L31/32 Physiotherapy and Cancer Flashcards
What is cancer?
- Cancer is a disease of the cells
- Occurs when abnormal cells grow in an uncontrolled way
- These cells can damage or invade the surrounding tissue –or spread to other parts of the body
Most cancers start in a particular organ –this is called the _____ site
primary
What are the 2 types of tumours?
- Benign tumours (not cancer)
- Malignant tumours (cancer)
What are the 5 different types of cancer?
- Sarcoma
- Carcinoma
- Starts on the skin, organ (eg, bowel , melanoma, ovarian
- Leukaemia
- Lymphoma + myeloma
- CNS tumours
- Begin in brain and spinal cor (glianoma..etc)
What is the staging of cancer?
can classify the spread of cancers (used for solid tumours eg. breast cancer rather than blood cancer)
What is the TNM staging system?
globally recognised standard for classifying the extent of spread of cancer
What are the 3 factors of the TNM staging system?
- T(tumour) –indicates the size and extent of the primary tumour (Tx, TIS, 0-4)
- N(nodes) –indicates whether the lymph nodes are affected (Nx0-3)- How close (eg. axillary nodes —> supra-clavaicular nodes)
- M(metastases) –indicates whether there are distant metastases (0-1)- 1= they do have distant metastases)
_____ is a major cause of ill health in Australia
Cancer
While more cancer cases are being diagnosed, death rates have continued to ____. Survival rates have also _____ Why?
fall; improved
Due to better technology (better scan, understandings) Treatment is improving
What is the estimated most commonly diagnosed cancers (2017) for Females?
What is the estimated most common cause of death from cancers (2017) for females?
What is the estimated most commonly diagnosed cancers (2017) for males?
What is the estimated most common cause of death from cancers (2017) for males?
Whata re the 3 principles of cancer treatment?
- Cure
- Not always possible as they might be diagnosed late
- Control & Prolongation of life
- Stop it worsening/stop it worsening –> can live quite well but need treatment
- Palliation of symptoms- Diagnosed very late
- Causing them pain (eg. reaceive radiation for bony mets)
What are 3 factor principles of cancer treatment?`
- Tumour factors
- Treatment factors
- Individual factors
What are tumour factors of principles of cancer treatment?
- Where is the tumour located ? (location- eg. lung cancer wrapped around superior vena cava)
- How far can it spread
What are treatment factors of principles of cancer treatment?
Effectiveness, cost?
What are individual factors of principles of cancer treatment?
- General health (older patient –> performing invasive surgery –> could be highly dangerous),
- Financial status
- Perceptions of cancer
- Location of living (rural, remote)
- Body image (don’t want to lose a breast, might metatase but they rather)
- Working Active/independent
What are 6 cancer treatment modalities?
- Surgery
- Drug Therapies
- Chemotherapy
- Hormone Therapy
- Targeted Therapy
- Immunotherapy
- Radiation Therapy
- Neoadjuvant
- Adjuvant
- Combination
What is neoadjuvant as cancer treatment?
Get initial use of treatment (chemo, radiadtion) before they operate (surgery)
What is adjuvant as cancer treatment?
Additional treatment of chemo, radiation) after surgery (try to make sure they get all of it during surgery and then use other treatment to make sure they get all of it)
What is combination of neoadjuvant and adjuvant as cancer treatment?
- Common in head and neck (have surgery and chemo/radiation at the same time
- Increase effectiveness
What is surgery for cancer treatment?
Performed by surgeon or surgical oncologist to remove cancer from the body or repair a part of the body affected by cancer
What are 8 reasons for surgery as a cancer treatment?
- Prevention
- Take both breast (in case it affects other side)
- Diagnosis
- Biopsy to confirm
- Staging
- Primary treatment
- Remove tumour (abnormal issue and issue around it)
- Debulking
- Common in brain tumours (eg. cant remove all so try and remove as much as possible)
- Reconstruction
- Use breast from own body parts
- Supporting other treatments
- Palliative
- Drain plural diffusion
What are the 7 side effects of surgery as cancer treatment?
