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Rehabilitation of Functional Movement > Oncology > Flashcards

Oncology Flashcards

1
Q

What is cancer

A

uncontrolled growth of abnormal cells
can arise from any type of cell in the body

Normal tissues are able to balance the rate of
new cell growth and old cell death

In cancer, this balance is disrupted resulting in uncontrolled growth or loss of cells ability to undergo cell death (apoptosis)

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2
Q

what are the four major subtypes of cancer

A

carciomas
sarcomas
lymphomas
leukaemias

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3
Q

carcinomas are?

A 
the most common forms of cancer 
arise from epithelial tissue such as the skin and lining of body cavities and organs
eg. lung carcinoma
breast carcinoma
colon carcinoma 
prostate carcinoma
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4
Q

what are sarcomas

A

found in connective and supportive tissue such as bone, cartilage, nerve, blood vessels, muscle and fat
eg.

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5
Q

what are lymphomas

A

arise in the lymph nodes and tissues of the body’s immune system

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6
Q

what is leukemia

A

cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in the bloodstream

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7
Q

cancer prefix - adeno

A

gland

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8
Q

cancer prefix - chondro

A

cartilage

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9
Q

cancer prefix - erythro

A

red blood cell

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10
Q

cancer prefix - hemangio

A

blood vessels

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11
Q

cancer prefix - hepato

A

liver

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12
Q

cancer prefix - lipo

A

fat

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13
Q

cancer prefix - lympho

A

lymphocyte

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14
Q

cancer prefix - melano

A

pigment cell

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15
Q

cancer prefix - myelo

A

bone marrow

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16
Q

cancer prefix - myo

A

muscle

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17
Q

cancer prefix - osteo

A

bone

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18
Q

benign tumours

A

non cancerous

unable to spread by invasion or metastasise, and depending on the location and size are often left in situ

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19
Q

malignant

A

cancerous

cells invade neighbouring tissues, enter blood vessels, and metastasise to different sites

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20
Q

Metastasis

A

metastatic cancer has spread to another part of the body from the primary origin
90% are the result of metastasis
majority can not be cured by rather controlled
all types of cancer have the potential to spread but rare for blood and lymphatic cancers
cancer cells can travel through the blood or the lymphatic system until they find a suitable location to settle and re-enter the tissue
detection of cancer cells in lymph nodes plays an important role in tumour staging

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21
Q

Staging - TNM staging system

A 
T= tumour size 0-4(4 being the largest) 
N= Nodal involvement 0-3(3 being most involved) 
M= metastasis 0/1 (1 being metastases present)

eg. T4N2M1
T1N0M0

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22
Q

What is the main sites of metastasis for breast cancer

A

lungs, liver, bones

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23
Q

What is the main sites of metastasis for colon

A

liver, peritoneum, lungs

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24
Q

What is the main sites of metastasis for kidney

A

lungs, liver, bones

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25
Q

What is the main sites of metastasis for melanoma

A

lungs, skin/muscle, liver

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26
Q

What is the main sites of metastasis for lungs

A

adrenal gland, liver, lungs

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27
Q

What is the main sites of metastasis for ovary cancer

A

peritoneum, liver, lungs

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28
Q

What is the main sites of metastasis for pancreas

A

liver, lungs, peritoneum

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29
Q

What is the main sites of metastasis for prostate

A

bones, lungs, liver

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30
Q

What is the main sites of metastasis for rectum

A

liver, lungs, adrenal gland

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31
Q

What is the main sites of metastasis for stomach

A

liver, peritoneum, lungs

32
Q

What is the main sites of metastasis for thyroid

A

lungs, liver, bones

33
Q

What is the main sites of metastasis for uterus

A

liver, lungs, peritoneum

34
Q

two types of cancer treatment

A

curative intent

palliative intent

35
Q

curative treatment

A

a ‘cure’ is when the rate of death for that particular cancer population is the same rate as the general population

however, it can reoccur
should be considered as prolonged remission instead of a cure

36
Q

palliative treatment

A

When a curative treatment option is not available

Focus is on maximising survival time and quality of life

Does not mean that the patient is going to die in the next 3 months or 6 months.
Equipment
Pain Mx

37
Q

treatment options

A

surgery
radiotherapy
chemotherapy
immunotherapy

38
Q

radiotherapy

A

treatment using iodising radiation to cause cell damage of death

39
Q

radiotherapy (XRT)

A

delivered via two methods
- external beam radiation/therapy (teletherapy), usually via a linear accelerator (also tomotherapy)

Bracytherapy (implants/seeding) -direct placement of radioactive source into the region of treatment (“hot” patients )

40
Q

side effects of radiotherapy

A

mostly site specific

  • radiation induced diarrhoea
  • nausea and vomiting
  • xerostomia (dry mouth)
  • oral mucositis (painful inflammation and ulceration of the mucous membranes lining the digestive tract)
  • skin reactions /burns/fibrosis
41
Q

general side effects

A

fatigue
depression
loss of ROM
pain

42
Q

chemotherapy

A

Using cytotoxic chemical agents to treat cancer

Can be used in conjunction with other therapies

Currently more than 50 different cytotoxic drugs are used and over 200 protocols with haematology patients alone.

