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Acute Care > Oncology > Flashcards

Oncology Flashcards

1
Q

Define neoplasm

A

persistent abnormal dysplastic cell growth

classified by:

  1. cell type
  2. growth pattern
  3. anatomic location
  4. degree of dysplasia
  5. tissue of origin
  6. ability to spread/remain in original location
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2
Q

List and describe different types of tumors (based on descriptors)

A
  1. Benign
    • differentiated cells that reproduce at a higher rate than normal
    • often encapsulated, allowing expansion
    • do not spread to other tissues
  2. Malignant
    • undifferentiated cells
    • uncapsulated
    • grow uncontrollably
    • invades normal tissue and causes destruction to surrounding tissues/organs
    • may spread/metastasize to distant sites in body
  3. Primary → orignal tumor in original location
  4. Secondary → metastases that have moved from primary site
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3
Q

define dysplasia

A

variability of cell size and shape w/an increased rate of cell division (mitosis)

may be a precancerous change or result from chronic infection

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4
Q

define metaplasia

A

replacement of one mature cell type by a different mature cell type, resulting from certain stimuli such as cigarette smoking

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5
Q

define hyperplasia

A

increased # of cells resulting in enlarged tissue mass

may be mechanism to compensate for increased demands, or be pathological when there is a hormonal imbalance

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6
Q

define differentiation

A

extent to which a cell resembles mature morphology and function

(a cell that is well differentiated is physiological and functions as intended)

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7
Q

List S/S of cancer

A
  1. Unusual bleeding or D/C
  2. Unexplained weight loss of >10 lbs
  3. Fever
  4. Fatigue
  5. Pain
  6. Persistent cough or hoarseness w/o a known cause
  7. Skin changes
    • hyperpigmentation, pruritis, erythema, excessive hair growth
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8
Q

how is cancer dx?

A
  1. medical imaging
  2. blood tests for cancer markers
  3. several types of biopsy: definitive test to ID cancer type
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9
Q

What is cancer staging?

A

describes location and size of primary site of tumor, the extent of lymph node involvement and the presence or absence of metastasis

TNM system

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10
Q

What is the TNM system?

A
  • T → extent (size/number) of primary tumor
  • N → lymph nodes involvment
  • M → presence/absence of metastasis
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11
Q

What is cancer grading?

A

reports the degree of dysplasia, or differentiation from the original cell type

lower grade tumors = highly differentiated cells that more closely resemble original cells (less aggressive tumors)

higher grade tumors = less differentiated cells that are less likely original cells (more aggressive tumors)

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12
Q

list and describe the grades for cancer

A
  • GX → undetermined grade, cannot be assessed
  • G1 → low grade, well-differentiated tumor
  • G2 → Intermediate grade, moderately differentiated tumor
  • G3 → High grade, poorly differentiated tumor
  • G4 → high grade, undifferentiated tumor
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13
Q

Describe the physical characteristics of cancer cells

A
  1. large number of dividing cells
  2. large, variable shaped nuclei
  3. small cytoplasmic volume relative to nuclei
  4. variation in cell size and shape
  5. loss of normal specialized cell features
  6. disorganized arrangement of cells
  7. poorly defined tumor boundary
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14
Q

List and describe cancer treatment goal categories

A
  1. Cure → chemo, biotherapy, radiation, and/or surgery
    • adjuvent
    • neoadjuvent
  2. Control → enables extension of life when cure not possible
    • attempts to reduce new cancer growth
  3. Palliation → decreased tumor burden, improve QOL, relieve pain
    • cure not possible
    • focus on making pt as comfortable as possible
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15
Q

List cancer treatment options

A
  1. Surgical removal of tumor
  2. Radiation therapy
  3. Chemotherapy
  4. Biotherapy
    • immunotherapy
    • hormonal therapy
    • bone marrow transplantation
    • monoclonal antibodies
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16
Q

List the indications for surgical management of cancer

A
  1. removal of precancerous lesions/organs at high risk for cancer
  2. establishing a dx by biopsy
  3. assisting in staging by sampling lymph nodes
  4. definitive trx by removing the primary tumor
  5. reconstruction of a limb or organ with or without skin grafting
  6. palliative care such as decompression or bypass procedures
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17
Q

what is the primary goal of radiation?

A

eradicate tumor cells, either benign or malignant, while minimizing damage to healthy tissue

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18
Q

What are the indications for radiation?

