Ch 9 - Cancer Rehabilitation Flashcards by Carmel@Brainscape AdminPro

What is the goal in preventive cancer rehab?

Achieve maximal function in patients considered to be cured or in remission

How well did you know this?

Not at all

Perfectly

What is the goal in Supportive cancer rehab?

Providing adaptive self-care equipment to offset steady decline in a patient’s functional skills. ROM and bed mobility in bed rest patients

How well did you know this?

Not at all

Perfectly

What patients is Supportive cancer rehab meant for?

Patients whose cancer is progressing

How well did you know this?

Not at all

Perfectly

What is the goal in Palliative cancer rehab?

Improve or maintain comfort and function during the terminal stage of the disease

How well did you know this?

Not at all

Perfectly

What can swallowing disorders be associated with?

Cognitive impairment
CNS involvement
Radiation treatment
Generalized deconditioning secondary to bed rest

How well did you know this?

Not at all

Perfectly

What should be done to extremities with concern of possible tumor involvement while work up is done?

Positioned in non-WB and ROM withheld

How well did you know this?

Not at all

Perfectly

What are the top two primary tumors in children?

Leukemia

2. Brain tumors

How well did you know this?

Not at all

Perfectly

What are the most common posterior fossa tumors in childhood?

Cerebellar astrocytoma (best prognosis)
Medulloblastoma (most prevalent in <70)
Brain stem gliomas

How well did you know this?

Not at all

Perfectly

What are the MC tumors that metastasize to the brain in men?

Lungs, gastrointestinal, and urinary tract tumors

How well did you know this?

Not at all

Perfectly

What are the MC tumors that metastasize to the brain in women?

Breast, lung, gastrointestinal, and melanoma

How well did you know this?

Not at all

Perfectly

What are signs and symptoms of brain tumors?

HA (MC sx)
Weakness (MC sign)
Seizures (1st presenting)

How well did you know this?

Not at all

Perfectly

What is the best diagnostic test of brain metastasis?

Contrast MRI

How well did you know this?

Not at all

Perfectly

What are the majority of spinal cord tumors?

Extradural (95%) and arises from the vertebral body

How well did you know this?

Not at all

Perfectly

What % of metastatic tumors are in the thoracic cord?

70%

How well did you know this?

Not at all

Perfectly

When does radiation induced transient myelopathy present?

1 to 30 months, with a peak onset at 4 to 6 months after radiation

How well did you know this?

Not at all

Perfectly

What is the prognosis of radiation induced transient myelopathy?

Resolves over a period of 1 to 9 months

How well did you know this?

Not at all

Perfectly

When does delayed radiation myelopathy present?

9 to 18 mo after radiation

Most w/in 30 mo

How well did you know this?

Not at all

Perfectly

What is the presentation of radiation myelopathy?

LE paresthesias followed by bowel dysfunction and weakness

How well did you know this?

Not at all

Perfectly

What cancers are peripheral polyneuropathy associated with?

Lung
Multiple myeloma
Breast
Colon

How well did you know this?

Not at all

Perfectly

What is the presenting symptom of brachial plexopathy 2/2 direct tumor extension?

90% pain

How well did you know this?

Not at all

Perfectly

What is the presenting symptoms of brachial plexopathy 2/2 radiation?

Numbness and paresthesias

How well did you know this?

Not at all

Perfectly

What part of the brachial plexus is involved in direct tumor invasion?

Lower trunk

How well did you know this?

Not at all

Perfectly

What part of the brachial plexus is involved in radiation?

Upper trunk

How well did you know this?

Not at all

Perfectly

What is a Pancoast tumor?

Tumor invasion (bronchial carcinoma) into the superior pulmonary sulcus

How well did you know this?

Not at all

Perfectly

How does a Pancoast tumor present?

Pain in shoulder, vertebral border of scapula, C8–T1 nerves (lower trunk plexopathy) as well as Horner’s syndrome

What is pathognomonic of radiation plexitis on EMG?

Myokymia

Describe Cognitive effects of radiation.

Dose related Children at higher risk d/t developing myelin susceptible to insult Presents slowly and delayed

What is Carcinomatous myopathy?

Seen in metastatic disease that is consistent with | muscle necrosis and presents with proximal muscle weakness

What is Carcinomatous neuropathy?

Affects peripheral nerves and muscle

What is the clinical presentation of Carcinomatous neuropathy?

Distal motor and sensory loss, proximal muscle weakness, and dec reflexes Type II muscle atrophy and distal peripheral polyneuropathy

Which cancer is most associated with Carcinomatous neuropathy?

Lung cancer

What does Chemotherapy-related and steroid myopathies result from?

Atrophy of Type II muscle fibers in proximal muscles

How does lymphedema occur?

Direct tumor invasion or lymph node drainage blocked causing accumulation of protein in the interstitium changing colloidal pressure and detracts fluid into the interstitial space

When is upper extremity lymphedema MC seen?

Breast cancer in patients who have had a nodal dissection or radiation therapy to the axilla

What cancers are associated with lower extremity lymphedema?

Uterine Prostate Lymphoma Melanoma

What causes lower extremity lymphedema in melanoma?

Nodal dissection

What causes lower extremity lymphedema in prostate cancer?

Whole pelvic radiation or surgery

Describe Acute, transient and mild lymphedema presentation in cancer.

Occurs a few days post-operatively

Describe Acute and painful lymphedema presentation in cancer.