43
Q

side effects of chemotherapy

A

can cause systemic issues more so than XRT
common acute reactions to chemotherapy include
- gastrointestinal toxicity (N&V)
-neutropenia

44
Q

Gastrointestinal toxicity

A

manifested by anorexia, nausea and vomiting

can occur prior to chemo treatment (anticipatory nausea) and can last for several days post treatment

Anti-emetic medication is very important & may be required to complete a physiotherapy session

Mouth care and other fact sheets are important (Dietician or Speech are usually involved)

45
Q

Neutropenia

A

Diminished ability to fight infections and at high risk of becoming infected

Depending on the severity of the neutropenia you may be required to wear a plastic apron, gloves and a mask (single room & signs)

Try and see these patients first

Respiratory infection- prophylactic treatment is important in these patients

46
Q

Chemotherapy precautions

A

Chemotherapy can be excreted via all body fluids, especially urine for 48 hours post dose but can be longer

No safe level of exposure - goal to reduce risk of exposure to As Low As is Reasonably achievable (ALARA)

Possible exposure routes:
-Inhalation, ingestion, dermal absorption, Mucosal absorption

Main risk for PT s is exposure to contaminated urine, faces or vomit.

*Sputum is not considered a risk.

Use cytotoxic precautions for 7-10 days after chemotherapy.

In case of exposure, remove self from the pt/ area immediately and wash the affected area with copious amounts of soapy water for 15 mins.

Cleanse eyes, mouth or nose that has been splashed with cytotoxic drug or contaminated waste with clean water for 15 mins

47
Q

pain can arise from

A

A tumour compressing or infiltrating tissue

Or treatments and diagnostic procedures

Can last long after treatment has ended

XRT burns – 2-3/52 post Tx

Chemo – peripheral neuropathy

48
Q

Pain

A

The presence of pain depends mainly on the location of the cancer and the stage of the disease.

At any given time, about half of all patients with malignant cancer are experiencing pain.

75% of pain is caused by the illness itself

49
Q

Bone pain

A

Most common source of pain

Cancer invades the bone
-tenderness, with constant
background pain
-spontaneous or movement- related exacerbation
-frequently described as severe.
50
Q

Neuropathic pain

A

Caused by diseased or damaged Nerves

-Often presents as burning, P&N, sharp shooting

51
Q

Breast anatomy

A

Female breast

Lobules (milk-
producing glands)

Ducts (tubes carry milk from lobules to nipple)

Stroma (fatty tissue and connective tissue surrounding ducts and lobules)

52
Q

Lymphatic system

A

Part of body’s defense system

Most lymphatic vessels in the breast connect to lymph nodes under the arm (axillary nodes)

Some connect to lymph nodes inside the chest (internal mammary nodes) and some to those above the collar bone (supraclavicular nodes)

53
Q

Lumpectomy/WLE

A

Removes the tumor with a rim of normal tissue (clear margins – 1cm)

almost always followed by radiation therapy
-decreases the likelihood of the cancer coming back in the breast by more than 50%

54
Q

Mastectomy

A

Removal of the entire breast including the nipple and areola, leaving the pectoralis major intact

With a mastectomy, radiation is usually not necessary

55
Q

sentinel lymph node biopsy

A

Sentinel lymph node is the first lymph node to receive drainage from the breast or a tumor in the breast

Injection of radiotracer +/- blue dye into the skin

A gamma probe used to detect radioactivity in the axilla

Only nodes that are hot and/or blue are removed

56
Q

axillary clearance

A

An important part of staging breast cancer is determining if the lymph nodes under the arm are involved with cancer

If nodes are +ve SNB > AC

10 – 40 lymph nodes are removed during an AC

Was once standard of care for breast cancer patients

57
Q

Shoulder

A

Shoulder ROM can be significantly limited due to

  • Pain (surgery, wound, bruising, drain)
  • Scar tissue
  • Axillary web syndrome (cording) ! Seroma
58
Q

Physiotherapy

A

Pre-op (gain pre-morbid levels)

