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Clin Path Final > Oncology and Lymphedema > Flashcards

Oncology and Lymphedema Flashcards

1
Q

Cancer Hallmarks

A
  1. Resisting cell death
  2. Sustaining proliferative signals
  3. Evading growth suppressors
  4. Activating invasion & metastasis
  5. Enabling replicative immortality
  6. Inducing angiogenesis
  7. Reprogramming cellular metabolism
  8. Avoiding immune destruction
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1
Q

Solid Tumors

A
  • An abnormal mass of tissue that doesn’t contain cysts or liquid areas.
  • May be either benign or malignant
  • Types:
    1. Carcinoma
    2. Sarcoma
    3. Lymphoma
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2
Q

Blood Tumors

A
  • Don’t form solid tumors
  • Types:
    1. Leukoma
    2. Multiple myeloma
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3
Q

Carcinoma

A
  • 85% of all cancers
  • In the epithelium: skin, lining of spaces, organs, gravities
  • Breast cancer: most common in women
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4
Q

Sarcoma

A
  • Cell type: Connective tissue and muscles
  • Types: fibrosarcoma, liposarcoma, chondrosarcoma, osteosarcoma, hemagiosarcoma, leiomyosarcoma, rhabdomyosarcoma
  • Ewing’s sarcoma: round-cell tumor in bone and soft tissue
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5
Q

Radiation Therapy

A
  • Definition: modifies or kills cancerous cells by changing the DNA (electrons removed from the atoms or molecules, causing ionization)
  • About 60% of patients will receive radiation therapy at some point in their disease management
  • Free radicals
  • Types: External beam and Internal beam radiation therapy
  • External: Proton beam therapy and Linear acceleration
  • Internal: Brachytherapy and Radiopharmiceuticals
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6
Q

Radiation side effects

A
  • Acute radiation syndrome: destruction of normal cells (hair
    loss, skin redness, salivary gland production, low sperm
    count)
  • Late side effects: fibrosis, infertility, sperm and egg
    mutations, free radical, GI dysfunction, cancer development
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7
Q

Radiation fibrosis

A
  • Progressive fibrotic tissue sclerosis
  • Can affect any tissue type- skin, muscle, ligament, tendon,
    nerve, heart, lung, GI, GU, bone
  • Can continue to worsen for 1-5 years after radiation
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8
Q

Metastatic pathways

A
  • Blood pathways
  • Lymph pathways
  • Along fascial planes
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9
Q

Metastatic sites

A
  • Lungs
  • Liver
  • Bones
    1. Vertebrae (approx. 60-70% patients with systemic cancer
    will have spinal metastases, unfortunately, only 10% of
    these patients are symptomatic
    2. Femur
    3. Ribs
  • Lymph nodes
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10
Q

Chemotherapy

A
  • Definition: Drugs that modify or kill cells at different phases of
    the cellular cycle.
    *Oral, intravenous, injection, intrathecal, intraarterial,
    intraperitoneal, topical
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11
Q

Chemotherapy goals

A
  1. Cure
  2. Control
  3. palliation
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12
Q

Chemotherapy side effects

A
  • Immunosuppression
  • Nausea/vomiting
  • Anemia
  • Alopacia
  • Chemo brain
  • Dehydration
  • Loss of appetite
  • Constipation
  • Mouth and mucous membrane sores
  • Fatigue
  • Skin and hair changes
  • Fertility problems
  • Neuropathy
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13
Q
A
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14
Q

Brain Tumors

A
  • Cell type: nerve tissue
  • Glioma (most common type- found in all 4 lobes of brain,
    brain stem, cerebellum & spinal cord):
    1. Ependymomas (benign),
    Oligodendrogliomas, Astrocytomas (Glioblastoma –
    Grade IV), mixed, brainstem, optic nerve
  • Neuroblastoma
  • Meningeal sarcoma (Meningioma)
  • Neurilemmoma
  • Retinoblastoma
  • Neurofibromatosis
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15
Q

Brain Tumor treatment

A

-Whole brain radiation
-Surgery (tumor resection/craniotomy)
-Chemotherapy

16
Q

Brain tumor grades

A
  • Low Grade: slowly growing
    ▪ Surgery may be able to completely remove tumor
  • High Grade: rapidly growing
    ▪ Usually treated with combination of surgery, radiation, and
    chemotherapy
17
Q

Brain tumor presentation

A
  • Headache
  • Nausea/Vomiting
  • Seizures
  • Focal neurological symptoms: hemiparesis, gait abnormalities,
    aphasia, vision changes, impaired sensation, bowel/bladder
    changes
  • Altered Mental Status
  • Personality or cognitive changes
18
Q

Leukemia

A

Cancer of the blood

19
Q

Lymphoma

A
  • Cancer of the lymphoid tissue
  • Hodgkins vs non-hodgkins (NH most common)
20
Q

Immunotherapy

A
  • Uses substances made from living organisms (biotherapy) to help the bodies immune system find and target cancer cells. A couple of
    examples:
  • Monoclonal antibodies
  • Flu like symptoms
  • CAR T Cell therapy
  • Neurological fluctuations
21
Q

Immunotherapy continued

A

Stem cell therapy role:
* Replace defective marrow
* Replete store of blood-forming cells, restoring
hematopoesis in patients with hematologic and non-
hematologic malignancies after intensive chemotherapy
regimens
* Induce a graft-vs tumor effect against the underlying
malignancy
* more commonly used with leukemias & multiple
myeloma

