Neoplasia Flashcards
Large group of diseases broadly defined by uncontrolled cell proliferation and spread of abnormal cells
Cancer (aka malignant neoplasm, tumor, malignancy, carcinoma)
The process by which normal cells undergo physical and structural changes as they develop to form different tissues of the body
Differentiation
A general category that indicates a disorganization of cells in which an adult cell varies from its normal size, shape, or organization
Dysplasia
First level of dysplasia, adult cell changes from one type to another; reversible and benign
Metaplasia
Loss of cellular differentiation; characteristics of malignant cells only
Anaplasia
Increase in the number of cells in tissue, resulting in increased tissue mass
Hyperplasia
Abnormal growth of new tissue and may be benign or malignant
Tumor (neoplasm)
Where cancer or tumor starts
Primary site
Where cancer spreads to
Secondary site
Pre invasive, premalignant epithelial tumor of glandular squamous cell origin; malignant tumor but hasn’t spread outside of primary site yet
Carcinoma in situ
How are neoplasms classified?
- Cell type
- Tissue origin
- Degree of differentiation
- Anatomic site
- Benign or malignant
Malignant and benign tumors have the same name except malignant tumors have a suffix. Name the 2 suffixes and their meaning.
- Carcinoma - epithelial
2. Sarcoma - mesenchymal (connective tissue
Generally harmless tumor because it does not spread or invade other tissue
Benign
Tumor of neural cell precursor (benign and malignant)
Benign - ganglioneuroma
Malignant - neuroblastoma
Malignant lymph nodes of the spleen
Lymphoma
Hematopeoitic malignant tumors of bone marrow and plasma cells
Leukemia, myelodysplasia, multiple myeloma
Germ cell tumor (embryonic cells) benign and malignant
Teratoma (benign); Teratocarcinoma, embyonal carcinoma, seminoma/dysgerminoma
The extent of the disease at the time of diagnosis; more predictive of prognosis
Staging
The degree of malignancy and differentiation
Grading
Staging used in lymphomas
Ann Arbor Staging
Name the 3 components of TNM classification
- Primary tumor - T
- Regional lymph nodes - N
- Metastasis - M
Is cancer incidence on the rise?
No, cancer overall has decreased 20% over the last two decades
Cancer due to genetics
Endogenous
Cancer due to environmental/external factors
Exogenous
Theory that cancer is due to a series of mutations; induced by carcinogenic agents and hereditary susceptibility; process involves many steps
Somatic mutation theory
Theory that there are cancer causing genes; transform normal cells into malignant cells (independently or with a virus)
Oncogenesis
Tumor supressor genes
Anti-oncogenes
What are clinical manifestations of cancer?
Asymptomatic early; destruction, necrosis, ulceration, hemorrhage; pain; nausea, vomiting; weight loss, m. weakness, anorexia, anemia, coagulation disorders; fever; GI, pulmonary, and vascular obstruction; fatigue; wasting
Clinical manifestations of: Pulmonary system? Hepatic system? Skeletal system? Central Nervous system?
Pulmonary - cough, hemoptysis, dyspnea
Hepatic - hepatomegaly, nausea, jaundice
Bones - bone pain, fx
CNS - Neurological symptoms such as headaches, seizures, vertigo
What are causes of pain with cancer?
- Depression/anxiety - may make pain worse
- Locally - pain due to pressure on structure
- metastasis
- Spinal cord compression
- From treatment - surgery, radiation, chemotherapy
Disease where tumors produce systemic signs and symptoms at a distance form the tumor or its metastasized sites; typically hormone related; when cancer expresses characteristics different from its cancerous tissues; malignant cells can acquire new cellular fans uncharacteristic of the originating tissue
Paraneoplastic syndrome
What are the medical screenings used for breast cancer?
- Breast Self Exam
- Clinical Breast exam
- Mammography
What are the medical screenings used for colorectal cancer?
- Fecal occult blood test (FOBT), or fecal immunochemical test (FIT)
- Stool DNA test
- Flexible sigmoidoscopy
- Double contrast barium enema
- Colonoscopy
- CT colonography
What are the benefits exercise for cancer, according to the exercise-cancer hypothesis
- Enhance immune function
- Prevent or minimize m. wasting (counteracting cancer or chemo)
- Maintain quality of life
What are the early warning signs of cancer?
- Change in bowel or bladder habits
- Sore that does not heal in 6 weeks
- unusual bleeding or discharge
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty swallowing
- obvious change in a wart or mole
- Nagging cough or hoarseness
What early cancer signs should physical therapists look for?
