Cancer Flashcards by Jessica Deak

Physical activity definition

Any bodily movement produced by the contraction of skeletal muscles that result in a substantial increase over resting energy expenditure
HEALTH BENEFITS

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Exercise definition

A type of PA consisting of planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.
FITNESS BENEFITS

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Do PTs exercise their patients?

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Definition of mobilization

The therapeutic and prescriptive application of low intensity exercise in the management of acute CP dysfunction - usually in acutely ill patients

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Two kinds of stress that relate to mobilization

Gravitational stress

Exercise stress

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The oxygen transport system involves these three structures

Tissue
Heart
Airways/lungs

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In the oxygen transport system, the tissue is responsible for

CO2 production and O2 consumption

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In the oxygen transport system, the heart is responsible for

CO2 Flow

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In the oxygen transport system, the airways/lungs are responsible for

Inspired and expired air

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What starts the oxygen transport system?

Mitchondia

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Resting HR should be?

After aerobic exercise, how much of an increase should you have?

60-90 BPM

Increase in 10-12 BPM/MET

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Resting SBP should be?

After aerobic exercise, how much should it change?

<120 mmHg

Should increase 7mmHg/MET

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Resting DBP is what?

What are the changes that occur with exercise?

<80 mmHG

Increase or decrease 10 mmHg in entire session

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Resting Sp02 should be?

After aerobic exercise, how will it change?

97-98

Should stay the same, or increase

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Examples of abnormal exercise responses

Unusual/severe fatigue
Chest, teeth, jaw, arm pain
Lightheaded
Dizzy
SBP drop >10 mmHg
DBP that increases or decreases by 10 mmHg
***HR above THR
Pallor
Ataxia

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THR formula

[(HRmax - RHR) x ___%] + RHR

HRmax= HR from stress test
HRmax= 208 - (.7 x age)
Only for normal individuals

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What is the goal THR during general exercise (how many beats above resting)?

20-30

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Wells Clinical Prediction Rule for DVT includes:

Cancer
Paralysis, paresis, immobilization of LE
Bedridden for more than 3 days bc surgery
Localized tenderness along distribution of deep veins
Entire leg swollen
U/L calf swelling of greater than 3 cm
U/L pitting edema
Collaterally superficial veins
Alternative Dx as likely as or more likely than DVT

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If you have a 3 or greater score on the Wells Clinical Prediction Rule for DVT, what risk are you at?

High (75%)

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If you have a 1-2 points score on the Wells Clinical Prediction Rule for DVT, what risk are you at?

Moderate risk (17%)

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If you have a less than 1 point score on the Wells Clinical Prediction Rule for DVT, what risk are you at?

Low risk (3%)

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What should you be monitoring during general exercise?

HR
BP
Breathing patterns
Sp02
Patients response
Auscultation changes
RPE

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List all vital signs

HR
BP
RR
Temp
Pain
Cognition (UTI will be seen in elders and causes cognitive issues)

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What is the most common new cancer case in males?

Prostate cancer

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What is the most common new cancer case in females?

Breast cancer

What is the cancer that is going to kill?

Lung cancer

What kills more females, heart disease or breast cancer?

Heart disease

There is a higher cancer incidence rate in what gender?

Males

At risk individuals for cancer death rates by race and gender..list the 4 in the PP in order

Black men > white men > black women > white women

What race has the highest cancer incidence rate?

Non-hispanic black

What is the cancer with the poorest 5 year relative cancer survival rate?

Pancreatic cancer, followed by lung and bronchus

What kind of cancer is the most common cause of cancer mortality in both men and women?

Lung cancer

What cancer is the most prevalent form of cancer: In males? In females?

Prostate | Breast

Approximately 90% of all lung cancers are related to what?

Smoking with a strong dose-response relationship

Approximately 67% of people diagnosed with cancer survive with a significant portion becoming...

Long term survivors

How many survivors of cancer in the US?

14.5 mil

Cancer definition

Defined by 4 characteristics that describe how cancer cells act differently from normal counterparts

List the 4 characteristics for describing cancer

Clonality Autonomy Anaplasia Metastases

Define clonality

Single stem cell proliferates into malignant clone

Define autonomy

Unregulated growth- no regulation by biochemical and physical influences

Define anaplasia

Lack of normal, coordinated cell differentiation

Define metastases

Cancer cells develop capacity for discontinuous growth and can disseminate to other parts of the body

Define malignant transformation

Process by which normal cell converts into one which exhibits the 4 characteristics (clonality, autonomy, anaplasia, metastases)

Fraction of individuals in US will develop cancer?

