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5 Pathology > L8 Cancer > Flashcards

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
Q

Oncology surgeon

A

remove tumor and provide clean margins
preform sentinel lymph node dissection and perform full lymph node dissection

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26
Q

Pathologist

A

describe the tumor characteristics

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27
Q

Medical oncologist

A

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

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28
Q

Radiation Oncologist

A

radiate the area where cancer was found to prevent local recurrence

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29
Q

PT treatment planning tips

A

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?

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30
Q

What is the therapeutic goal of medical treatment?

A

CURE (no recurrence)
Prolongation of life
Palliation of symptoms

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31
Q

Cancer treatment options

A

Can include any one or all of the toptions. Sequence depends on cancer characteristics

surgery
chemo
radiation
bioagents (hormonal and targeted)

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32
Q

Surgery

A

often part of treatment for patients with solid tumors (vs blood cancers)
local treatment

often have impacts to the surrounding systems

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33
Q

Nervous System, impacts of surgery

A

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

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34
Q

Lymphatic system impacts of surgery

A

at risk for lymphedema

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35
Q

Skin and fascia impacts of surgery

A

adhesions /scar tissue

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36
Q

MSK system impacts of surgery

A

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

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37
Q

Bone marrow impacts of surgery

A

complex treatment related issues

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38
Q

Common cancers that involve surgical lymph node removal

A

Breast
Ovarian
Prostate
Melanoma
Head and Neck

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39
Q

Bottom Line for PTs and Surgery

A

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
Q

Chemotherapy

A

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
Q

Chemo side effects

A

General: blood cells, hair cells, mucosa of GI tract

Drug specific: depends on the drug

42
Q

RBC and chemo

A

signs of anemia
PTS should monitor lab values

43
Q

WBC and chemo

A

increased risk for infection
practice infection protocols

44
Q

Platelets and PT

A

decreased clotting ability

45
Q

GI mucosa

A

nausea, vomiting, diarrhea
cocktail of steroids during chemo

46
Q

Hair follicles and chemo

A

alopecia

47
Q

Ovary/testes suppression and chemo

A

may elect to harvest eggs

48
Q

Cancer related fatigue

A

severe persistnt fatigue
can be physical, cognitive, emotional

49
Q

Chemobrain

A

difficult to wuantify
decreased memory, feeling in a brain fog

50
Q

Pattern of General ADRs of Chemo

A

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
Q

Acute vs persistent chemo related impairments

A

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
Q

Dose

A

described in mg/m
given in cycles

53
Q

adjuvant

A

after surgery

54
Q

neoadjuvant

A

before surgery

55
Q

dose dense

A

every 1 to 2 weeks rather than every 3 weeks

56
Q

Nadir

A

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
Q

Bioagents

A

targeted systemic therapy

include monoclonal antibodies, hormone suppressors, hormone and other receptor blockers

58
Q

Monoclonal antibodies

A

MAB drugs
flags cells to be cleaned up by the immune system

59
Q

Testosterone and Bioagents

A

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
Q

Estrogen Bioagents

A

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
Q

Estrogen REceptor Blockers

A

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
Q

Bottom line for PTs with bioagents

A

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
Q

Radiation

A

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
Q

Radiosensitive Tissues

A

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
Q

Radioresistant tissues

A

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
Q

Acute Integumentary Effects

A

typically short lived, lasting from a few weeks to months

skin erthema, inflmmation
dry desquamation =
Wet desquamation =

67
Q

Wet desquamation

A

takes weeks to resolve, new cell proliferation is inadequate and dermis is exposed w/oozing of serum

68
Q

Dry desquammation

A

dry, flaking, scaling that resolves 1-2 weeks after

69
Q

Late/persistent skin effects

A

severity is dependent on total dose

hyperpigmentation
decreased tissue mobility (contraction, adhesions, fibrosis, pain)

70
Q

Phase 1 Radiation induced fibrosis

A

Pre-fibrotic phase

chronic inflamm
increased vascular permeability
edema formation
firbroblast proliferation and activation

71
Q

Phase 2 Radiation induced fibrosis

A

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
Q

Phase 3 Radiation induced fibrosis

A

fibroatrophic phase
months to years after

loss of parenchymal cells and retraction

ECM becomes dense and tissue is poorly vascularized

73
Q

Aerobic Exercise Helps with

A

cancer related fatigue
general deconditioning
nerve health
prevention
recurrence

74
Q

Aerobic Exercise Considerations

A

monitor blood labs if taking chemo

modify as necessary

start off low and increase as fatigue decreases

75
Q

Strengthening Exercise Helps with

A

cancer related fatigue
general deconditioning
post surgical weakness
drug related weakness (prednisone and testosterone suppressing)

76
Q

Strengthening considerations

A

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
Q

Stretching and Manual Therapy, Joint Mobs, Helps with

A

help regain ROM of joint and soft tissue after radiation and/or surgery

decrease pain b/c of soft tissue restrictions

78
Q

Stretching Considerations

A

Post op: AROM and dynamic

Radiation fibrosis: long hold to help realign collagen

79
Q

Manual therapy considerations

A

can begin 4-6 weeks after surgery/radiation, progressing to more intense 6-8 weeks

avoid PORT, monitor edema, infection, open skin

80
Q

Gait Training Helps with

A

improve gait after amputation
improve gait with peripheral neuropathy

81
Q

Gait Training considerations

A

consider AFO/orthootics, prosthetist

look for gait deviations when fatigued

consider pool

82
Q

Balance Training Helps with

A

decrease fall risk
increase confidence in ambulating with variable conditions

83
Q

Patient education helps with

A

lymphedema
faill risk
peripheral neuropathy management

84
Q

Prevention of Breast Cancer

A

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
Q

Local recurrence breast cancer

A

changes to breast skin color
swelling
lumps
thickening

86
Q

Regional recurrence breast cancer

A

difficulty swallowing
change in sensation
pain of shoulder/arm
lump near breastbone/collar bone
swelling/lump in axillary lymph nodes

87
Q

Distant recurrence breast cancer

A

numbness or weakness
persistent dry cough
changes to vision/headaches/nausea
pain in bones
balance issues
seizures

88
Q

Prostate cancer

A

288,300 cases of prostate cancer

RF: non hispanic black men, 65+ older

local survival rate >99%
distant survival rate = 31%

89
Q

S/S Prostate Cancer

A

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
Q

Benign Prostatic Hyperplasia

A

common condition in older men
causes difficulty urinating
puts pressure on urethra

91
Q

Prostate specific antigen

A

blood test
usually <4 is normal

4-10 = 25% of cancer
>10 = 50% of cancer

BUT CHANGE IN NUMBER is most important

92
Q

Other factors that can cause elevated prostate specific antigen

A

enlarged prostate
older age
prostatitis

93
Q

Treatment for Prostate Cancer

A

active surveillance
surgery w/lymph node removal
radiation
hormonal treatment
chemo (NOT FIRST LINE OF TREATMENT)
bioagent

94
Q

Active surveillance

A

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
Q

Cancer is common…

A

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
Q

Treatment considerations–> disease related issues

A

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
Q

Treatment considerations, treatment related issues

A

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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