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Clinical Exercise Physiology > Lecture 13 > Flashcards

Lecture 13 Flashcards

1
Q

What is cancer?

A

proliferation of cells- anywhere in body / any type of cell

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2
Q

What is proliferation?

A

rapid growth and cell reproduction- in number

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3
Q

Tumor

A

a neoplasia/new growth, accumulation of abnormal cells
- cancer is type of tumor, usually grows rapidly ( not always)
- cancer = malignant tumor (not benign)

can break off and travel to other areas

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4
Q

Benign

A

slow, relatively localized, well defined, nerve fibers (can produce pain)

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5
Q

Malignant

A
  • cancerous
  • grows rapidl
  • consists of different types of cells with various mutations that occur
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6
Q

Development of cancer

A
  • abnormal changes
  • Hyperplasia identifies state in which cells divide faster than normal and extra cells accumulate, but cells still look normal under micrscope
  • Dysplasia used when cells divide and proliferate more rapidly than normal and look abnormal under microscope; there are chanves in organization of cells within tissue
  • cancer is a breakdown in normal regulation of cell growth, aging, death
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7
Q

Process of developing cancer

A
  • normal cell transorms because of genetics, infection, enironment, carcinogen, etc.
  • First hyperplasia
  • then displaysia ( abnormal development, change in tissue) - proliferation and angiogenesis
  • then neoplasia (in situ)- tumor develops
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8
Q

Angiogenesis

A

new formation of BVs and maturation ( angiogenic factors secreted= VEGF, PDGF, bFGF) which bind to receptors to cause new BVs to form

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9
Q

Cancer characterized by:

A
  • Anaplasia loss of differentiation and organization
  • Autonomy independence from normal cellular control (mutate- variety of cancer cells, never same)
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10
Q

Carcinoma vs sarcoma

A
  • Carcinoma: start in cells of tissue lining organs (liver, kidneys)
  • Sarcoma: in connective tissues (muscles, bones, nerves)
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11
Q

Invasive neoplasia

A
  • move into vessels and invade other cells and tissues
  • angiogenesis allows more cancer cells to enter blood stream (by pressure and chemicals) then tumors can move to other parts of body
  • can invade immune system which is trying to fight cancer (goes to heart then the lungs - secondary site of invasion)
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12
Q

Metastasis

A
  • can spread in lymph vessels (heart, other tissues, brain, bone)
  • When cancer cells can travel from the tumor (primary tumor) through blood or lymphatic vessels to form a cancerous growth in another part of body
  • development of cancer is commonly multistep process (starts with genetic changes to cell)
  • 5-10% of cancers are genetic inherited from parents
  • majority of genetic changes arise from damage to DNA - from environmental factors (but rate varies individually)
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13
Q

Manifestation/ pathophysiology

A
  • second leading cause of mortality in both men and women in US
  • one in two american men and one in three american women will experience a cancer diagnosis during lifetime
  • over 100 diff. types oc cancer (diff. anatomical locations, diff. cell of origin-etiological factors, susceptibility to treatment = individualized)
  • melanoma - melanocytes (in skin and eyes)
  • lymphoma - lymph nodes
  • carcinoma - epithelial cells
  • adenocarcinoma - glandular epithelial cells
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14
Q

Commonly diagnosed:

A
  • 2/3 most - lung cancer bc smoking when spread - first to lungs
  • female: breast, lung, colorectal
  • male: prostate, lung, colorectal
  • 5 year survival rate once diagnosed with cancer
  • 60% - more people living
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15
Q

Types: cancers involvin epithelial cells are called carcinomas:

A
  • adenocarcinomas form in epithelial cells that produce fluids or mucus (glandular tissue), breast, colon, prostate cancer
  • basal cell carcinomas form in epithelial cells in the base or basal level of epidermis, skin cancer
  • squamous cell carcinomas form in epithelial cells that lie beneath outer surface of skin, skin cancer
  • transitional cell carcinomas form in epithelial cells that function to stretch an organ such as the bladder
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16
Q