1/3

Cancer is the 2nd most common cause of death. What is the 1st?

Cardiac disease

What are the three most common cancers?

Lung, breast, colorectal

What is the typical presentation of cancer?

Local expansion Biochemically active molecules Invasion into adjacent or distant tissue sites

What does treatment plan of cancer depend on?

Extent of disease- stage Knowledge of diseases natural history Available therapeutic options

(Metastases) cells lose _________- restrained position within organized tissue

Adherence

(Metastases) Where to cells move? This is where they develop the capacity to invade and to egress from blood vessels

To adjacent sites

(Metastases) Cells become capable of proliferating where?

In unnatural locations

(Metastases) Changes in growth patterns accompanied by biochemical alterations which promote what?

Metastatic process

(Metastases) Secretion of what?

Tissue degrading enzymes (collagenases, lysosomal hydrolases)

(Metastases) produce of plasminogen activators which promotes ________?

Fibrinolysis

(Metastases) Pro-coagulant compounds released into environment at stage when focal aggregation of cells might be of ________ advantage

Tumor survival

Patterns of cancer incidence vary at 4 different things:

Age Sex Race Geographic location

True or false: variation in diet can contribute to the development of cancer

True

Environment agents linked to cancers fall into 3 categories:

Radiation Chemicals Viruses

Name the 8 etiologies of cancer

``` Genetics Radiation- ionizing radiation Tobacco Occupational exposure Air pollution Medications Diet Viruses ```

What are 3 medications that contribute to cancer?

Conjugated estrogens Alkylating agents Immunosuppressive agents

Breast cancer goes to the... (4)

Bone Brain Lung Liver

Lung cancer goes to the...(3)

Bone Brain Liver

Prostate cancer goes to the... (4)

Bone Brain Lung Liver

This chemo is given AFTER surgery to prevent a possible reoccurrence

Adjuvant Chemo

This chemo is given prior to surgical procedure, attempts to shrink the tumor

Neoadjuvant chemo

This chemo is given to induce a remission, generally used in the Tx of acute leukemias

Induction chemo

This chemo is given if a disease has not responded or reoccurred after first line, in some cases known as salvage therapy

Second line chemo

This chemo is given specifically to address symptom management without significantly reducing the cancer

Palliative chemo

This term is used in the discussion of chemo and refers to WBC, RBC, and platelet count

Nadir

Nadir means low point- basically a drop in what three things are noted?

WBC RBC Platelets

How many days after treatment is nadir and how long does it take for the counts to return to normal

10 days after treatment Takes about 3-4 weeks for the counts to return to normal

This term is used to describe both the long term and late term effects of cancer treatment

Persistent effects

There are persistent effects in ______, ______, and _______ after surgery, chemo, hormonal therapy, targeted therapies, and radiation

Fatigue, pain, and cognitive

In surgery, chemo, and hormonal therapy, These things increase or decrease? Body weight Fat mass Lean mass

Body weight increases or decreases Fat mass increases Lean mass decreases

Surgery, chemo, hormonal therapy, and radiation will all cause MS soft tissue change damage, true or false.

True

Chemo, hormonal therapy, targeted therapies, and radiation all do what to the immune system?

Impairs the function

Surgery, chemo, hormonal therapy, targeted therapies, and radiation can do what to the GI system?

Impair the function

Surgery, chemo, hormonal therapy, targeted therapies, and radiation do not affect the skin, true or false?

False, it causes changes in the skin

List the most common toxicities associated with treatment (6)

``` Fracture risk CV events Neuropathies MS morbidities Cardiotoxicity Pulmonary toxicity- not as frequent ```

This toxicity can develop in an acute, subacute, or chronic matter- from infusion to years later after the end of chemo

Cardiotoxicity

This toxicity can range from heart failure, dysarrhythmias, cardiomyopathy, LVD, valve disease, MI

Cardiotoxicity

This toxicity includes lung fibrosis, pnemonitis, non cardiac pulmonary edema

Pulmonary Toxicity

This toxicity presents symptoms like SOB, decrease exercise capacity, fatigue, cough

Pulmonary toxicity

What can help the symptoms of pulmonary toxicity?

