Oncology/cancer Flashcards
Cancer
Uncontrolled cell proliferation
- abnormal cells
- malignant/malignancy neoplasm, tumor, carcinomas
- 5% genetic
- most common: lung, breast, colorectal
Typical cells
Uniform size, shape and structure
Differentiation
Normal cells change to form specific tissue and physiologic function
Dysplasia
Disorganization of cells, varies, van reverse or progress
Hyperplasia
Increased # of cells in tissue = mass
Tumors
Abnormal growths, new tissue without purpose = neoplasms
- benign or malignant
- primary: local cells
- secondary: metastasized from other tissue (in predictable pattern)
- carcinoma in situ: pre-invasive, premalignant, epithelial from glándula/squamos cells
- anaplastic: undifferentiated, no sign of parent tissue
Neoplasm
Classified by cell or tissue type, origin, differentiation site, benign, malignant
Benign
Moles, ganglion, fibromas, lipomas
- small to 3-4 inches
- usually painless
- does not spread
Eptithial type
Protect, excrete, absorb
- carcinoma
- adenocarcinomas - glandular
Connective tissue type
Connective tissue, muscle, bone, cartilage, fat
- sarcomas
Nerves type
Brain, spinal cord, nerves
- astrocytoma
Lymphoid type
Spleen and lymph nodes
- lymphoma
Hematopoietic
Bone marrow
- leukemia
Staging
Extent of disease - rate of growth - prognosis - comparisons
- In situ (remained in place, has not spread)
- Local
- Tumor size
- Spread
- Distant sites
TMN pic
Tumor, nodes, mestatases
Chart
Grading
Degree of malignancy (1-4)
- More closely resembles the tissue of origin
- Poorly differentiated cells, more likely to metastasize early
Epidemiology
- geographic/environment
- lifestyle
- 2nd leading cause of death in US
- nutrition, smoking, lack of exercise, ozone destruction
- men: prostate, lung, colon
- women: breast, lung, colon
Etiology
- genetic: theory of oncogenes
- environmental/exogenous
- multi-factorial: viral, chemical, hormones, ETOH
Risk factors
Age - lifestyle
- modifiable: tobacco, ETOH, obesity, inactivity, diet/nutrition, unsafe sex, pollution (air, smoke, fuels)
Metastases
- primary tumor cell breaks away, travels via blood and or lymph to organ capillaries
- common sites: nodes, liver, lung, bone, brain
- influences: aging, immune suppression, hormonal, pregnancy, stress
- occur 3-5 years up to 15-20 years
Related to PT?
- contras to modalities
- confusion (brain mets) or pain unrelieved with rest (bone mets)
- err on side of caution!
- thoracic pain is RED FLAG
- ask dont assume
Questions for pt
- pain worse at night
- pain not relieved with rest
- is pain constant, rather than intermittent
- night sweats
- unexplained weight loss >10lbs in few months?
