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Cuccurullo Book > Ch 9 - Cancer Rehabilitation > Flashcards

Ch 9 - Cancer Rehabilitation Flashcards

1
Q

What is the goal in preventive cancer rehab?

A

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

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2
Q

What is the goal in Supportive cancer rehab?

A

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

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3
Q

What patients is Supportive cancer rehab meant for?

A

Patients whose cancer is progressing

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4
Q

What is the goal in Palliative cancer rehab?

A

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

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5
Q

What can swallowing disorders be associated with?

A

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

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6
Q

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

A

Positioned in non-WB and ROM withheld

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7
Q

What are the top two primary tumors in children?

A
  1. Leukemia

2. Brain tumors

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8
Q

What are the most common posterior fossa tumors in childhood?

A
  1. Cerebellar astrocytoma (best prognosis)
  2. Medulloblastoma (most prevalent in <70)
  3. Brain stem gliomas
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9
Q

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

A

Lungs, gastrointestinal, and urinary tract tumors

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10
Q

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

A

Breast, lung, gastrointestinal, and melanoma

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11
Q

What are signs and symptoms of brain tumors?

A

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

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12
Q

What is the best diagnostic test of brain metastasis?

A

Contrast MRI

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13
Q

What are the majority of spinal cord tumors?

A

Extradural (95%) and arises from the vertebral body

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14
Q

What % of metastatic tumors are in the thoracic cord?

A

70%

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15
Q

When does radiation induced transient myelopathy present?

A

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

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16
Q

What is the prognosis of radiation induced transient myelopathy?

A

Resolves over a period of 1 to 9 months

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17
Q

When does delayed radiation myelopathy present?

A

9 to 18 mo after radiation

Most w/in 30 mo

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18
Q

What is the presentation of radiation myelopathy?

A

LE paresthesias followed by bowel dysfunction and weakness

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19
Q

What cancers are peripheral polyneuropathy associated with?

A

Lung
Multiple myeloma
Breast
Colon

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20
Q

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

A

90% pain

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21
Q

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

A

Numbness and paresthesias

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22
Q

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

A

Lower trunk

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23
Q

What part of the brachial plexus is involved in radiation?

A

Upper trunk

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24
Q

What is a Pancoast tumor?

A

Tumor invasion (bronchial carcinoma) into the superior pulmonary sulcus

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25
Q

How does a Pancoast tumor present?

A

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

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26
Q

What is pathognomonic of radiation plexitis on EMG?

A

Myokymia

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27
Q

Describe Cognitive effects of radiation.

A

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

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28
Q

What is Carcinomatous myopathy?

A

Seen in metastatic disease that is consistent with

muscle necrosis and presents with proximal muscle weakness

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29
Q

What is Carcinomatous neuropathy?

A

Affects peripheral nerves and muscle

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30
Q

What is the clinical presentation of Carcinomatous neuropathy?

A

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

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31
Q

Which cancer is most associated with Carcinomatous neuropathy?

A

Lung cancer

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32
Q

What does Chemotherapy-related and steroid myopathies result from?

A

Atrophy of Type II muscle fibers in proximal muscles

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33
Q

How does lymphedema occur?

A

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

34
Q

When is upper extremity lymphedema MC seen?

A

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

35
Q

What cancers are associated with lower extremity lymphedema?

A

Uterine
Prostate
Lymphoma
Melanoma

36
Q

What causes lower extremity lymphedema in melanoma?

A

Nodal dissection

37
Q

What causes lower extremity lymphedema in prostate cancer?

A

Whole pelvic radiation or surgery

38
Q

Describe Acute, transient and mild lymphedema presentation in cancer.

A

Occurs a few days post-operatively

39
Q

Describe Acute and painful lymphedema presentation in cancer.

A

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

40
Q

Describe Erysipeloid form lymphedema presentation in cancer.

A

Results from minor trauma

Superimposed on chronic edema

41
Q

Describe Insidious and painless lymphedema presentation in cancer.

A

No erythema
Happens years after first treatment
Most common form

42
Q

Describe Grade 1 (mild) edema.

A

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

43
Q

Describe Grade 2 (moderate) edema.

A

■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

44
Q

Describe Grade 3a (severe) edema.

A

■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

45
Q

Describe Grade 3b (Massive) edema.

A

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

46
Q

Describe Grade 4 (Gigantic) edema.

A

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

47
Q

Describe compression therapy.

A

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

48
Q

What happens when there is >1 lympedematous area?

A

No place for fluid resolution and other areas may become edematous

49
Q

What are immediate post-operative therapies after mastectomy?

A 
Hand pumping
Hand and elbow ROM
Positioning techniques
Postural exercises
Shoulder ROM exercises to 40° of flexion and abduction
50
Q

When can Active assistive exercises be started after mastectomy?

A

When the surgical drains have been removed

51
Q

What is the most consistent symptom of metastatic bone disease?

A

Pain that is most severe at night or upon WB

Pain lying down and improves with sitting in spine

52
Q

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

A

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

53
Q

What is the most common site of pathological fracture?

A

Proximal femur

54
Q

Describe locations of bone metastasis.

A

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

55
Q

Where do most cancers metastasize in the upper extremity?

A

90% of upper extremity metastases involve the humerus

56
Q

Which cancers metastasize to the upper extremity?

A
  1. Breast cancer
  2. Multiple myeloma
  3. Renal cancer
57
Q

Where do most cancers metastasize in the lower extremity?

A

Hip and femur

58
Q

Which cancers metastasize to the hip?

A

Breast
Lung
Lymphoma
Prostate

59
Q

Which cancers metastasize to the femur?

A

Breast
Prostate
Multiple myeloma
Renal

60
Q

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

A

Get an x-ray which may be positive

61
Q

When is the spine considered unstable?

A

> 2 columns involved
Middle column involved
20° of angulation

62
Q

What are indications for surgery in metastatic bone disease?

A
  1. Intractable pain
  2. Impending pathological fracture
  3. Pathological fracture has occurred
63
Q

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

A

Lesion size >3 cm

>50% cortex involved

64
Q

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

A

Lesion size >2.5 cm

>30-50% cortex involved

65
Q

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

A

Lesion size >1.3 cm

>1.3 cm axial length cortex involved

66
Q

How do osteolytic lesions present?

A

Net loss of bone by osteoclast mediated bone reabsorption

Dec strength and stiffness of bone

67
Q

How do osteoblastic lesions present?

A

Sclerotic areas of bone formation

Dec stiff but do not change strength

68
Q

Which type of bone lesion is more prone to fracture?

A

Lytic lesions

69
Q

What are typical causes of lytic lesions?

A 
– Myeloma 
– Lung 
– Kidney 
– Thyroid 
– Malignant lymphomas 
– Breast
70
Q

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

A

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

71
Q

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

A

Variable, depends on medical condition

May be as short as 6 months

72
Q

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

A

40 months

90% Blastic lesions

73
Q

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

A

24 mos

60% blastic lesions

74
Q

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

A

Osteosarcoma

75
Q

Describe imaging in multiple myeloma.

A

Bone scans may be normal

Skeletal survey may reveal diffuse “punched out” lytic lesions with black sclerotic borders

76
Q

Describe Step 1 on the WHO analgesic ladder.

A

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

77
Q

Describe Step 2 on the WHO analgesic ladder.

A

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).

78
Q

Describe Step 3 on the WHO analgesic ladder.

A

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).

79
Q

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

A

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

80
Q

Which NSAID has the least incidence of thrombocytopenia?

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