Pulmonary rehab

Radiation to the chest can cause _____ toxicity by increasing inflammation in the heart and surrounding tissues

Cardiac

Radiation can cause what kind of cardiomyopathy?

Restrictive

Radiation for the lungs can cause (2 listed things)

Pneumonitis | Pulmonary fibrosis

Radiation to the chest can cause symptoms how many years post treatment?

10 years

Radiation for the lungs can cause symptoms how many months after treatment?

One to 3 months

Radiation for the lungs causes a ____ regulation of a proinflammatory cascade in local tissue leading to excessive deposition of _____ and ______, vascular damage, and ischemia

Up regulation ECM Collagen

What are the precautions of anemia? (7)

Fatigue Tachycardia Bluish/pale tinge about nail bed Sp02 is 100% on room air Decreased exercise tolerance Decreased DBP from patient normal Dyspnea on low levels or exertion

If patient has dyspnea on low levels of exertion, what should you do?

Call MD RIGHT AWAY

What is the most common chemo dose-limiting side effect?

Neutropenia

What are the consequences of neutropenia?

``` Infection Hospitlization Antibiotics Reduced QOL Chemo dose delays and reductions Reduced Tx effectiveness Increased cost ```

What is neutropenia?

An abnormally low amount of neutrophils

Risk factors for neutropenia?

``` Age Female Nutritional status Open wounds Co-mobidities ```

Symptoms of neutropenia

``` Fever Chills Sweating Sore throat Cough SOB Sinus tenderness ``` ``` Burning urination Diarrhea Abdominal pain Rectal discomfort Redness and swelling ```

Precautions for WBCs:

Susceptible to infection if low Below 1000 or neutrophils are less that 500, a mask must be worn Febrile neutropenia or any of the other symptoms that should be reported

Colony-stimulating factors encourage the bone marrow stem cells to divide and develop into ___, ___, and _____

WBCs RBCs Platelets

Do colony stimulating factors affect the tumor?

No, but they support the persons immune system during cancer treatment

Prefligrastim and filgrastim increase what?

WBCs

Epoetin alfa increases what?

RBCs

CRF stands for

Cancer related fatigue

This is described as a clinical entity chracterized by tiredness to exhaustion not precipitated by activity, or if after activity, out of proportion to the level of exertion

Cancer related fatigue

CRF interferes with usual functioning. Is is relieved by rest or sleep?

Not completely

What is the cause of CRF

Unknown But may be the final common pathway of several contributing systems including the CNS, immunoregulatory pathways and the NM and CP systems

What are the potential contributors to CRF?

Proinflammatory cytokines

What is an effective strategy for treating CRF?

Aerobic exercise

Aerobic exercise for CRF decreases __________

Serum proinflammatory cytokines

A mobilization of ______ is a pathway for treating CRF

Visceral fat

Increased _________ sensitivity and _____ uptake is a pathway for treating CRF

Increased insulin sensitivity Glucose uptake

CRF affects how many patients with cancer?

70-100%

True or false: CRF can persist for months or years following completion of treatment and can start prior to any treatment

True

CRF is more prevalent in what types of cancers?

Pancreatic Breast Lymphoma

CRF has 7 treatable factors:

``` Pain Emotional distress Sleep disturbance Anemia Nutrition Activity level Comorbidities ```

Pre-treatment and treatment phases should include a ___________ to figure out what patient is able to do and to predict what is likely to influence functioning subsequently

Functional assessment

A systematic evaluation of what system is essential for targeting areas likely to need prevention for maintaining or restoring function?

Neuromuscular system

Post-definitive treatment phase gives an opportunity for...

Initiating preventive measures, early mobilization

Use wraps and limb massage to help do what?

Mitigate disease For deconditioning Control lymphedema and limb swelling

(Body, structure, function) What is one of the most significant problems facing cancer patients?

Immobility

(Body, structure, function) ______ is associated with numerous metabolic and physiologic changes

Bed rest

(Body, structure, function) Bone loss can lead to what?

Hypercalcemia

(Body, structure, function) Osteoporosis and bone metastases can lead to what?