A
  1. definitive trx w/intent to cure
  2. Neoadjuvent trx to improve chances of successful surgical resection
  3. Adjuvent trx to improve local control of cancer growth after chemo or surgery
  4. Prophylactic trx to prevent growth of cancer in asymptomatic, yet high-risk areas for metastasis
  5. Control to limit growth of existing cancer cells
  6. Palliation to relieve pain, prevent fracture, and enhance mobility when cure not possible
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19
Q

List some considerations for radiation therapy

A
  1. General side effects
    • skin reactions
    • fatigue
    • N/V/D
    • weight loss
    • myelosuppresion (bone marrow suppression)
  2. Site-specific toxicities may occur
  3. Antiemetics often prescribed
  4. use caution w/skin that has become fragile from radiation
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20
Q

what is the purpose of chemotherapy?

A

inhibit various signaling pathways that control cancer cell proliferation, invasion, metastasis, angiogensis, and cell death

can be primary trx, neoadjuvent, adjuvent therapy

mode of delivery → IV/central line, injection to tumor site

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21
Q

What are the typical side effects to chemo?

A
  1. N/V
  2. cancer pain
  3. loss of hair and other fast growing cells
    • platelets
    • RBCs
    • WBCs
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22
Q

what is the difference between CCS and CCN agents?

A
  • CCS → cell-cycle specific agents = work best in a portion of the cell cycle, most likely prophase
  • CCN → cell-cycle-nonspecific agents = work through the entire cell cycle
23
Q

Chemotherapeutic drugs are often given in cycles, what is a typical timeframe?

A

6-8 cycles

given every 3 weeks (21 days)

24
Q

List some chemotherapy PT considerations

A
  1. N/V may limit rehab participation
  2. Nutritional status may be impacted due to decreased ability to consume/absorb nutrients
  3. Activities may need modification due to fatigue
  4. Monitor VS
  5. Chemo targets ALL cells that are actively dividing
  6. Common AE
  7. Nadir
  8. Minitor Lab values
  9. High risk for infection
25
Q

what is Nadir?

A

10-28 days after chemo when WBCs reach lowest values

generally withold therapy

26
Q

What lab values are important to know for a pt on chemotherapy?

A
  1. Absoulte Neutrophil count (ANC)
  2. Platelets
    • <10k = hold PT
    • 10k-20k = no resisted exercises
    • >20k = exercise with or w/o resistance
  3. Hemoglobin
    • 8-10 = light aerobic and weight
    • <8 = light ROM/ISOM, no weights, aerobic ex, progressive ex
  4. Hematocrit
    • 25-35% = light aerobic and weight
    • <25% = light ROM/ISOM, no weights, aerobic ex, progressive ex
27
Q

list specific chemo considerations

A
  1. Neutropenia
  2. Lymphedema
  3. Memory problems
  4. Peripheral Neuropathy
  5. Pain
28
Q

T/F: research does not support exercising PTs on chemo

A

FALSE

exercise can lead to increased neutrophil levels, elevated VO2max, improved mood, decreased N/V

29
Q

when should you withhold/stop exercise with a chemo pt?

A
  1. at rest:
    • HR >100 bpm
    • dyspnea
    • low diastolic BP
  2. during execise:
    • abnormal BP response
    • abnormal fatigue
    • dizziness
    • Nausea
    • Pallor
    • excessive sweating
30
Q

what is Biotherapy?

A

aka immunotherapy, uses the pts native host defense system as mechanism to trx cancer

highly targeted while minimizing toxicity/AE

includes: cytokines, monoclonal antibodies, and vaccines

31
Q

List some common cancer related impairments

A
  1. Cancer related fatigue
  2. Pain
  3. Cognitive function deficits
  4. Lymphedema
  5. ROM deficits
  6. Muscle strength and endurance deficits
  7. CV and respiratory deficits
  8. Hearing and Vestibular function deficits
  9. Sensory deficits
  10. Balance, gait, and sensory integration deficits
  11. Distress, Anxiety, depression
32
Q

describe cancer related fatigue

A

unremitting and does not get better w/rest

33
Q

what can be used to assess pain in cancer pts?

A
  1. Brief Pain Inventory
  2. Pain Treatment Satisfaction Scale
  3. VAS
  4. Numeric Pain Rating Scale
34
Q

what aspects of cognitive function may be impacted by cancer/cancer trx?

A
  1. visual memory
  2. spatial function
  3. executive function
  4. attention
  5. memory
  6. concentration
35
Q

T/F: orientation deficits but not executive function and memory deficits is associated with increased risk of falling in cancer pts?

A

FALSE

orientation not associated

executive function inversely related to falls

36
Q

when assessing cognitive function in cancer pts what should you include/use/remember?

A
  1. Pay attention:
    • forgetfullness
    • signs of decreased recall within sessions
    • signs of decreased executive function
  2. Outcome measures
    1. FACT-COG
    2. Percieved Cognition Questionnaire
    3. Mini-Mental State Exam
37
Q

T/F: lymphedema is associated with decreased QOL

A

TRUE

38
Q

Deficits in ROM following cancer may be due to what causes?