Types: cancers that form in conncective tissues of body (bone or soft tissue, muscle/fat) are called sarcomas

A
  • blood cancers (leukemia) do not form solid tumors, instead abnormal cells circulate in blood
  • cancer can arise from neural cells in brain
  • types of cells and organ where cancer begins influence treatment and prognosis
  • cancer staging = process in which oncologist (physician specializing in cancer) or other provider assesses the extent and severity of cancer in patent’s body
17
Q

Cancer stages

A
  • stage 0: carcinoma in situ, abnormal cells present but still in basement membrane site where they started, not cancer, could become cancer
  • Stage 1-3: cancer is present. higher number, larger tumor. Stage 3 cancer indicates that it has spread to nearby tissues
  • Stage 4: cancer has spread to distant parts of body
18
Q

Breast Cancer

A
  • 200,000 women/year diagnosed in US, average age 62 (> 3.5 million survivors alive in US)
  • 5-year survival = 89%, if localized = 99%
  • self-detection, mammogram, maybe combined with MRI or ultrasound
  • biopsy… PET (positron emission tomography) scan spread to lymph or distant organs
19
Q

Gynecologic Cancer

A
  • ovarian, fallopian tube, endometrial cropus (most common), endometrial cervix, vaginal, vulvar
  • 1.2 million survivors in US
  • presents with symptoms - varied - vaginal bleeding
  • 5-year survival varies per type - if diagnosis early 95% but can be as low as 45-68% in ovarian and cervical
20
Q

Prostate Cancer

A
  • most common non skin cancer in men in US, 1:7 men diagnosed
  • average age 66 years old, rare in < 40 year olds
  • presents via blood screening- prostate specific antigen (PSA) - rectal palpitation exam
  • symptoms: issues in urination, erectile dysfunction, bone mestastases (pain), spinal cord compression - biopsy
  • 5-year survival rate = 99% and decrease with increased severity
  • 2.9 million survivors in US in 2016
21
Q

Lung cancer

A
  • second most common cancer (both men and women) and lead cancer causing deaths in US
  • 1:14 men and 1:17 women - regardless of smoking history, increase if smoke
  • later in life diagnosis >70 years old
  • 3 types: Non small cell lung cancer- (85% cases) includes 3 subtypes: adenocarcinoma, squamous cell carcinoma, and large cell (undifferentiated) carcinoma (can develop in nonsmokers); Small cell cancer- strongly linked to smoking and is a fast-growing cancer; **Carcinoid tumors- ** relatively rare and are slow growing
  • presents in chest x-ray, new low-dose computer tompography (LDCT)
  • symptoms: persistent cough, wheezing, shortness of breath, among others
  • 5-year survival rate = overall 17%, if local can be 55%
22
Q

Colorectal Cancer

A
  • 3rd most common cancer in men (1:22) and women (1:24) more common in those > 50 years
  • slw developing tumor, polyps (non-cancerous growth in inner lining of color or rectum)
  • screening - stool test, common = colonoscopy or flexible sigmoidoscopy - recommended for adults > 50 years
  • symptoms - bloody stool, bowel obstruction, several day diarrhea, unintentional weight loss
  • 1.45 million survivors in US ( 5-year survival rate = 65%, local = 90%, distant - 14%)
23
Q

Head and Neck Cancer

A
  • oral cavity, larynx, tongue, lip, throat, nasal cavity (paranasal sinuses, salivary glands)
  • 62,000 new cases each year - risk = smoke tobacco (smoke and smokeless) and alcohol
  • HPV (human papilloma virus) increases risk
  • function of area are symptoms - need exam for screening
  • 5-year survival rate about 60-90%
  • impact on quality of life - impact on speech, swallowing, taste, smell
  • 436,000 survivors in US
24
Q