- decreased memory
- thoracic pain
- family hx
S&S
- frequently asymptomatic
- N/V, retching, anorexia, unplanned weight loss
- pain (most common)
- depression
- fatigue
- mole, non healing wound
Pain
Somatic
Visceral
Neuropathic
Fatigue
- common after radiation and chemo
- ask pts about fatigue and changes in sleep pattern
- emotional changes: depression and anxiety
Medical management
- prevention: early detection, state of the art services, research
- diagnosis: tissue biopsy, tumor markers
- treatment: curative or palliative
Prevention
- Screening, eliminate risks
- Early detection, prompt treatment
- Managin symptoms, limit complications, prevent associated disability
Categories of medical treatment
- complementary and alternative medicine
- radiation
- chemotherapy
- biotherapy
- hormonal
Types of skin cancer
- Benign: keratosis or nevi (moles)
- Premalignant
- Malignant
- basal cell: most common, slow growth, usually head and neck
- squamous cell: 95% cure w/ early detection
- malignant melanoma: rarest and most deadly
Prevention and early detection of skin cancer
- avoid sun exposure between 10-4
- use sunscreen
- WHO recommends no one <18 yo use tanning beds
- have skin inspected for nodules, red patches, brown or black moles
Warning signs of skin cancer
- a sore that does not heal
- a change in the shape, size, color, or texture of a leasion, esp an expanding, irregular circumference or surface
- new moles or odd shaped lesions that develop
- a skin lesion that bleeds repeatedly, oozes fluid, or itches
ABCDE
Asymmetry: lopsided
Border: irregular or indistinct in shape
Color: unevenly colored with a mixture of shades
Diameter: 1/4”+
Evolution: recent changes
Basal cell
Most common form of skin cancer in US
- men 2x > women, fair skinned
- malignant, slow growing, rarely metastasizes
- on sun expose areas
- originates in epidermis
- x-ray exposure and immunosuppression
- S&S: painless and any color, sunken center, bleeeds, non-healing, nodular
- Tx: biopsy, surgical removal, ointment
Squamous cell carcinoma
2nd most common skin cancer
- 50+ yo men 3x > women
- sun/ UV exposure, chewing tobacco or smoking, burned/scar tissue, carcinogen exposure, actinic keratosis, fair skinned, HPV, immunosuppression, hx of chemo, chronic inflammation, HIV/AIDS
- S&S: non-healing irregular shape, thickened rough crust, trunk and head, change in leasion
- 95% detection curable
- Tx: excision, cream, injection
Malignant melanoma
Invasive af
- 4-5% CA, 75% deaths
- childhood overexposure to sun, fair skinned, family history, multiple moles
- nodules spread rapidly
- S&S: mixed, flat/raised, irregular shape, dark varied color, itching, >6mm, bleeding, sudden appearance
- PT need observation for early detection
Skin cancer tax
- surgery (Moh’s for clean margin)
- electrodessication (basal and squamos)
- radiation therapy (melanoma)
- cryosurgery
- systemic immunotherapy
Physical therapy
- prevention, restoration, support, palliative
- functional deficits (weak, inflexible, falls, breathing, lymphedema, psychosocial)
- goal: maximizing funciton, improve quality of life
- breast CA pts often need shoulder rehab
Precautions
- Blood, vitals, infection, bleeding, arrhymias
- dilated neck veins, facial/arm lymphedema
- tumor lysis syndrome (TLS): muscle weakness and cramping, arrhythmia, decrease BP, tachycardia 6-72 hrs post chemo
- spinal cord compression (back pain, weakness, gait changes)
- thrombocytopenia (low platelets and high risk of bleeding)
- severe anemia relates to fatigue
- neutropenic precautions (risk for infection)
Physical agents
Heat modalities
US
Estim
Laser
Palliative care
- improve QOL
- prevent symptoms and side effects to terminally I’ll
- decrease suffering, physical and psychological, support spiritual and emotional
- maintenance of independence, dignity
- pain manement (positioning and breathing)
- endurance, energy conservation, home modifications
- after curative treamtin is no longer an option
General benefits of exercise
- macrophages
- natural killer cells
- lymphokine-activated killer cells
- neutrophils
- regulating cytokines
Exercise for prevention
- physical activity: energy expenditure, movement
- exercise- intensity, duration, frequency designed for fitness
- increase HR/RR lasting 30 min 5x/wk
- survivors 30-60 min moderate-vigorous 5x/wk
Exercises with chemo or radiation
- platelets < 50,000
- hemoglobin <10g/dL
- no exercise writhing 2 hrs of treatment
- moderate aerobic
- balance, strength, coordination
- 6 minute walk test
- 15-30 min, 3-5 days/wk, 60-80% max HR
- high reps, low weight
- <11-15 RPE
- > 60 min increased fatigue reported
- ROM, gentle resistance, interval
- high energy periods
