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L8 Cancer Flashcards

1
Q

Cancer Prevention Pathway

A

Education in adhereing to cancer screening, meeting physical activity and nutrition guideles, smoking cessation and sun protection

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2
Q

Survivor pathway

A

disease related impairments
treatment related impairments (acute, late, persistent)

goals are restorative and patient education

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3
Q

Treatment pathways for cancer

A

Prevention
Survivor
End of life

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4
Q

Cancer definition

A

group of disease characterized by uncontrolled growth and spread of abnormal cells that can result in death if not treated

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5
Q

Causes of cancer

A

external factors = tobacco, infectious organisms, chemicals, radiation

internal factors = inherited mutations, hormones, immune conditions, mutations from metabolism

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6
Q

Cancer classification

A
  1. Tissue of origin/histogenesis
  2. Stage of cancer –> TNM staging OR Stave 1-4 system
  3. Tumor grade
  4. Receptor Status
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7
Q

Tumor grade

A

how closely the cell resembles normal cells

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8
Q

TNM staging

A

T = extent of tumor
N = extent of spread to lymph nodes
M = presence of metasteses

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9
Q

Types of cancer receptors

A

hormone –estrogen, progesterone, testosterone
epidermal growth factor
vascular endothelial growth factor

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10
Q

Why are cancer receptors important?

A

they can lead to increased cell proliferation of tumor cells

they can be a therapeutic site for stopping the diviion or growth of tumor cells

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11
Q

Malignant

A

cancer cells invade neighboring tissues, etner blood vessels, and metastasize to different sites

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12
Q

Benign

A

not cancer
tumor cells grow only locally and cannot spread by invasion or metastasis

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13
Q

Metastatic Cancer

A

cancer that has spread from the palce where it first started to another place in the body

has the same name and type of cancer cells as the original cancer

all malignant cancer types can metastasize

difficult to treat

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14
Q

Metastatic disease process

A
  1. primary tumor
  2. metastatic clone evolves
  3. proliferation of the clone and invasion of lymphatic or venous
  4. transported by circulation
  5. new tumor formation at the site of metastasis

it is a dynamic interaction between cancer cell and environmnet

specific organs harbor metastases from one type of cancer by stimulating their growth

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15
Q

Bone metastases and exercise

A

pre-exercise screening and exercise modifaction are required for safe exercise in patients with bone metsE

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16
Q

Exercise screening for bone mets

A

MD clearnace prior to exercise OR
minimum level of functioning that includes independent ambulation and self care OR
absence of unstable bone mets or pain related to lesion

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17
Q

Exercise mods for bone mets

A

=decreased load, pain free exercise, decreased reps

modified strength programs can improve strength and physical function without adverse effect

proceed with cautioN! exercises should be modified and monitored

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18
Q

High risk individuals for bone met execise

A

those with functional impairments
unstable mets
bone pain

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19
Q

Weight bearing precautions for bone mets

A

if patient has bone mets in weight bearing bone, ask radiologist to calculate what percentage of the cortex is involved

> 50% = NWB
25-50% = PWB
0-25% = FWB

use pain as your guide is the expert opinion

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20
Q

Spine mets and fracture

A

patients are often not referred to PT for education

PT role is to teach spine precaution ed for comfort, pain management, and to maintain independence

no evidece for role of spine precatutions to prevent pathologic fracture

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21
Q

Take home message of met disease

A
  1. document location
  2. Location impacts PT assessment
  3. Mets will impact PT treatment –> bone protection w/fractures, aerobic capacity with lung mets, strengthening potential w/neuro mets
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22
Q

Tumor classification

A

histogenesis/receptor status
dictates medical treatment, as you should be treating related impairments

screening for mets

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23
Q

Stage importance

A

extensiveness of disease
dictates medical treatment
location of known disease and mets
disease related impairments could impact PT plan

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24
Q

Grade importance

A

aggressiveness of cancer
dictates medical treatment
prognosis of patient and POC impacted