Occurs 4 to 6 weeks post-operatively resulting from acute phlebitis or lymphangitis

Describe Erysipeloid form lymphedema presentation in cancer.

Results from minor trauma | Superimposed on chronic edema

Describe Insidious and painless lymphedema presentation in cancer.

No erythema Happens years after first treatment Most common form

Describe Grade 1 (mild) edema.

■Pitting edema that can be reversed by elevation of the extremity ■Present in distal arm or leg ■Circumference diff <4 cm

Describe Grade 2 (moderate) edema.

■Non-pitting, brawny edema not reversible with elevation of the extremity ■ Skin hardened 2/2 development of fibrotic tissue due to chronic excess protein in the interstitial spaces and deposition of adipose tissue ■ Edema moderate, reversible with effort. Involves entire limb or corresponding trunk ■ Infection: none to occasional ■ Circumference diff 4-6 cm

Describe Grade 3a (severe) edema.

■Lymphostatic elephantiasis ■Edema in one limb and its associated trunk ■Non-pitting ■Edema minimally reversible or not reversible ■ Cartilage-like ■Infection 2/2 skin breakdown ■ Circumference diff >6 cm

Describe Grade 3b (Massive) edema.

Same symptoms as stage 3a except that two or more extremities are affected

Describe Grade 4 (Gigantic) edema.

■ Complete obstruction of the lymphatic channels ■ Edema is severe and irreversible ■Edema may involve face and head ■ Infection >4x/year

Describe compression therapy.

Sequential graded pumps effective in reabsorption of water from the interstitium into the venous capillaries

What happens when there is >1 lympedematous area?

No place for fluid resolution and other areas may become edematous

What are immediate post-operative therapies after mastectomy?

``` Hand pumping Hand and elbow ROM Positioning techniques Postural exercises Shoulder ROM exercises to 40° of flexion and abduction ```

When can Active assistive exercises be started after mastectomy?

When the surgical drains have been removed

What is the most consistent symptom of metastatic bone disease?

Pain that is most severe at night or upon WB | Pain lying down and improves with sitting in spine

What are high risk factors for fracture in metastatic bone disease?

Highly anaplastic and rapidly growing vascular lesions, which are usually osteolytic High stress areas such as lesser trochanter

What is the most common site of pathological fracture?

Proximal femur

Describe locations of bone metastasis.

Axial skeleton Proximal femur Humerus 70% thoracic spine, 95% extradural and involve vertebral body anterior to the spinal canal

Where do most cancers metastasize in the upper extremity?

90% of upper extremity metastases involve the humerus

Which cancers metastasize to the upper extremity?

1. Breast cancer 2. Multiple myeloma 3. Renal cancer

Where do most cancers metastasize in the lower extremity?

Hip and femur

Which cancers metastasize to the hip?

Breast Lung Lymphoma Prostate

Which cancers metastasize to the femur?

Breast Prostate Multiple myeloma Renal

What if the bone scan is negative in a cancer patient with bone pain?

Get an x-ray which may be positive

When is the spine considered unstable?

>2 columns involved Middle column involved >20° of angulation

What are indications for surgery in metastatic bone disease?

1. Intractable pain 2. Impending pathological fracture 3. Pathological fracture has occurred

What are indications for surgery in metastatic bone disease of the upper extremity?

Lesion size >3 cm | >50% cortex involved

What are indications for surgery in metastatic bone disease of the lower extremity?

Lesion size >2.5 cm | >30-50% cortex involved

What are indications for surgery in metastatic bone disease of the femur?

Lesion size >1.3 cm | >1.3 cm axial length cortex involved

How do osteolytic lesions present?

Net loss of bone by osteoclast mediated bone reabsorption | Dec strength and stiffness of bone

How do osteoblastic lesions present?

Sclerotic areas of bone formation | Dec stiff but do not change strength

Which type of bone lesion is more prone to fracture?

Lytic lesions

What are typical causes of lytic lesions?

``` – Myeloma – Lung – Kidney – Thyroid – Malignant lymphomas – Breast ```

What is the median survival rate of lung cancer with bone mets?

6 months Aggressive course Mets higher risk of fx Cortical metastases are common in lung cancer

What is the median survival rate of renal cancer with bone mets?

Variable, depends on medical condition | May be as short as 6 months

What is the median survival rate of prostate cancer with bone mets?

40 months | 90% Blastic lesions

What is the median survival rate of breast cancer with bone mets?

24 mos | 60% blastic lesions

What is the most common primary malignant bone tumor in children?

Osteosarcoma

Describe imaging in multiple myeloma.

Bone scans may be normal | Skeletal survey may reveal diffuse “punched out” lytic lesions with black sclerotic borders

Describe Step 1 on the WHO analgesic ladder.

Mild/moderate pain are treated with nonopioid analgesics (acetaminophen, ASA, NSAIDs)

Describe Step 2 on the WHO analgesic ladder.

Mild to moderate pain despite taking a non-opioid analgesic, the dose of the non-opioid analgesic should be maximized with addition of a weak opioid (codeine, hydrocodone, oxycodone, tramadol).

Describe Step 3 on the WHO analgesic ladder.

Moderate to severe pain despite therapy with Step 2 opioids require an increase in the dose of opioid or a change to Step 3 opioid when pain is severe (morphine, oxycodone, methadone, levorphanol, fentanyl).

What is the agent of choice on Step 3 on the WHO analgesic ladder?

Morphine is the agent of choice. Its dose should be maximized before other agents are added

Which NSAID has the least incidence of thrombocytopenia?

Ketoralac