk for cancer again)
  • factors that affect the risk of late effects = tumor-related factors, treatment-related factors, and patient-related factors
  • solutions = regular follow up care, health habits, support through schools, and therapy
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25
Q

Types of tumor cell

A
  • benign
  • malignant
  • metastasize
26
Q

Benign tumor cell

A
  • cells are genetically like the original cell
  • unable to spread to other tissues, organs, or body structures
  • grow slowly
  • when surgically removed, it generally does not return
  • if the tumor was in the brain, it can be removed and the brain can do neuroplasticity and recover
27
Q

Malignant tumor cell

A
  • invasive cancerous cells that have grown into surrounding tissues
  • capable of spreading to distant tissues
  • capable of recurring after removal and/or may recur as metastatic disease
28
Q

Metastasize tumor cell

A
  • when tumor cells spread to distant tissues, organs, or other structure
  • when the cancer from one organ or part of the body has spread to another organ or part of the body
  • can occur months or years after a person has been cancer free
29
Q

Diagnosis of cancer

A
  • once found the tumor, goes in and takes the biopsy of it
  • biopsy can be done by a bone marrow biopsy, excisional biopsy, needle biopsy, and sentinel node biopsy
  • symptoms develop
  • medical history review
  • blood tests
  • CT scans
  • MRI
  • ultrasound
  • PET scan (illuminates tumor and is very expensive and produces lots of radiation)
  • diagnose, stage, and monitor cancer
30
Q

Stages of cancer

A
  • cancers are stages when they are first diagnosed
  • the stage of the cancer diagnosis is static and does not change, even though the tumor may shrink or conversely become metastatic, progress in sizes, recurs after remission (sticks with the stage because it gives you the idea of the course of treatment and how the illness is
  • stages I to IV

*benign tumors have different stages (measured in centimeters)

31
Q

Stage 1 - Early Stage

A
  • a small, invasive mass or tumor has been found
  • no spread to lymph nodes or other tissues
  • sometimes called early-stage or “localized” cancer
32
Q

Stage 2 - Localized

A
  • cancer has started to affect nearby tissue
  • mass may have grown in size
  • spread to lymph nodes near the mass
33
Q

Stage 3 - Regional Spread

A
  • cancer affects more surrounding tissue
  • mass may have grown in size
  • spread to distant lymph nodes away from the mass
34
Q

Stage 4 - Distant Spread

A
  • cancer has spread to other tissues or organs beyond the region where it originated
  • sometimes called advanced or “metastatic” cancer
35
Q

Cancer treatment options

A

*occupational implications come from the treatment
* pancreatic cancer is the fastest and most deadly cancer in regards to that there is no treatment for it

  • hormone therapy
  • surgery
  • bone marrow transplantation
  • chemotherapy (common) = what’s problematic is that it poisons the entire body, all the good cells can handle it and the bad cells die off so it makes the patient super sick
  • targeted therapy
  • radiation therapy (common)
  • immunotherapy
36
Q

Surgery

A
  • often used to remove the tumor
  • may happen before or after other treatments
  • recover can take weeks to months
37
Q

Chemotherapy

A
  • drugs are used to destroy cancer cells
  • chemotherapy cycles usually last 2-6 months, depending on the protocol
  • once or twice per week
38
Q

Radiation therapy

A
  • high-energy rays are used to kill cancer cells
  • typically daily over several weeks
39
Q

Targeted therapy/immunotherapy

A
  • focuses on specific molecules or the immune system to attack cancer cells
  • may last months or even years
40
Q

Breast cancer surgery - mastectomy

A
  • lymphectomy = remove the lump and the good surrounding tissue called margins
  • when doing mastectomies, often takes out the lymph nodes because they are right near your breasts which you get lots of lymph edema and lose ROM on your arm because of scar tissue
  • total mastectomy
  • modified radical mastectomy
  • nipple-sparing mastectomy
41
Q

Total mastectomy

A
  • removes the entire breast, areola, nipple, and breast tissue
  • in some cases, a pocket of skin may be preserved for use during breast reconstruction
42
Q

Modified radical mastectomy

A
  • removes all breast tissue as well as several lymph nodes under the arm
43
Q

Nipple-sparing mastectomy

A
  • just the removal of the tumor or breast tissue affected but sparing and saving the nipple
44
Q

Colon cancer surgery

A
  • takes out the cancer and the margins and then sew up the colon
  • such an intense surgery that sometimes they put temporary colostomy bag as the colon heals and then to a reversal colostomy
45
Q

Chemotherapy

A
  • takes a few hours
  • a form of cancer treatment in which chemicals are used to kill cancer cells
  • frequently used as the main form of cancer treatment (via IV)
  • can be done with a PICC line too which is a line that goes to the superior vena cava in your body and put chemical through the line in the chest
46
Q

Side effects of chemotherapy

A
  • infection
  • oral hygiene
  • nausea and vomiting
  • loss of appetite
  • change of taste
  • sore mouth and throat
  • constipation
  • diarrhea
  • hair loss (alopecia)
  • fatigue
  • infertility and sex
  • peripheral neuropathy (permanent)

*chemo kills the last parts of the nerve endings, so they cannot feel their fingers and toes (numbness and tingling)

47
Q

Radiation

A
  • takes 10-20 min
  • a machine that emits high rays of radiation, burn that tumor, and hopefully shrink it
  • palliative radiation = a tumor is so big and painful that they know they might not be able to take care of it and might die, but the radiation can shrink the tumor to make it more tolerable for awhile but not permanently
48
Q

Bone marrow transplant

A
  • comes from the donor
  • stem cells removed from the patient
  • patient receives treatment to kill cancer cells
  • patient receives stem cells
49
Q