- Pain
- Blood loss
- Swelling + bruising
- Numbness/nerve pain/nerve damage
- Infection
- DVT
- Nausea/vomiting
What is chemotherapy?
- The use of drugs to kill or slow the growth of cancer cells
- Chemotherapy destroys the cells that are dividing rapidly
- Can be a single drug or a combination of several
What are 12 side effects of chemotherapy?
- Fatigue
- Appetite changes, nausea, vomiting
- Constipation
- Skin and nail (Go yellow and fall out) changes
- Hair changes (fall out)
- Mouth sores- Can’t eat
- Thinking and memory changes
- Can’t remember things
- Nerve and muscle effects
- Peripheral neuropathy (eg. Have trouble putting on shoes)
- Fertility
- IVF (will impact ability to have kids)
- Low platelet count
- Bruising and bleeding more easily
- Low red blood cells
- Contributes to fatigue
- Neutropaenia
- Greater risk of infection (can be a medical emergency in cancer patients)
- Cardiac toxicity
- Already in stage A heart failure (more common after having chemo, treatment than having a relapse)
What is radiation therapy?
Ionisation radiation Radiation to kill cancer cells or damage them so they cannot grow or multiply
Radiation therapy is a ______ treatment.
localised
While chemo affects whole body
What are the 4 ways that radiotherapy can be given?
- External radiotherapy
- External –> provides radiation
- Lie on couch
- Machine moves around but wont touch
- No. of beams prescribed for treatment
- Internal radiotherapy
- Brachytherapy
- Implants
- Common in prostate cancer to deliver small doses of radiation
What are 8 side effects of radiation therapy?
- Radiation = localised (depends on body part
- May build up over time- Accumulative (even after treatment)
- Fatigue
- Skin problems- Bad sunburn
- Appetite loss- Often in brain
- Nausea- Often in brain
- Bladder and bowel irritation- Colorectal or prostate
- Hair loss
- Infertility- Pelvic region
- Radiation induced fibrosis- Scarring, poor vasculature –> cosmetic impact –> impacts QoL (restricts movement)
What are the impacts for physiotherapist of radiation therapy?
- Do not apply heat or perform manual techniques over irradiated skin
- Avoid forceful stretching of any irradiated joints/muscles
How does skin type get affected by radiation therapy?
- Darker skin = less problems (compared to paler skin)
- Dull erythema = sun burn affect
- Dry desquamation
- Moist desquamation
What is targeted therapy?
- Focuses on proteins or mutations found in some tumours
- Attack specific targets inside tumours that cause the tumour to grow uncontrollably
- Herceptin
- HER-2 (breast cancer)
- Dabrafenib
- B-RAF (melanoma)
What are the 2 types of Attack specific targets inside tumours that cause the tumour to grow uncontrollably (target therapy)?
- Herceptin (To try attack pathway)–> HER-2 (breast cancer)
- Quite aggressive
- Dabrafenib –> B-RAF (melanoma)
How did immunotherapy works?
- Boost the immune system so it works better against cancer
- Remove barriers to the immune system attacking cancer
What are 3 characteristics of advanced melanoma using immunotherapy?
- Keytruda
- Opdivo
- Yervoy
What is a characteristic of cervical cancer using immunotherapy?
HPV vaccination
How does hormone therapy work?
- Use other hormones bind to receptor rather than estrogen binding
- High levels of estrogen –> increased risk of breast cancer
How does head and neck cancer develop?
- Use to only be common in smokers men
- Becoming common due to oral sex (herpes virus)
What are the 8 risk factors for cancer?
- Tobacco smoking
- Alcohol consumption
- Overweight/obesity
- Physical inactivity
- UV radiation
- Infections –ieHPV, Hep B/C
- Occupational exposure
- Family History
______% of cancer would be prevented
30
What are the 4 risk factors that contribute to 90% of cancer?