  • Check sh ROM and function
  • UL measures
  • Cancer Council handout – review stage 1 & 2 exercises
  • Education re: role of physio, expectations post op, return to work/activity and Lymphoedema
  • Sh ROM to 90deg only while drain insitu (4-10 days draining less than 100mls/day)
  • Post op exercises – circulation, DBExs, Sitting out of bed and reg Mob
59
Q

post op physio

A

Day 1 post op
-Review stage 1 & 2 exercises (90 deg if drain
insitu)
-Circ exs, DBExs, SOOB, Mob, Stairs Ax (if req)
-Review Education
-Book appt for 2/52 post op

60
Q

outpatient appt 2/52

A

Review UL measures & Sh ROM

  • Progress Sh ROM exercises (drain removed) ! Posture retraining & Pec stretch
  • Scar advice & Mx
  • L/O ex s
  • Cording edu & Mx
61
Q

follow up

A

R/V 1,6 &12 Months for UL measurements and monitoring

  • Seen fortnightly during XRT (incresed risk of L/O)
  • ? More regularly with Sh dysfunction, complex scaring and ongoing cording & L/O
62
Q

cording (axillary web syndrome

A

Can be seen after any axillary surgery

Presents as a series of tender, cord-like structures that are visible and palpable beneath axillary skin

Cords can extend down the arm, into forearm

“Cording” is due to disruption of lymphatic vessels during axillary surgery

Incidence:

  • 20% after sentinel node biopsy
  • 44%-72% after axillary clearance

Develops in early post-operative period (within first 6/12)

Limits range of motion

Can present as burning pain

63
Q

treatment of cording

A

The aim of treatment is to either stretch the cords or to break the cords

  • Modified stretching
  • Deep tissue massage and self massage
  • Reassurance
  • Heat
  • Strengthening
64
Q

contraindications

A

Reddening of the scars

Radiation - manual techniques should not be carried out in an area subjected to radiation until two weeks post

Metastasis in the axilla

65
Q

lymphoedema

A

Lymphoedema can occur as result of lymph nodes being removed from surgery or if they are damaged from radiotherapy.

Definition = Reduced lymphatic transport capacity which is overloaded by a normal lymphatic load

66
Q

what is lymphoedema

A

Lymphoedema is the swelling of one or more parts of the body that occurs when the lymphatic system does not function properly

Once the lymphatics are damaged swelling can occur at any time. It may develop gradually or immediately and affect all or part of a limb

Can occur weeks, months or years later, triggered by an incident which overloads the lymphatic system

67
Q

lymph nodes

A

All lymph passes through one or more nodes which are largely arranged in regional groups. Macrophages in the nodes break down proteins and fight infections. They are unable to regenerate once removed.

68
Q

signs and symptoms of lymphoedema

A

Tightness

Fullness/constricting
feeling

Discomfort/pain

Persistent/fluctuating swelling

Deepening of skin folds

Indentations in skin from clothing

69
Q

Assessment

A

Detailed history required
Photos and detailed descriptions

Surgical history
!  When/where was the surgery
!  Lymph node status (number removed, number positive)
!  Cancer status
!  Post op healing/complications
!  Type of sx
!  XRT/Chemo
!  Medical history (contraindications, respiratory problems- COPD, emphysema)

Swelling
! Onset on swelling
! When is swelling worse?
! What reduces oedema?

Other allied health input

Work

Social situation

Previous musculoskeletal injuries

70
Q

visual inspection

A

Where is the swelling visible?

Extent of swelling?

Where are the scars situated?

Condition of scar – healed, thickened, mature

Skin condition
-Radiation fibrosis, fragile, blistered, thickened, nodular skin changes, ulcerations, pigmentation changes

71
Q

Palpation

A

Texture of the skin and underlying tissue

  • Scars (Mobility of the scars, thickened, soft, adhesions, raised)
  • Extent of fibrosis

Consistency of Oedema
-pitting, non pitting, fibrosis

72
Q

treatment goals

A

Reduce oedema

Improve elasticity of radiated/fibrotic areas !

Increase shoulder ROM

Reduce scarring

73
Q

management of lymphoedema

A

Skin care and protection

Elevation

Deep breathing

Self Massage

Exercises

Compression

Manual Lymphatic Drainage

74
Q

contraindications

A

Infection to treatment area (cellulitis)

Skin breakdown due to radiation (pain and
infection control)

Current radiation treatment

Mets

75
Q

education includes

A

Skin Care

No sunburn or hot baths

Avoid Cuts, scratches & bruises to affected arm

No needles & blood pressure cuffs

Avoid heavy lifting

Exercise & UL movement/ elevation

Compression: wear for long distance travel and for heavy work…

Ongoing Surveillance

Rehabilitation of Functional Movement (12 decks)

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