22
Q

Myelosuppression

A
  • Bone marrow activity is decreased resulting in fewer RBCs, WBCs and platelets.
    1. Cancer cells (passes incorrect DNA for a new blood cell)
    2. Blood cancers
    3. Chemotherapy
    4. Radiation
    Anemia, thrombocytopenia, neutropenia, pancytopenia
  • Cachexia: extensive weight loss and muscle mass loss; >5% in 6 mos. Sarcopenia. Shortened survival.
  • Can be tumor effects and chemotherapy
  • ID physiologic barriers: dysphagia, digestive pains, depression, N/V, vitamin deficiencies
23
Q

Anemia

A
  • Reduction of RBCs (hemoglobin)
  • Side effects: decreased oxygenation, increased cardiac output and respiratory rate, fatigue
  • lack of appetite, unable to eat.
    Supplements help
24
Q

Thrombocytopenia

A
  • Low blood platelets (blood clotting
    ability)
  • Bleeding precautions:
    <25K: no resistance exercise; most likely to get infusion
    <10K: refrain from straining & mod A or greater transfer
25
Q

Neutropenia & pancytopenia

A
  • Neutropenia: Low neutrophil count in the blood:
    <1,500 per mm3
  • Precautions: hand washing, protective isolation, hygiene, no fresh flowers/animals
26
Q

Corticosteroids

A

Indications: improves appetite, improved immune response, decreased inflammatory response, transplant rejection
* Side effects: numerous, common:
Sleep disturbance- too much energy at night
Steroid induced myopathy
– Strength training important
* Hydrocortisone, prednisone, dexamethasone

27
Q

Cancer-related fatigue

A
  1. Sleep disorder
  2. Non-cancer comorbidities
  3. Emotional distress/pain
  4. Cnacer
  5. Myelosuppression
  6. Chemo/radiation
  7. Malnutrition
  8. Activity level
28
Q

CIPN

A
  • Prominent dose-limiting toxicity
  • Common chemo is vincristine
  • Peripheral nerve involvement (hands/feet more affected)
    Sometimes causes foot drop
  • Management - pharmacology, cognitive / behavioral, pain management, acupuncture, exercise, desensitization
29
Q

Pulmonary Dysfunction

A
  • Common toxicities:
    1. Pulmonary effusion
    2. Radiation pneumonitis
    3. Pulmonary fibrosis (associated with certain chemo drugs and radiation)
  • pt considerations
    1. Supplement with O2
    2. Assessing SOB/dyspnea at rest and during activity
30
Q

Cardiac Dysfunction

A
  • Valve disease, pericardial disease, rhythm disturbances, myocardial dysfunction, heart failure
  • Due to chemotherapy, cancer and radiation. Patients often admitted during chemotherapy if drugs are expected to affect heart function (cardiotoxic)
  • Patient considerations:
    Monitor RPE, HR, O2 sats
31
Q

Renal Dysfunction

A
  • Renal function: filters waste from blood, role in BP regulation
  • Acute renal failure/injury/insufficiency: elevated creatinine or blood urine nitrogen
    Side effects: weakness, shortness of breath, lethargy, edema, confusion
  • Chronic renal failure: fatal without dialysis to filter waste
    Therapy as tolerated even on days of dialysis
32
Q

Lymphedema

A
  • When the lymphatic system cannot carry the required lymphatic fluid back to the circulatory system
  • Protein-rich fluid accumulation in the interstitial space due to reduced transport capacity (result of damage to or malformation of the lymph vessels/nodes)
  • Most commonly caused by the removal of or damage to lymph nodes as a part of cancer treatment

Symptoms
* Feeling of heaviness/tightness
* Limited range of motion
* Aching/discomfort
* Infection

33
Q

Primary Lymphedema

A

Primary Lymphedema
* Hereditary
* Females > males, legs > arms
* Usually begins distally and moves proximally
* Unilateral presentation (sometimes bilateral)

Three forms
* Congenital lymphedema
* Lymphedema praecox
* Lymphedema tarda

Turner Syndrome
* Underdevelopment of the lymphatic system
* Lymphedema present in more than 60% of patients

34
Q

Secondary Lymphedema

A

Caused by damage to the lymph system
* Surgical removal
* Radiation
* Filariasis

Usually begins proximally and moves distally
Unilateral presentation

35
Q

Lymphedema Stages

A

Stage 0 – subclinical/latency
* Known damage to lymph system without onset of swelling, normal limb measurements

Stage 1 – mild/spontaneously reversible
* Pitting edema, resolves while sleeping, elevation helps

Stage 2 – moderate/not spontaneously reversible
* Doesn’t pit as much secondary to fibrosis

Stage 3 – severe/lymphostatic elephantiasis
* Fluid may weep out from the skin, severe skin changes

36
Q

Lymphedema Treatment plans

A
  • Stage 0 – range of motion, exercise, preventative garments
  • Stage 1 – compression bandaging, garments
  • Stage 2 – manual lymph drainage (MLD), bandaging, and/or garments
  • Stage 3 – MLD, bandaging, garments, pump, possible surgical intervention

MLD:
* Skin stretch technique to move fluid under the surface of the skin
* Avoid heavy pressure
* Follow with compression

Short-stretch bandages:
* Acute episodes or initial treatment
* 2-6 weeks
* 23 hours per day
* Transition to garments

Compression garments:

Compression class I
* Stage 0-1 lymphedema, Edema, 20-30 mmHg

Compression class II
* Stage 2-3 lymphedema, 30-40 mmHg

Off the shelf if it works, if not then custom

Clin Path Final (2 decks)

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