- Smoking
- Alcohol
- Overweight/obesity
- UQ radiation
What are the 2 characteristics of prevention for cancer?
- Minimise risk factors
- Vaccines
What are the 3 characteristics of early detection for cancer?
- Self examination
- Early warning signs
- Lump in armpit, breast ; wound that is not healing, changing with continence (eg, difficulty to star urinating)
- Screening programmes
What are the 2 characteristics of diagnosis for cancer?
- Clinical signs and symptoms
- Investigations -imaging, blood tests, biopsy
What are the 4 red flags for physiotherapy assessment for cancer?
- Markers of risk factors in musculoskeletal disorders
- Signs of serious pathology –often require urgent medical opinion
- Asking the ‘special questions’
- LBP
What are 11 cancer red flags?
- Constant, progressive, non-mechanical pain
- Unremitting night pain/pain when lying down
- Thoracic pain
- Age: <20yrs >50yrs
- Previous cancer history- Eg. breast cancer –> metastased into spine
- Worsening neurology
- Night sweats
- Sudden weight loss
- Failure to improve with conservative management
- Symptoms of spinal cord compromise (non-dermatomalsymptoms, ataxia, increased reflexes, +ve babinski or clonus, non-myotomal muscle weakness)
- Cauda Equina symptoms (bladder/bowel dysfunction), saddle anaesthesia, gait disturbance, global limb weakness
What are the 2 roles that the physio have for breast cancer?
- Shoulder ROM
- Lymphoedema monitoring
What are the 2 roles that the physio have for prostate cancer?
- Pelvic floor retraining and continence
- Resistance training
What are the 2 roles that the physio have for brain tumour?
- Balance and mobility retraining
- UL + LL strengthening and coordination
What is a role that the physio have for ned and neck cancer?
Shoulder and neck dysfunction post surgery
What are the 4 roles that the physio have for all cancer?
- Lymphoedema monitoring and management
- Exercise
- Fatigue management
- Scar management
What are 6 characteristics of cancer related fatigue?
- Very common among cancer patients
- Acute or ongoing
- Negatively affects oncology patients
- Leads to decreased treatment adherence and poor patient outcomes
- Exercise therapy significantly more effective at reducing CRL both during and after treatment compared with medication or psychological treatment
- AMA recommends clinicians should be prescribing exercise as a first line treatment for cancer patients Fatigue that may not made better by rest of sleep
What is exercise in cancer care like?
A safe and effective intervention to counteract many of the adverse physical and psychological side effects of cancer and it’s treatment
What are the 5 characteristics complex lymphatic therapy “intensive treatment”
- Frequency of treatment and degree of compression adapted depends on severity of oedema
- Requires multiple visits (often daily) over the course of weeks
- Greatest volume reduction is in the first week but is continued for 2-4/52 to continue reduction and stabilise
- Consider patient’s ability to wear garment required for sustained treatment success
- Bandaging/Garments will cause difficulty with hygiene (Unable to shower for a while), functional tasks (incldriving), clothing choices, mobility, Hydrotherapy - can also be used
What are 4 action of compression therapy?
- Reduction in capillary filtration
- Shift of fluid into non-compressed parts of the body
- Promote fluid movement in venous and lymphatic vessels
- Breakdown of fibrosclerotictissue
What are 3 contraindications of compression therapy?
- Severe arterial insufficiency
- Uncontrolled heart failure
- Severe peripheral neuropathy
What are the 4 characteristics for physiotherapy and breast cancer?
- In 2018 it is estimated that 18 087 women and 148 men will be diagnosed ~50 people every day
- 1 in 8 women will be diagnosed by 85
- Average age of first diagnosis is 65
- 90% survival at 5 years Cancer that starts as ducts or lobules
- Duct cancer in situ
- Outside into normal breast tissue or out into lymph nodes = invasive ductile carinoma
What are the 4 types of surgery for breast cancer?