Hematological

A
  • cancer that begins in blood-forming tissue ex. bone marrow, cells of immune system (called blood or hematological cancers)
  • 3 main categories: lymphoma arises in the tissues of the lymphatic system (swollen lymph nodes, shortness of breath, chest pain, abdominal fullness, loss of appetite, and intermittent fever; myeloma(or multiple myeloma) is cancer of the plasma cells in the bone marrow; leukemias are cancers that affect blood-forming tissues and usually involve leukocytes (white blood cells) (symptoms of myeloma and leukemia include fatigue, paleness, repeated infections, bleeding or bruising easily, bone or joint pain, and swelling lymph nodes)
  • in 2016 there were 81,080 new cases of lymphoma (91% were non-Hodgkin lymphoma)
  • 30,330 new cases of myeloma and 60,140 new cases of various types of leukemia
25
Q

Most common treatments

A
  • based on stage, size, extent of spread, patient preference
  • surgery: if remove lymph nodes- greater association with lymphedema
  • chemotherapy: risk of heart damage (heart failure, cardiomyopathies, toxicity), peripheral neuropathy
  • radiotherapy: risks of function loss, lymphedema, etc.
  • targeted biological, hormonal, or immune therapies (risks of arthralgias, fatigue, tenderness, anemia, hot flashes/sweats, cognitive difficulties, vertigo, loss of bone/muscle, weight gain)
  • many patients receive more than one type of therapy
  • Goal of cancer treatment: complete remission and meaning that there is no evidence of disease; signs and symptoms have disappeared
  • cancer survivors are often monitored for many years after active treatment ends
26
Q

Roles of exercise

A
  • exercise = reduce risk of cancer (regular exercise)
  • research indicates a protective role of exercise in cancer in recurrence and mortality (primary = lower risk of 13 types of cancer, secondary = reduction of cancer-related mortality with seeveral common cancers)
27
Q

Mechanisms- how does exercise help?

A
  • alteration of metabolic pathways and growth factors (insulin and IGF axis pathways)
  • reduction in sex-steroid synthesis
  • improved immune function
  • reduced systemic inflammation and oxidative damage
  • interrupting angiogenesis in the tumor
  • possible protective effect- changes in amount and/ or activity of adipose or skeletal muscle tissue
28
Q

For patients undergoing treatment

A
  • pre-screening
  • need medical clearnace (check on symptoms and safety to begin exercise)
29
Q

Exercise prescription for patients undergoing treatment

A
  • indviduals exercise tolerance or ability to progress exercise volume may fluctuate with treatment cycles with accumulation of treatment side affects
  • durign chemotherapy be aware of changes in blood counts, dehydration, and low energy intake
  • both resting and exercise HR and BP may be less reliable during treatment - RPE may be advised to monitor intensity
  • prepare to modify for safety
30
Q

Treatment-related issues which may affect exercise

A
  • fatigue
  • pain
  • ROM
  • lymphedema (resistant training may help, careful approach to exercise to avoid exacerbation of symptoms, consider compression garments)
  • neurotoxicity (numbness/tingling in hands or feet, risk of grip, loss of mobility, risk of falls
31
Q

Life after cancer

A
  • awareness of symptoms (lymphedema, bone lesion, peripheral neuropathy)
  • ease into it, gradual build
  • triage with goal to get as many cancer survivors active while avoiding risk
32
Q

Lasting affects that may linger after treatment ends

A
  • CVD- especially with chemo and radiation- interfere with processes (myocardial stress, endothelial dysfunction, artherosclerosis, platelet activation)
  • metabolic disease - obesity, type 2 diabetes
  • frailty- unintentional weight loss, weekness, exhaustion, low level of PA
  • bone loss- more osteoporosis, fractures, to reduce fracture risk = fat prevention is goal of therapy
  • psychological distress- emotional toll and PTSD (worries, fears, psychological downfall - how get back to daily life - different)
  • may affect ability to maintain exercise program- exercise, social support, group exercise for survivors

Clinical Exercise Physiology (8 decks)

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