Oncology Flashcards
benign tumor
- differentiated cells that reproduce at high rate and are encapsulated
- expand but do not spread to other tissues
malignant tumor
- undifferentiated cells
- uncapsulated and grow uncontrollable
- invade other tissues and cause destruction to surrounding tissue
primary vs secondary
primary - original tumor in original location
secondary - metastases that have moved from primary site
dysplasia
variability of cell size and shape w/ increased rate of cell division
- can be precancerous change or result from chronic infection
metaplasia
replacement of 1 mature cell type by a different mature cell type
hyperplasia
increased number of cells resulting in enlarged tissue mass
- can be because of increased demand or pathological
differentiation
cell resembles mature morphology and function
- well differentiated = physiological and functions as intended
- poorly differentiated = cell does not resemble a mature cell in both morphology and function
S&S of cancer
- unusual bleeding or discharge
- unexplained weight loss of 10 lbs or more
- fever
- fatigue
- pain
- persistent cough or hoarseness w/o known cause
- skin changes
stool guaiac
detects small quantities of blood in stool
pap smear
type of biopsy in which cells from cervix are removed and examinated
sputum cytology
sputum specimen is inspected for cancerous cells
sigmoidoscopy
sigmoid colon is examined w/ sigmoidoscope
colonoscopy
upper portion of the rectum is examined w/ colonoscope
PET scan
dye injected to detect subtle changes in metabolic and chemical activity in body
- detect biopsy location, benign vs malignant, stage, cancer recurrence
TNM system
T - extent (size/number) of primary tumor
N - lymph nodes involvement
M - presence or absence of metastasis
TX, T0, Tis, T1-T4 meaning
TX - primary tumor cannot be assessed
T0 - no evidence of primary tumor
Tis - carcinoma in situ (site of origin)
T1-T4 - progressive increase in tumor size and local involvement
NX, N0, N1-N3 meaning
NX - nodes cannot be assessed
N0 - no metastasis to local lymph nodes
N1-N3 - progressive involvement of local lymph nodes
MX, M0, M1 meaning
MX -presence of distant metastasis cannot be assessed
M0 - no distant metastasis
M1 -presence of distant metastasis
low grade vs high grade tumors
low grade - highly differentiated cells that more closely resemble original cells (less aggressive tumor)
high grade - less differentiated cells that are like original cells (more aggressive)
GX, G1, G2, G3, G4 meaning
GX - undetermined grade, cannot be assessed
G1 - low grade, well-differentiated
G2 - intermediate grade, moderately differentiated tumor
G3 - high grade, poor differentiated tumor
G4 - high grade, undifferentiated tumor
Undifferentiated cells have a _______ prognosis
poorer
palliation
decreased tumor burden, improve QoL, relieve pain
- cure nor control possible
- focus on making patient as comfortable as possible
adjuvent vs neoadjuvent
adjuvent - given in addition to primary treatment
neoadjuvant - given prior to “main” treatment to reduce size as much as possible
What type of patient has the best chance of cure?
patient who has no lymph involvement (N0) and no metastases (M0)
What type of patient has a poor chance of cure?
patient who has widespread lymph involvement (N2-3) and metastases (M1)
indications for surgical management
- removal of precancerous or primary cancer
- establish diagnosis by biopsy
- assist in staging by sampling lymph nodes
- reconstruction of limb or organ
- palliative care - decompressive or bypass procedures
primary objective to radiation
eradicate tumor while minimizing damage to healthy tissue
3 options for radiation
- external beam radiation therapy (EBRT) - most common
- brachytherapy
- intraoperative radiation therapy (IORT)
indications for radiation
- definitive treatment w/ intent to cure
- neoadjuvant treatment
- adjuvant treatment
- prophylactic treatment - prevent growth of cancer
- control to limit growth of existing cancer cells
- palliation to relieve pain, prevent fracture, and enhance mobility when cure is not possible
radiation considerations
- side effects
- site-specific toxicities
- antiemetics
- use caution w/ skin that it has become fragile from radiation
purpose of chemotherapy
inhibit various signaling pathways that control cancer proliferation, invasion, metastasis, angiogenesis, and cell death
why does chemo affect multiple areas of the body?
Targeting replicating cells which is why hair loss, N&V (GI cells), and reproductive issues occur after chemo because they are affected as well
chemotherapy PT considerations
- N/V may limit participation
- nutritional status - decreased ability to consume/absorb nutrients
- modifications in activities - fatigue
- monitor vitals
- nadir - 10-28 days after chemo and WBC are lowest - high risk for infection
At what point does neutropenic precautions kick in?
< 1500 mm^3
At what platelet level do you hold PT?
< 10,000 hold PT
At what platelet level is no resisted exercise appropriate?
10k - 20k
At what platelet level can the patient exercise w/ or w/o resistance?
> 20k
specific chemo considerations
- neutropenia
- lymphedema
- memory problems
- peripheral neuropathy
- pain
When should you withhold or stop exercise for patients on chemo?
- rest HR > 100 bpm
- dyspnea
- low diastolic BP
- during exercise - abnormal BP response, abnormal fatigue, dizziness, nausea, pallor, excessive sweating
What is biotherapy?
aka immunotherapy
- uses the patient’s native host defense as mechanisms to treat cancer
- including cytokines, monoclonal antibodies, and vaccines
Pain is a ______ risk for cancer patients
fall risk
Why would a cancer patient have a deficit in ROM?
- scar formation after surgery
- disuse of a joint following chemotherapy or surgery
- fibrosis caused by irradiation
______ leads to muscle weakness that is linked to poor balance and falls
sarcopenia
Decreased endurance can lead to decreased ability to complete_______ related tasks
balance
What Increases risk of postural control impairments, falls, and gait alterations in cancer patients?
sensory impairments from chemotherapy-induced peripheral neuropathy
What is a predictor of falls in older cancer survivors?
limitations in full tandem stance
________ is a leading cause of emotional distress in cancer survivors
physical disability
_______ is more strongly related to level of disability than to the cancer diagnosis itself
distress
general PT guidelines for cancer patients
- optimize functional mobility
- minimize or prevent cancer-related fatigue
- prevent joint contracture and skin breakdown
- prevent or reduce limb edema
- prevent postoperative pulmonary complications
What should be done before and during exercise treatment for cancer patient? What kind of exercise should be done?
aerobic and resistive exercise
before - rule out instability or decline in medical status
before and during - monitor vitals
Basal vs squamous cell cancer
basal - noduloulcerative lesion from sun on head, ears
squamous - variable presentation of pink lesions to scaly plaques
ABCDE rules
Asymmetry Border - irregular Color - varied Diameter - > 6mm Evolving - appearance changes
What is the gold standard treatment for stage 1 and 2 lung cancer?
lobectomy
What results in a very painful incision?
thoracic surgery for lung cancer