Pathological fractures

(Body, structure, function) Muscle atrophy develops rapid inability to walk in as short as ____ week

One

(Body, structure, function) Immobility can cause

Contractures

(Body, structure, function) Lack of mobility puts a patient at risk for

DVT and pulmonary embolus

(Body, structure, function) Immobility causes: _____ muscle mass _____ soft tissue covering body prominences Predisposition to _______

Decreased Decreased Pressure ulcers

(Body, structure, function) Muscle wasting and cachexia This is seen in a variety of tumors including:

Gi tract, breast, colon, prostrate, lung, small cell lung

This is characterized by weight loss, anorexia, weakness, loss of functional capacity

Cachexia

(Body, structure, function) Muscle wasting and cachexia: Fundamental changes in metabolic processes: Presence of _________ Severe negative ______ balance Increased _______ _____ muscle mass, body fat mass, energy stores

Inflammatory cykokines Nitrogen Proteolysis Decreased

(Body, structure, function) Muscle wasting and cachexia Is exercise effective in building lean body mass?

(Body, structure, function) Generalized deconditioning Each week of immobility requires as much as a ______ of rehab to regain functional mobility

A month

(Body, structure, function) Generalized deconditioning If you have a pt with mild disease restrictions, how often should you ambulate?

Once or twice a day

(Body, structure, function) Generalized deconditioning If the pt cannot ambulate, what should you do?

Start exercise program in bed

(Body, structure, function) Generalized deconditioning What device can be used for maintain sympathetic tone and reduce orthostatic HTN?

Tilt table

(Body, structure, function) Generalized deconditioning For severe dependent edema, what should you use and do to reduce it?

Compressive garments Manual therapy

(Body, structure, function) Generalized deconditioning You should do this to maintain joints in functional alignment...

Passive or active assistance stretching

(Body, structure, function) Skin breakdown Patient should not remain in a single position for greater than __ hours

(Body, structure, function) Skin breakdown Dragging patient across sheets of examine tables may cause...

Shearing forces

(Body, structure, function) Skin breakdown Hygiene is important if a person has....

Irradiated skin

(Body, structure, function) Skin breakdown Healing is promoted in a ____ wound environment

Moist

(Body, structure, function) Skin breakdown ____ agents predispose to maceration and breakdown

Greasy agents

(Body, structure, function) Contractures Prolonged disease, fixed joint positions, can cause ____ fibers to shorten

Collagen

(Body, structure, function) Contractures How many times a day should AROM and PROM be performed for prevention

2-3 times a day

(Body, structure, function) Contractures Once contractures exist, they require ________ to regain full or functional motion

Months of therapy

(Body, structure, function) Bone replacement by tumor Bone invasion by tumor- via direction extension (sarcoma) via embolization through _____ side of the heart via direct venous spread through _________ involving vertebral bodies and pelvis

Right | Batson's plexus

(Body, structure, function) Bone replacement by tumor What kind of tumors invade bone marrow?