Signs and symptoms of cancer

A
  • changes in bowel or bladder habits and functions
  • sores that do not heal
  • white patches inside mouth or on tongue
  • unusual bleeding or coughing up blood
  • thickening or lump on the body
  • indigestion or troubles swallowing
  • recent changes in skin including new wart or mole
  • nagging cough or hoarseness
  • weight/appetite loss
  • coughing up blood (phlegm with blood in it) and aches or pains when breathing or coughing
  • changes to your moles
  • fatigue
  • changes in your bowel habits
  • unusual bleeding and problems peeing
  • unexplained lumps and changes in your breasts
50
Q

Unique factors impacting occupational performance in survivors (occupational implications)

A
  • cancer-related cognitive impairment, late effects of cancer treatment
  • fatigue
  • pain
  • on-going treatments and medication side-effects
  • physiological changes = anxiety, stress, depression
  • lymphedema
  • strength and sensation changes
51
Q

Pain (occupational implications)

A
  • between 75-90% of people experience cancer pain, describe it as having a major impact on their daily life
  • growth of the tumor or side effects of cancer treatment
  • the higher the pain level, the less active individuals tend to be
  • impact on the individual’s work, sleep, social experiences, and well-being
  • pain medication required for management and its side effects also have an impact on daily occupations
52
Q

Chemotherapy-induced peripheral neuropathy (CIPN) (occupational implications)

A
  • one of the most commonly reported side effects in cancer care
  • peripheral nervous system is damaged by chemotherapeutic drugs
  • causes weakness, numbness, or pain in the hands, fingers, feet, and toes
  • long term can create muscle weakness, balance problems, and limitations in mobility all of which can lead to an increased risk of falling and lack of coordination
53
Q

Compromised bone (occupational implications)

A
  • breast cancer and prostate cancer are known to metastasize to the bone and cause bone cancer or because of medication and radiation, the bone becomes so brittle that it breaks easily
  • the primary type of cancer that originated in the bone = sarcoma
  • greater risk of injury due to the loss of bone mass and density
  • fractures, pain, loss of mobility, and hypercalcemia
  • routine bone density, screening during and after treatment is important to increase awareness
  • breast and prostrate cancer are known to have increased metastatic disease to the bone
  • bone pain
  • broken bones
  • urinary incontinence
  • bowel incontinence
  • weakness in the legs or arms
  • high levels of calcium in the blood (hypercalcemia) which can cause nausea, vomiting, constipation, and confusion
54
Q

Bone metastasis (occupational implications)

A
  • cancer originates somewhere in the body
  • cancer travels through the blood
  • cancer grows in the bones
  • typically affects people with breast cancer, prostate cancer, and lung cancer
55
Q

Cancer-related fatigue (occupational implications)

A
  • important to rest to allow the body to heal
  • cancer-related fatigue (CRF) is recognized as one of the most prevalent and distressing side effects of cancer both during and after treatment
  • 60-90%
  • a persistent, subjective sense of tiredness or exhaustion that is related to cancer or cancer treatment
  • not proportional to recent activity
  • interferes with usual functioning
  • can occur after strenuous or no strenuous activity
  • not relieved or improved by rest
  • can create barriers in the ability to perform daily activites
  • low levels of certain blood cells, sleep , problems, stress, pain, lack of nutrition, and lack of exercise
56
Q

Cancer-related cognitive impairment (CRCI) (occupational implications)

A
  • their brain is so focused on trying to kill the cancer or trying to deal with the treatment that it just doesn’t have the power to think very clearly
  • a decrease in mental “sharpness”
  • associated with a decline in and limitations with cognitive domains of executive functions, attention, concentration, memory, and learning
  • referred to as “chemo brain”
  • memory lapses or forgetting things
  • taking longer to finish things due to disorganization or slower thinking and processing
  • concentrating, focusing, or having a short attention span
  • remembering details like names, dates, and sometimes larger events
  • multitasking, like answering the phone while cooking, without losing track of one task (they are less able to do more than one thing at a time)
  • learning new things
  • word finding or remembering common words
57
Q

Lymphedema (occupational implications)

A
  • when you damage a lymph node, it causes a traffic jam between all other nodes
  • a chronic inflammatory disease resulting from the failure of the lymphatic system
  • lymph fluid builds up beneath the skin
  • a life-long condition resulting from cancer
  • can occur in any region of the body such as arms, legs, breast, trunk, head, neck, and genitals
58
Q

Nutrition concerns (occupational implications)

A
  • decreased appetite
  • decreased sense of taste
  • nausea and/or vomiting
  • diarrhea
  • dehydration
  • may lead to poor oral intake or poor metabolism of intake
  • 30-70% of patients with cancer experience malnutrition during their treatment journey
59
Q

Psychological issues (occupational implications)

A
  • anxiety and depression
  • stress
  • fear of recurrence
  • changing of self-esteem and body image
  • changing or losing occupational roles
  • insomnia
60
Q

Cancer and work performance (occupational implications)

A
  • 62% of cancer survivors return to work (RTW) after treatment
  • factors related to RTW = disease and treatment, person-related, work-related factors
  • research is sparse but overall indicates there is a detrimental effect on ability to work
  • inability to return to work
  • decrease in ability to work (less hours or difficulty with certain skills)
  • decrease in quality of work produced
61
Q

Summary of cancer

A
  • clients with cancer experience prolonged medical treatment and have unique therapeutic needs
  • cancer treatments vary depending on type of cancer, point in the care continuum, and prognosis
  • the impact on occupational performance might be acute during the cancer treatment or continued changes in occupational performance can be seen when cancer treatments are completed

Clinical Conditions (27 decks)

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