Oncology and PT implications Flashcards
What is cancer
- malignant neoplasm
- tumor
- can be named by cells of origin: lipoma, osteoma, neuroma, myeloma
what is a carcinoma
- a tumor that is not necessarily cancer
- arise from epithelial cells
sacromas
develop from connective tissue
lymphomas
originate in lymphoid tissue
leukemias
- cancer from hematologic system
What is the most prevalent cancer
breast cancer
what cancer causes the most deaths worldwide
lung cancer
incidence of cancer
- most commonly diagnosed: lung, breast/prostate, colorectal
- estimated 1 in 3 people will have cancer in their lifetime
what are some modifiable risk factors for cancer
- tobacco use
- environment
- diet
- physical activity
- sexually transmitted disease/infections
- alcohol/drug use
- occupation/military work
- ionizing radiaition
what are non-modifiable risk factors
- age
- ethnicity
- family history and genetics
What is paraneoplastic syndrome
- cancer cells take on new roles of other cells
- resemble primary disorders of endocrine, metabolic, hematologic, cutaneous, neurological, neuromuscular
- unknown cause
what are potential causes of paraneoplastic syndrome
- inflammation due to tumor growth
- autoantibodies
examples of paraneoplastic syndrome
- cushings syndrome: small cell lung cancer
- lambert-eaton syndrome: SCLC
- raynaud’s plasma cell
- polymyalgia-lymphoma
- necrotizing vasculitis-lymphoma
- palmar fasciitis- ovarian cancer
- ALS, myasthenia gravis
- polymyositis, dermatomyositis
What is stiff-person syndrome
- rare paraneoplastic syndrome
- precursor to lung or breast cancer
- can also be genetic or autoimmune disorder
symptoms of
stiff person syndrome
- sudden painful spasms in hips or back
- can progress to abdomen, arms, face
- affects walking, adls, mental health
Other examples of paraneoplasmic syndrome: non-specific
- anorexia (Related to TNF: cachexin which supresses hunger)
- fatigue
- fever (related to pyrogen production)
What is cancer related fatigue
- persistent tiredness or exhaustion
- may no be related to course of disease
- common ith chemotherapy, radiation, biological modifiers, bone marrow transplant
- may be related to higher levels of inflammatory markers, TNF
- lower cortisol levels
- anemia
Oncologic pain
- signs of cancner or related to cancer treatment
Biologic causes of oncologic pain
- bone destruction
- visceral or circulatory obstruction
- nerve compression
- tissue or skin distension
- inflammation, infection, necrosis
Pain management - PT
- functional activities
- exercise
- relation
- massage/manual therapy
- E-stim
- ice
- biofeedback
- complementary/alternative interventions
Chemo-induced peripheral neuropathy PT exercises
- ther ex during chemo reduces risk
- aerobic exercise
- HIIT
Meds for chemo-induced peripheral neuropathy
- miragabalin: gabapentinoid, long half-life, binds to Ca+ channels
- PEA: endogenous bioactive lipid, modulates inflammation
- clonidine: used for ADD, reduces allodynia
Breast-cancer related lymphedema
prevention and intervention
- monitoring
- compression garments: KT tape
- MLD, CDT massage
- resistance and aerobic exercise
- low level laser therapy
- acupuncture, yoga
Multiple myeloma
PT interventions to reduce..
- fatigue
- muscule wasting
- sleep disruption
- improve QOL
multiple myeloma
considerations for exercise and mobilization
- hemoglobin - bone marrow cancer could affect
- platelets
- neutropenia: common side effects of chemo causing severe immunocompromised
- bony lesions
Hospice
end of life or near end of life
within 6 months
palliative care
serious condition that may require hospice
What does hospice and palliative care both focus on
- focuse on management of pain and other symptoms
- can occur with hospice
- can occur with rehab
What are the goals of hospice/palliative care
- maximize Quality of life
- prevent secondary conditions
- rehab in reverse (goasl for maintaince/training caregiver)
- hospice services are bundled: patient gets personnel as needed, PT for pain/mobility, interdisciplinary team
Pain management - medical for hospice/palliative care
- as needed
- around the clock
- patient controlled analgesia
- may need a pain pump
prevention of cancer: primary
- risk factor assessment
- early detection
- follow the ten commandments
Tertiary prevention of cancer
- radiation, chemo
- complmentary and alternative medicine
- surgery
- biotherapy, antiangiogenic therapy
What is biotherapy
- immunotherapy, immune based therapy
- uses biological response modifiers (interferons, IL-2 cytokines)
- bone marrow or stem cell transplants
- monoclonal antibiodies
What are monoclonal antibodies
- rituximab (rituxan): lymphoma, leukemia
- trastuzumab (herceptin): breast cancer, stomach cancer
- alemtuzumab (campath-1H): chronic lymphocytic leurkemia
- cetuximab (erbitux): bowel cancer
- Bevacizumab (Avastin)
mab=monoclonal antibodies
What is antiangiogenic therapy
- stops growth of blood vessels
- uses antiangiogenesis factors: endostatin, angiostatin, calpastatin
- cuts of blood supply to tumor
- stops pathologic angiogenesis
- may need to mutliple inhibitors due to redundancy
not as effective if cancer has spread
what is hormonal therapy
- used if cancer is affected by a specific hormone
- tamoxifen: anti-estrogen
- leurprolide: inhibits testosterone
- goserelin: inhibits gonagotropins in pituitary => decreases testosterone