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25
Oncology surgeon
remove tumor and provide clean margins preform sentinel lymph node dissection and perform full lymph node dissection
26
Pathologist
describe the tumor characteristics
27
Medical oncologist
chemo, given systemically, to kill any cancer cells that were not removed during surgery perform tests to see if the cancer has spread to distant sites bioagent therapy to control growth of any tumor that has not been killed follow patient closely to watch for cancer recurrence
28
Radiation Oncologist
radiate the area where cancer was found to prevent local recurrence
29
PT treatment planning tips
What are the possible effects of the disease on systems for mobility? what are the possible effects of treatment on systems of mobility? if there are multiple impairments, how do you prioritize and formulate a treatment plan?
30
What is the therapeutic goal of medical treatment?
CURE (no recurrence) Prolongation of life Palliation of symptoms
31
Cancer treatment options
Can include any one or all of the toptions. Sequence depends on cancer characteristics surgery chemo radiation bioagents (hormonal and targeted)
32
Surgery
often part of treatment for patients with solid tumors (vs blood cancers) local treatment often have impacts to the surrounding systems
33
Nervous System, impacts of surgery
pain--hyperalgesia and allodynia weakness numbness impairments are based on cancer type and surgery performed CNS cancers often have surgery as part of treatment peripheral nerves can be injured during surgery
34
Lymphatic system impacts of surgery
at risk for lymphedema
35
Skin and fascia impacts of surgery
adhesions /scar tissue
36
MSK system impacts of surgery
amputation (common for osteosarcoma) decreased ROM weakness adhesions/scar tissue myofascial restrictions limiting ROM. worse if there is an infection or ROM restrictions w/post op PT role is to address the impairments and related activity restrictions as you would for patients that have these problems w/out cancer
37
Bone marrow impacts of surgery
complex treatment related issues
38
Common cancers that involve surgical lymph node removal
Breast Ovarian Prostate Melanoma Head and Neck
39
Bottom Line for PTs and Surgery
read surgical report to find out what anatomy was involved ask surgeon about post op restrictions seek mentorship, oncology residency, or con-ed to learn about common surgeries by cancer type
40
Chemotherapy
systemic control of cancer affect any dividing cell in the body, especially those that rapidly divide given via port or PICC line. avoid manual therapy near them b/c you can dislodge them they are at risk for blood clot with PICC, report vein engorgement ASAP
41
Chemo side effects
General: blood cells, hair cells, mucosa of GI tract Drug specific: depends on the drug
42
RBC and chemo
signs of anemia PTS should monitor lab values
43
WBC and chemo
increased risk for infection practice infection protocols
44
Platelets and PT
decreased clotting ability
45
GI mucosa
nausea, vomiting, diarrhea cocktail of steroids during chemo
46
Hair follicles and chemo
alopecia
47
Ovary/testes suppression and chemo
may elect to harvest eggs
48
Cancer related fatigue
severe persistnt fatigue can be physical, cognitive, emotional
49
Chemobrain
difficult to wuantify decreased memory, feeling in a brain fog
50
Pattern of General ADRs of Chemo
1st chemo = notice changes in lab values PT should occur at the beginning of the first week and then the third week, as the patient is preparing for their 2nd chemo, as they are usually feeling better try to time it so that you are working either during the "up times" or tat the beginning of the chemo
51
Acute vs persistent chemo related impairments
Severity, timing, and persistence of impairments depend on 1. Cumulative dose 2. amount of time to recover between doses 3. Co-morbidities most acute resolve over time, but can become persistent
52
Dose
described in mg/m given in cycles
53
adjuvant
after surgery
54
neoadjuvant
before surgery
55
dose dense
every 1 to 2 weeks rather than every 3 weeks
56
Nadir
time point between chemo cycles where blood values drop to their lowest point different for each drug, the dose, and how close it was given to the previous dose
57
Bioagents
targeted systemic therapy include monoclonal antibodies, hormone suppressors, hormone and other receptor blockers
58
Monoclonal antibodies
MAB drugs flags cells to be cleaned up by the immune system
59
Testosterone and Bioagents
inhibitors are given to men with prostate cancer as long as it continues to control cancer cell growth and there aren't intolerable side effects PT: myopathy/weakness is observed with LT. S/S similar to menopause
60
Estrogen Bioagents
Arinatase inhibitors are given to women with ER+ breast cancer does not block estrogen production used in post-menopasual women PT: increased risk for osteoporosis and fx. given for 2-5 years after completion of other treatment
61
Estrogen REceptor Blockers
also called selective estrogen receptor modulators SERMS inhibit ER in the brest, but activate ER in the bone and endometrium PT: strengthens bone, increased risk for uterine cancer, increased blood clots and stroke, menopause like s/s (joint pain), given 2-10 years after completion
62
Bottom line for PTs with bioagents
it is not sufficient to document that patient received chemo or bioagents you need to know specific medications investigate common side effects of those drugs
63
Radiation
local control of cancer not given to every patient, depends on cancer type and radiosensitivity of tumor causes direct and indirect damage to cell DNA resulting in cell death only affects tissues that are in field of radiation does cause cancer related fatigue