A
  1. Scar formation following surgery
  2. Disuse of a joint following chemo/surgery
  3. Fibrosis caused by irradiation
39
Q

How can radiation fibrosis be managed?

A
  1. Conservative management:
    • manual release techniques
    • stretching exercises
    • corticosteroid injections
  2. Referral for use of antifibrotic agents, such as pentoxifyline, Botox injections
40
Q

Deficits to muscle strength following cancer can be due to what?

A
  1. Tumor-produced inflammatory intermediates that are catabolic
  2. Surgical interventions may damage muscle groups and peripheral nerves
  3. Radiation and chemo can damage muscle or peripheral nerves
  4. Corticosteroid preferentially damage prox limb muslces
  5. Pain, fear, and fatigue lead to inactivity, causing further loss of muscle strength
41
Q

list some clinical measurements for muscle endurance in cancer pts

A
  1. seldom assessed in a clinical setting
  2. lack of established reliable and valid clinical methods to test
  3. Most studies use some % of 1-RM to determine the load, and test endurance using a rep to failure activity
  4. no norm data for age, gender, and muscle group
42
Q

How should you asses CV and respiratory function in cancer pts?

A
  1. results of cardiac testing and pulmonary function tests, performed both before and after trx as appropriate
  2. VS: HR, RR, BP, and O2 sat
  3. Response to exercise
  4. Dyspnea scale
  5. Borg RPE
  6. Outcome measures:
    • Graded exercise test
    • 2/6 MWT
43
Q

list some vestibular impairments that may be due to cancer/cancer trx

A
  1. Vestibular schwannoma → relatively rare benign tumor that can impair vestibular function
  2. Cisplatin → chemo drug that has been assocaited with both vestibular toxicity and ototoxicity
44
Q

What is included in the hearing and vestibular function assessment for cancer pts?

A
  1. Finger rub test
  2. Balance assessment
  3. VOR testing
  4. Dynamic Visual Acuity test
  5. Outcome measures:
    • dizziness handicap inventory questionnaire
45
Q

what is the most common cause of sensory impairments in cancer pts?

A

chemotherapy induced peripheral neuropathy

characterized by:

  1. paresthesias
  2. Dyesthesias
  3. decreased touch pressure thresholds
  4. decreased vibration thresholds
  5. decreased proprioception
  6. reduced DTR

*other common causes = compression secondary to tumors

46
Q

List some outcome measures that can be used for distress, anxiety, depression in cancer pts

A
  1. Profile of Mood States
  2. Distress Thermometer
  3. Hospital Anxiety and Depression Scale
  4. 2-item depression questionnaire
  5. general anxiety disorder 2-item
47
Q

List general PT guidelines for working w/cancer pts

A

similar goals for other pts w/exception that timeframes for recovery will be longer

  1. optimize functional mobility
  2. minimize/prevent cancer-related fatigue (CRF)
  3. prevent joint contracture and skin breakdown
  4. prevent or reduce limb edema
  5. prevent postop pulmonary complications
48
Q

List some ways to minimize cancer related fatigue

A
  1. aerobic and resistance exercise programs
  2. monitor VS throughout exercise
  3. emphasize importance of exercise log to monitor progress and promote adherence
  4. pt/caregiver edu
  5. emotional support for both pt and family
  6. timely communciation w/entire healthcare team
  7. monitor lab values
    • HgB, HCT, WBC, platelet, and INR daily
49
Q

List surgical options, common post-op issues, and mobility concerns for breast cancer

A
  1. Surgical options
    • lumpectomy
    • total mastectomy
    • total skin-sparing mastectomy
    • bilateral mastectomy
  2. Common post-op concerns
    • pain, lymphedema, nerve damage
    • post-op drains often used
  3. Mobility Concerns
    • do not displace drain
    • use abdominal support during coughing
    • use log-roll
50
Q

what are the 3 main types of skin cancer?

A
  1. Melanoma
    • from sun exposure
    • most common
  2. Basal cell carcinoma
    • noduloulcerative lesion from sun exposure on head, ears
  3. Squamous cell carcinoma
    • variable presentation of pink lesions to scaly plaques
51
Q

What are the ABCDE rules for ID skin cancer?

A
  • Asymmetry
  • Border-irregular
  • Color → varied
  • Diameter → >6 mm
  • Evolving → appearance changes
52
Q

what are the 2 major categories for lung cancer?

A
  1. non-small cell lung cancer (NSCLC) → most common
  2. small-cell lung cancer (SCLC)
53
Q

List symptoms of lung cancer

A
  1. chronic cough
  2. dyspnea
  3. chest pain
  4. hemoptysis
54
Q

List common sites of metastasis for lung cancer

A
  1. bone
  2. adrenal glands
  3. liver
  4. intraabdominal lymph nodes
  5. brain and spinal cord
  6. skin

Acute Care (11 decks)

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