What are the 4 adjuvant treatment for breast cancer?
- Chemotherapy
- Radiotherapy
- Hormone Therapy
- Targeted Therapy (HER-2 +vecancers)
What are 7 implications for physiotherapy in breast cancer?
- Shoulder ROM recovery
- Scar management- Scared to move –> in case they rip scar
- Axillary web syndrome/cording- Hardening of vessels –> prevents movement (treat –> massage and stretching)
- Lymphoedema awareness and prevention
- Activity/exercise and functional capacity
- Early identification and intervention
- Psychosocial support
What is the initial post-op management for day 1 and 2?
Day 1
- Hand, wrist, elbow
Day 2
- Assisted shoulder movement (limited to <90°shoulder flexion)
What is the drain removal/2 weeks post op?
progress exercises above shoulder
Neck, shoulder girdle –assisted and active
What is the ongoing physiotherapy management?
- Lymphoedema risk management
- Exercise prescription
- Surveillance of complications ie. cording, psychosocial
What are 6 characteristics of Physiotherapy and Head & Neck (H&N) Cancer?
- There are 18 different cancer sites categorisedas H&N cancers
- Males account for a much higher compared with females.
- often associated with lifestyle risk factors.- Eg. smokers, and drinkers
- In 2014 4537 H&N cancers were diagnosed
- 1080 deaths in 2016
- 5 year survival rate is 70%
What is the aim of head and neck cancer surgery?
head and neck cancer is to remove cancerous tissue and preserve functions of the head and neck as much as possible iebreathing, swallowing and talking
What is the recovery of minor surgery in head and neck cancer?
quick recovery
What are the 3 characteristics of major surgery for head and neck cancer?
Bone graft, flap reconstruction
- Can take 12+ hours
- Longer lasting/permanent side effects
- May include plastic reconstructive surgery to rebuild the area
What are 2 things that might happen if cancer has spread to the lymph nodes in the neck, or if there is a chance it will spread a neck dissection (removal of lymph nodes) is recommended?
- Neck dissection may be the only surgery needed when the primary will be treated with XRT- Significant surgery –> many morbidities
- May be part of a longer H&N operation
What is the Radical Neck Dissection (RND)?
To ensure complete cancer removal in individuals with very advanced H&N cancers
What are 5 lateral neck nodes and tissues that will be removed?
- Lymph nodes
- Submandibulargland
- SCM muscle
- Jugular vein
- Spinal accessory nerve (SAN)
What are the 3 characteristic cosmetic and physical changes in radical neck dissections (RND) for head and neck cancer ?
- One side of the neck may appear flatter
- Drooping of shoulder
- Difficulty lifting arm above shoulder height
- Due to lack of supply to trapezius
- Significant scarring
What are 3 types of surgery for head and neck cancer?
- Radical Neck Dissection (RND)
- Modified Radical Neck dissection (MRND)
- Selective neck dissection (SND)
What is Modified Radical Neck dissection (MRND)?
Variety of neck dissections that preserve structures that are usually sacrificed in the RND
What are 2 characteristics of Selective neck dissection (SND)?
- Preserve important structures
- Remove specific groups of lymph nodes rather than all of the lymph nodes on the side of the neck
- Less cosmetic changes
- Reduced impact on neck and shoulder movement
What are 7 commonly reported symptoms of head and neck cancer?
- Shoulder weakness
- Shoulder / neck pain
- Loss of shoulder movement –limited active shoulder abduction <90 degrees
- Shoulder girdle depression / drooping / protraction
- Trapezius atrophy
- Altered skin sensation
- Functional deficits
- Rounded shoulder with tight pecs –> uopposed
What is the post op for physiotherapy post neck dissection?
Prevention/management of respiratory complications including excess secretions, DVT
What are 4 characteristics of unload shoulder for physiotherapy post neck dissection?