64
Radiosensitive Tissues
rapidly dividing tissue like skin or tumor acute effects, damage within weeks to months of exposure temporary effects normal cells are capable of repair dependent upn dose-time-volume
65
Radioresistant tissues
not rapdily dividing, nerve, blood vessels, fascia late effects damage months or years after first exposure permanent changes damage becomes more severe as time goes on dependent on dose, time, volumen
66
Acute Integumentary Effects
typically short lived, lasting from a few weeks to months skin erthema, inflmmation dry desquamation = Wet desquamation =
67
Wet desquamation
takes weeks to resolve, new cell proliferation is inadequate and dermis is exposed w/oozing of serum
68
Dry desquammation
dry, flaking, scaling that resolves 1-2 weeks after
69
Late/persistent skin effects
severity is dependent on total dose hyperpigmentation decreased tissue mobility (contraction, adhesions, fibrosis, pain)
70
Phase 1 Radiation induced fibrosis
Pre-fibrotic phase chronic inflamm increased vascular permeability edema formation firbroblast proliferation and activation
71
Phase 2 Radiation induced fibrosis
weeks to months after radiation damaged tissue is made of activated fibroblasts that are depositing collagen in a disorganized ECM BEST TIME TO BEGIN MANUAL THERAPY
72
Phase 3 Radiation induced fibrosis
fibroatrophic phase months to years after loss of parenchymal cells and retraction ECM becomes dense and tissue is poorly vascularized
73
Aerobic Exercise Helps with
cancer related fatigue general deconditioning nerve health prevention recurrence
74
Aerobic Exercise Considerations
monitor blood labs if taking chemo modify as necessary start off low and increase as fatigue decreases
75
Strengthening Exercise Helps with
cancer related fatigue general deconditioning post surgical weakness drug related weakness (prednisone and testosterone suppressing)
76
Strengthening considerations
ensure they don't have post op lifting restrictions know how to modify for other impairments may need manual therapy for ROM compression garments with lymphedema mod intensity
77
Stretching and Manual Therapy, Joint Mobs, Helps with
help regain ROM of joint and soft tissue after radiation and/or surgery decrease pain b/c of soft tissue restrictions
78
Stretching Considerations
Post op: AROM and dynamic Radiation fibrosis: long hold to help realign collagen
79
Manual therapy considerations
can begin 4-6 weeks after surgery/radiation, progressing to more intense 6-8 weeks avoid PORT, monitor edema, infection, open skin
80
Gait Training Helps with
improve gait after amputation improve gait with peripheral neuropathy
81
Gait Training considerations
consider AFO/orthootics, prosthetist look for gait deviations when fatigued consider pool
82
Balance Training Helps with
decrease fall risk increase confidence in ambulating with variable conditions
83
Patient education helps with
lymphedema faill risk peripheral neuropathy management
84
Prevention of Breast Cancer
exercising strenuously for more than 4 hours a week is associated with reduced breast cancer risk average RR reduction is 30-40% effect may be reatest for premenopausal women of normal or low body weight
85
Local recurrence breast cancer
changes to breast skin color swelling lumps thickening
86
Regional recurrence breast cancer
difficulty swallowing change in sensation pain of shoulder/arm lump near breastbone/collar bone swelling/lump in axillary lymph nodes
87
Distant recurrence breast cancer
numbness or weakness persistent dry cough changes to vision/headaches/nausea pain in bones balance issues seizures
88
Prostate cancer
288,300 cases of prostate cancer RF: non hispanic black men, 65+ older local survival rate >99% distant survival rate = 31%
89
S/S Prostate Cancer
difficulty urinating frequent urination weak or interrupted flow of urine painful or burning urination blood in urine or semen erectile dysfunction pain in hps/back
90
Benign Prostatic Hyperplasia
common condition in older men causes difficulty urinating puts pressure on urethra
91
Prostate specific antigen
blood test usually <4 is normal 4-10 = 25% of cancer >10 = 50% of cancer BUT CHANGE IN NUMBER is most important
92
Other factors that can cause elevated prostate specific antigen
enlarged prostate older age prostatitis
93
Treatment for Prostate Cancer
active surveillance surgery w/lymph node removal radiation hormonal treatment chemo (NOT FIRST LINE OF TREATMENT) bioagent
94
Active surveillance
recommended for slow growth or in older men MD visits every 3-6 months, PSA test teratment begins when significant increase in PSA, change in rectal exam or positive biopsy results also called expectatnt management or watchful waiting
95
Cancer is common...
high likelihood treating someone in active treatment even higher likelihood of treating a survivor remember that there will be persistent treatment impairments, be aware of red flags of reoccurence and secondary cancers
96
Treatment considerations--> disease related issues
know staging, grade, type is the disease progressing or responding to treatment --> changes plan of care Clinical findings can be related to undiagnozed mets
97
Treatment considerations, treatment related issues
What treatment have they already received? --specific surgery, chemo, radiation What treatment are they receiving in the future? --> patient education, prospective screening Timing of treatment side effects--> acute vs late vs persistent

5 Pathology (9 decks)

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