Oncology Flashcards
What are the 5 stages in the cancer trajectory?
Prevention Diagnosis Interventions Survivorship Issues End of life issues
What role do practitioners have during prevention stage?
Diet and Physical activity
What role do practitioners hve during diagnosis stage?
Mammograms
Ultrasound
Digital Tomosynthesis
Screening
What role do practitioners have during interventions stage?
Surgery
Radio
CHemo
Hormone treatments
- Associated impacts following treatment
What role do practitioners have during survivorship stage?
Physical, emotional, psychosocial, economic care post intervention
Describe the stages of cancer classification system
TNM system
T- tumour and size 0-4
N- Regional lymph nodes 0-3
M- Metastasis 0-1
How can you determine where the original cancer cells originate from?
Metastatic cells have the same properties as original cancer cells.
What are the 4 treatments for cancer?
Surgery
Chemotherapy
Radiotherapy
Adjuvant Treatments
What side effects occur due to surgery?
- Pain
- Neurological damage/ changes
- Swelling
- Movement restrictions
- Axillary web syndrome
- SOB
- Incontinence
- Sexual dysfunction
What side effects occur due to chemotherapy?
Neuropathies
Pain
Swelling
SOB
What side effects occur due to radiotherapy?
Pain
Tissue fibrosis
Swelling
Movement restrictions
Adjuvant therapies
Pain
Movement restrictions
Bone loss
What occurs in lymph node dissection groups vs non
Symptom increases in intensity with ALND and take longer to recover.
What are 2 sources of pain?
Tumour- pressing on tissue Treatment from cancer - nerve damage during surgery, chemo, radio - nerve receptors sensitised by chemo - other medication side effects
What is the course of pain in first 18 months after surgery?
Severe or moderate pain from early stages generally does not improve.
What is the course of pain in first 18 months after surgery?
Severe or moderate pain from early stages generally does not improve.
How many women experience neuropathic pain post BC treatment
1/3
Define neuropathic pain
Pain caused by damage or disease affecting somatosensory nervous system.
Can present with dysesthesia or allodynia.
What do you need to screen and assess for pain and neuropathic pain
- Detailed history
- Physical assessment : sensory testing including touch, pinprick, pressure, cold/heat, vibration
- motor function: muscle strength, tone, reflexes
What are other sensory changes patients experience?
Paraesthesia: numbness, tingling, hardness
Hyperesthesia: excessive sensitivity
Dysesthesia: abnormal, unpleasant sensation when touched
What are the treatments for pain?
Medical: pharmaceuticals
- Simple analgesics, NSAIDs, Opioids
Physio
- Early and correctly completed ROM exercises
- movement and exercise program
- Manual therapy
- EDUCATION
How can CBT help with pain?
Helps patient self-address and change unhelpful ways of thinking. Essentially positive thinking
What is CIPN?
Chemotherapy-induced peripheral neuropathies
- Pain, sensory and occasionally neuromotor changes as a result of chemotherapy
- taxane based chemo
Unclear incidence, pathophysiology, treatment
What symptoms arise from CIPN?
Symptoms begin in extremities, hands and feed and move upwards
Includes pain, burning, tingling, numbness, electric shock, pins and needles, temperature sensitivity.
What are the treatments for neuropathic pain?
No current clinical guidelines
- medication
- Address impairments if possibe
- pain relief and rehabilitative care
- Protect hands and feet
- Multimodal exercise: low impact exercises + balance/proprioception
What is axillary web syndrome?
- cording, webbing, fibrous cording
Visible web of axillary skin overlying palpable cords of tissue that are tout during abduction.
- Usually appears 3 months post surgery and resolves within same time
- pathophysiology unclear
What is the incidence of AWS?
Unclear incidence
Higher in those who undergo ALND
Higher in breast conserving surgery
How can you you diagnose AWS?
Primarily: Patient reported symptoms
- feeling of tightness through axilla
- Pulling sensation
- Pain in axilla radiating down arm
- Palpation
- Reduced ROM, shoulder abd
Treatments for AWS?
- Education: post op education and reassurance
- Exercises: stretching, ROM, strength, postural advice
- Manual therapy: Myofascial release techniques, manual lymphatic drainage
What cancers might cause pelvic floor dysfunction?
- Prostate, cervical, some GI/rectal
How can you prevent pelvic floor dysfunction?
Pelvic floor strengthening prior to surgery, as issues appear 3-6 months post surgery.
What are the exercise guidelines for cancer patients?
Similar to health populations. Should be tailored to meet specific needs and impairments.
What are the effects of exercise?
- Address physical impairments
- Improve psychosocial impairments
- Reduce factors related to recurrence
- May improve treatment efficacy
What is cancer related fatigue?
Persistent sense of tiredness, impacts functioning
Impacts are widespread
What type of exercise should patients do?
Specific, tailored multimodal exercise.
Consider patient preferences
Why are fractor risks higher in postmenopausal women with BC?
- Oestrogen loss and bone mineral density loss postmenopause
- Aromatase inhibitor therapy for oestrogen positive tumours
- In males: androgen depriation therapy
What are the two medications used to treat breast cancer cells?
Tamoxifen: increase bone density post menopausal women
Aromatase inhibitors: Stop androgens from being changed to oestrogen, decreases bone mineral density
Medications are usually cycled during treatment