- Reduce neck and shoulder pain
- Prevent stretch fibrosis of trapezius
- Prevent contracture of unopposed pecmuscles
- Strengthening for residual muscles to compensate for lost muscles
What are 3 possible requirements/conditions for physiotherapy post neck dissection?
- Postural modification and re-education
- Trismus/TMJ dysfunction due to radiotherapy and scarring
- Lymphoedema
What are 2 characteristics of Neurotmesis for physiotherapy post neck dissection??
- Strengthen alternative scapular elevators, abductors & retractors
- Shoulder brace
What are 3 characteristics of Neuropraxic for physiotherapy post neck dissection?
- Temporary loss of nerve function- Spinal accessory nerve affected although not removed from lymph removal
- Anticipate re-innervation over 12/12 post op
- Stimulate subsidiary nerve supply
What are the 3 characteristics in terms of prevalence of prostate cancer?
- Estimated that there will be 17 729 new cases of prostate cancer diagnosed in 2018
- More than 3,000 men die of prostate cancer in Australia every year
- More men die of prostate cancer than women die of breast cancer
What is the prostate gland?
forms part of the male reproductive system
It is a walnut-sized organ that surrounds the urethra at the base of the bladder.
What is the main function of the prostate?
The main function of the prostate is to produce the fluid that protects and enriches sperm.
What does prostate cancer result from?
uncontrolled replication of cells in the prostate.
What are 5 symptoms of prostate cancer in the later stages?
- Feeling the frequent or sudden need to urinate
- Finding it difficult to urinate (for example, trouble starting or not being able to urinate when the feeling is there or poor urine flow)
- Discomfort when urinating
- Finding blood in urine or semen
- Pain in the lower back, upper thighs or hips.
What are the 4 treatments of prostate cancer?
What are 3 common treatment side effects of surgery in prostate cancer?
- Long term impotence
- Incontinence
- Erectile dysfunction
What are 5 common treatment side effects of hormone therapy in prostate cancer?
- ↓ muscle mass
- ↓ muscle strength
- ↓ BMD
- Weight gain
- Hot flushes
What are 6 common treatment side effects of radiation therapy in prostate cancer?
- Increased urinary frequency
- Urinary urgency
- Burning when urinating
- Incontinence
- Fatigue
- Lymphoedema
What are the 3 aims of physiotherapy in prostate cancer?
- Pelvic floor retraining
- Lymphoedema monitoring and management
- Exercise advice and prescription
What are 2 characteristics of cancer survivorship?
- An estimated 1.1million people living in Australia have had a diagnosis of cancer
- As survival for cancer overall continues to improve, an increasing proportion of the population will require ongoing treatments, support and long-term follow-up care
What is cancer survivorship?
Survival but often left with morbidities due to treatment
What are 8 physical characteristics of cancer survivorship?
- Fatigue
- Cardiac/pulmonary effects
- Neurological effects
- Peripheral neuropathy
- Lymphoedema
- Malignant neoplasms/second cancers
- Pain
- Long term physical effects Eg. child with cancer –> impact on development (eg. puberty)
What are 4 social characteristics of cancer survivorship?
- Changes in relationships
- Treated differently by friends/family and colleagues
- Feel like friends/family do not fully understand
- Relationship problems can resurface
- Marriage break down (feel obliged to stay; friends find it hard to react (sya wrong things); patients feel like other people don’t understand what they are going through
What are 7 emotional characteristics of cancer survivorship?
- Fear of cancer recurrence
- Uncertainty about the future
- Survivors guilt
- Increased anxiety
- Feeling loss/abandonment after moving away from treating team
- Why they are the “unlucky” ones getting cancer?
- Can be anxious about relapse
- Confused why once treatment is over, what to do with their life
What are 2 risks of radiation?
- Second cancer developing
- Pain
What is the lymphoedema grading system?