- Proximal muscle weakness (shoulder girls, hip)
2. Change in deep tendon weakness
What are the early melanoma signs?
ABCD's - Asymmetry Border Color Diameter
What are the curative cancer treatments?
- Surgery
- Radiation
- Chemotherapy
- Biotherapy (immunotherapy)
- Hormonal therapy
Treatment of disease by delivery of radiation to a particular area of the body using high energy ionizing radiation to kill cancer cells; interacts with nuclear DNA preventing the cell’s ability to divide
Radiation therapy
What are the clinical manifestations of radiation therapy that PTs are to look out for?
Connective tissues -
- Fibrosis, atrophy and contraction
- Limb length discrepancies. scoliosis
- Lymphadema
What are the clinical manifestations of radiation therapy?
- Esophagitis and enterocolities
- Heart Disease
- Lung Disease
- Dermatitis
- Connective tissue
- Nervous system
What is an absolute contraindication of radiation therapy?
Pregnancy
What should you do post radiation therapy?
- Avoid topical use of alcohol, lotions, gels, oils, salves, creams
- Avoid positions where pt is lying on radiated area
- Avoid exposure to direct sunlight, heat lamps, thermal modalities
- Expect delayed wound healing
Used to cure, palliate prior to bone marrow transplant or adjunct other therapies; goal is to destroy malignant cells and maintain normal cells
Chemotherapy
What are the 4 primary agents of chemo therapy? Which has clinical importance for PTs?
- Alkylating
- Antimetabolites
- Antibiotics ** - tend to be cardiotoxic; increases risk of cardiac problems
- plant alkaloids
What are adverse effects of chemotherapy?
- Nausea/vomiting
- Mucositis
- Myelosuppression
- Sterility
- Toxic to fetus
- Alopecia
- GI toxicity
- Fatigue
- Cardio, pulm, renal, hepatic toxicity
- Peripheral neuropathy
What should PTs be aware of with chemotherapy?
- Possibility of myelosuppression
- Monitor hematology values
- Signs and symptoms of myelosuppression
- Symptoms may lay latent (pulmonary fibrosis)
- Neuropathies
What cancer treatments are palliative (attempt to improve quality of life, not cure cancer)?
- Radiation
- Chemotherapy
- Physical therapy
- Medications
- Acupuncture
- Chiropractic care
- Alternative medicine
- Hospice care
Clues to screening for cancer: Previous personal history of cancer, especially in the presence of carpal tunnel symptom, back pain, shoulder pain, or joint pain of ______ or _______ cause at presentation
Unknown (think systemic); rheumatic
-if not following normal progression during treatment
Clues to screening for cancer: Any woman with chest, breast axillary or ________ pain of unknown cause
Shoulder
Clues to screening for cancer: Anyone with back, pelvic, groin, or hip pain accompanied by vague _______ complaints, _____ mass
Abdominal; palpable
Clues to screening for cancer: When back “injury” is not __________ or if symptoms are _______.
improving as expected; increasing
Clues to screening for cancer: Constant pain (unrelieved by ______ or ________); pain present at _______
Rest; change in position; night
Clues to screening for cancer Signs of __________ compression must be screened for cancer as a possible cause
Nerve root
Clues to screening for cancer: Changes in ____, _____, _____, and ______ of lymph nodes, especially painless, hard rubbery lymph nodes present in more than location and occurring for more than 4 weeks.
Size; Shape; Tenderness; Consistency
Document the number, type, and severity of difficulties that an individual may be facing as a result of the cancer diagnosis; looks at impact cancer has on pts life
CARES (cancer rehabilitation evaluation system)
What should PTs address in exercise intensity?
- Don’t just use HR
- Borg RPE (no greater than 12)
- Anemia
- Peak capacity 3-5 MET’s
- 40-65% of peak HR, HR reserve, or VO2 max (just below anaerobic threshold)
- High rep low load weight circuit
What are the time restriction guidelines to follow after radiation?
- Do not exercise within 2 hours of radiation
- Slow carful stretching skin and connective tissue can tear
- low to moderate intensity aerobic exercise during the weeks of radiation may be beneficial
- Assess fatigue leve (cancer related fatigue as well)
What are the most common childhood cancers?
- All acute lymphoblastic leukemia
- Non-hodgkin’s lymphoma
- Hodgkin’s disease
- Primary CNS tumor
What are the physical therapy interventions with cancer?
- Fall prevention; neuropathy and fatigue
- Physical agents; decreased sensation, increased blood flow
- when to refer