Leukemia Lymphomas Myeloma

(Body, structure, function) Bone replacement by tumor What are the diseases most frequently associated with bone metastates

``` Lung Prostate Colon Kidney Breast ```

(Body, structure, function) Bone replacement by tumor What is the most common symptom associated with bone mets

Pain

(Body, structure, function) Bone replacement by tumor What is the most common site of body metastatic spread?

Lumbar spine

(Body, structure, function) Bone replacement by tumor Vertebral body involvement causes ________ in 50% of patients

Radicular pain

(Body, structure, function) Bone replacement by tumor This is the most common from thoracic region involvement

Cord compression

(Body, structure, function) Pathologic fractures A fracture is imminent when size of a lyric lesion exceeds ____ of the total bone width

60%

(Body, structure, function) Pathologic fractures Pain with weight bearing suggest need to reduce load on or mobilize the affected structure, true or false?

False; you want to immobilize it

(Body, structure, function) Pathologic fractures Does radiation directly repair the damaged bone?

No.

(Body, structure, function) Pathologic fractures What do you use for small lesions?

RT and cane

(Body, structure, function) Pathologic fractures What do you use for larger lesions?

Surgical stabilizations

(Body, structure, function) Spinal cord compression What are some other causes of paraparesis in a cancer patient?

PN Lumbosacral plexitis Radiation myelitis

(Body, structure, function) Spinal cord compression What kind of dysfunction is universal in a SCI population?

Bowel and bladder dysfunction

(Body, structure, function) Lymphedema and DVT What can be excluded by imaging studies?

Tumor

(Body, structure, function) Lymphedema and DVT What can be seen through impedance plethysmography, and US venogram?

DVT

(Body, structure, function) Lymphedema and DVT PE can be seen with a ...

CT scan

(Body, structure, function) Lymphedema and DVT What is seen after a lymph node dissection usually?

Lymphedema

(Body, structure, function) Lymphedema and DVT This is usually related to radiation therapy

Late edema

(Body, structure, function) Lymphedema and DVT You can minimize edema by...

Extremity elevation

(Body, structure, function) Lymphedema and DVT Describe MLD

Manual lymphatic drainage Based on concept of emptying central regions first to give lymph from periphery somewhere to go

(Body, structure, function) Lymphedema and DVT When can MLD be used?

Followed by use of a sequential pneumatic compressive device or compression bandaging

True or false: Exercise guidelines have been developed by the APTA, ACSM, AHA, ACS, and the US DHHS

False; no APTA

More than 50% of cancer diagnoses and 71% of cancer deaths are in individuals of what age?

Older than 65

Up to 70% of cancer survivors do not meet US national _________

Exercise recommendations

_____ and _______ lifestyle are highly prevalent in cancer survivors

Obesity and a sedentary lifestyle

The pathophysiology of certain cancers might directly affect the functional or structural integrity of components of the _________ system

Oxygen transport

True or false: | Exercise IS SAFE DURING and AFTER cancer treatment

True

True or false: Breast cancer survivors and people at risk for lymphedema should not be performing resistive training.

False

Exercise can _____ chemo completion rates

Increase

Exercise improves immune function by increasing the _____ count and ____ count

NK cell | Neutrophil

Precautions for exercising patients with cancer

``` Neuropathies Bone metastases Infection Muscles wasting Osteoporosis Radiation Nutritional status Cognitive issues High intensity exercise Catheters Joint pain Thermoregulatory symptoms Cardiac monitoring Bleeding, eccymosis ```

What should women with lymphedema wear during exercise?

Well fitting compression garment

For those being treated with hormonal therapy, what should you be aware of?

Possible osteoporosis

If a patient has an ostomy, you want top avoid excessive intra-abdominal pressure, so should you exercise?

As long as it is not excessive

Those with multiple myeloma should be treated as if they are _______

Osteoporotic

Exercise guideline If pt is exercising 5x/week, Intesity in METS? How many minutes? Type? Volume?

3-6 METS 30 mini Walk, bike, elliptical 150 min

Exercise guideline If pt is exercising 3x/week, Intesity in METS? How many minutes? Type? Volume?

>6 METS 25 min Walk, bike elliptical 75 min

Exercise guideline: strength training: How many reps should be done? How many times per week?

8-12 reps | 2 times per week

Exercise precautions for everyone! If you have WBC <1000/mm3, Should you exercise?

No exercise, wear protective mask

Exercise precautions for everyone! If WBC <5000 or 10,000 with fever, should you exercise?

Exercise precautions for everyone! If WBC is >5000 should you exercise?

Lightly, progress to resistive exercise

Exercise precautions for everyone! IF HCT is <25%, should you exercise?

Exercise precautions for everyone! If HCT is >25% should you exericse?

Lightly

Exercise precautions for everyone! If HCT is 30-32%, what should you add?

Resistive exercise

Exercise precautions for everyone! If Hgb is <8, should you exercise?

No | Do bed mobility, dangling

Exercise precautions for everyone! If Hgb is 8-10, should you exericse?

Light exercise: walking, ADL

Exercise precautions for everyone! If Hgb is >10, should you exercise?

Yes | Resistive and aerobic

Exercise precautions for everyone! Platelets are <20,000 Should you exercise?

Exercise precautions for everyone! Clients receiving anticoagulant therapy INR (international normalized ratio) > 2.5-3.0 What should you do?

Consult with MD

Exercise guidelines for thrombocytopenia ``` 150,000- above: 50,000- 150,000: 20,000- 50,000 10,000- 20,000 <20,000: ```

Normal Biking, swimming, resistive ex Walking, moderate ex on bike, no PROM, no prolonged stretching Light ex, walking as tolerated, AROM only Activity restricted to ADLs