Oncology: Common Cancers And Their PT Management Flashcards
Who has the highest incidence of breast cancer? Highest mortality?
White and black women have the highest incidence, black women have the highest mortality
What are the risk factors for breast cancer?
Estrogen exposure
Age
Personal hx of breast cancer
Family hx of breast cancer
High BMI
High breast tissue density
Long term use of HRT
Previous chest radiation
Genetic predisposition
What gene mutations put people at risk of either breast or prostate cancers?
BRCA1 and BRCA2
T/f: the longer someone is exposed to estrogen, the higher their risk for breast cancer
True
Does early onset mensus and late onset menopause increase or decrease breast cancer risk?
Increase
Does late onset mensus and early onset menopause increase or decrease breast cancer risk?
Decrease
Most breast cancers are caused by what?
Estrogen exposure
What are protective factors against breast cancer?
Younger age of first full term pregnancy
More than 2 full term pregnancies
Longer time spent breastfeeding
Physical activity
What are the common clinical manifestations of breast cancer?
Palpable mass
Significant asymmetry in shape
Change in contour
Nipple retraction/dimpling
Lymphadenopathy
What are less common manifestations of breast cancer?
Breast enlargement
Heat
Orange peel skin appearance
Color changes
What quadrants of the breast do most cases of breast cancer arise from?
The upper and outer quadrants
What is the most common site of metastasis with breast cancer?
Local lymph nodes
Other than the local lymph nodes, what are the common areas of metastasis with breast cancer?
Brain, lung, liver, bone, and adrenals
How often should women get a mammogram? What age do they start getting them?
Every other year after 40
How is breast cancer diagnosed?
With biopsy
What biopsy is used for staging, prognosis, and treatment decision in breast cancer?
Lymph node biopsy
What are the 2 types of lymph node biopsies for breast cancer?
Sentinel lymph node dissection
Axillary lymph node dissection
What is a sentinel lymph node dissection (SLND)?
Use of a radioisotope injected into the area of the tumor and follow where it goes
The first node to receive the lymph drainage is identified by the radioisotope and is removed
What is an axillary lymph node dissection (ALND)?
Removal of the axillary lymph nodes usually performed during a lumpectomy or mastectomy
Is there greater risk for UE morbidity with SLND or with ALND?
ALND
What is stage 0 breast cancer?
Abnormal cells that haven’t spread
What is stage 1 breast cancer?
Spread to other tissues in a small area
What is stage 2 breast cancer?
A 20-50mm tumor with some lymph node involvement
OR
A 50mm tumor with no lymph nodes
What is stage 3 breast cancer?
A tumor >50mm with more lymph node involvement
What is stage 4 breast cancer?
Distant metastasis
In addition to classifying breast cancer by the metastasis, what else is considered?
Biomarker status
What are the three different biomarkers considered in classification of breast cancer?
Estrogen status
Progesterone status
Oncogene status
What is ER (+) breast cancer?
The breast cancer is estrogen dependent
What is ER (-) breast cancer?
The cancer is not estrogen dependent
What is PR(+) breast cancer?
The cancer is progesterone dependent
What is PR (-) breast cancer?
The cancer is not progesterone dependent
What is HER2 (+) breast cancer?
Cancer from oncogene mutation
What is HER2 (-) breast cancer?
The cancer is not from an oncogene mutation
What is triple negative breast cancer?
When the cancer is ER (-), PR (-), and HER2 (-)
Very aggressive form of breast cancer that has the worst prognosis bc there are few treatment options
What are the treatment options for breast cancer?
Chemo
Radiation
Hormonal therapy
Surgery
What are the risks with chemo in breast cancer treatment?
CIPN and cardiotoxicity
What are the risks of radiation for breast cancer?
Soft tissue damage, nerve damage, lymphedema
What chemo drug is used to treat hormone (+) breast cancers that has significant implications for PT?
Aromatase inhibitors
What is the goal of aromatase inhibitors for breast cancer?
To improve survival and decrease local and distance recurrence
What are the PT implications when a pt is on aromatase inhibitors?
Arthralgia
Increased fall risk
What is a significant reason that pts stop aromatase inhibitors?
Bc of the arthralgia that often results
What PT interventions should we use when a pt is on aromatase inhibitors?
Fall risk reduction
Balance exercises
Comprehensive exercise program to decrease arthralgia
Pain science education to increase adherence to
What is the gold standard treatment for stage 1/2 breast cancer?
Surgery
What is involved in breast conserving surgery for breast cancer?
Lumpectomy followed by XRT
What are the 3 types of mastectomies?
Simple mastectomy
Skin sparing mastectomy
Modified radical mastectomy
What is a simple mastectomy?
Removing all breast tissue, skin, and nipple
What is a skin sparing mastectomy?
Removal of the breast tissue and nipple with the skin spared
A mastectomy with immediate reconstruction with a tissue expander under the pecs and an implant
What is a modified radical mastectomy?
Removing all breast tissue, skin, nipple, lining of the pecs, and includes a ALND and SLND
Which type of mastectomy has the greatest risk for shoulder dysfunction after the surgery?
A modified radical mastectomy
T/f: a breast reconstruction can use either implants or autologous tissue
True
What is the PT concern with breast reconstruction?
The pecs get stretched out from the implant and tissue expander and can become tight leading to increased kyphosis, rounded shoulders, and forward head
What is a deep inferior epigastric perforator (DIEP) flap?
Use of abdominal fat, skin, and tissue with the ms spared
A free flap
What is a free flap?
When the vasculature is cut from the area the tissue is from and sewn to the vasculature of the new area
What is a transverse abdominus myocutaneous (TRAM) flap?
Use of the abdominal fat, skin, tissue, and part of the rectus abdominus
Pedicled or free flap
What is a pedicled flap?
When you keep the vasculature connected to its original area
When is a latissimus dorsi flap used?
When the TRAM or DIEP flaps fail bc of blood supply issues
What are the immediate post op considerations following breast cancer surgery?
JP drain
Postural corrections
Scapular exercises
Shoulder AROM AFTER drain removal
No lifting >5lbs
Surgeons may give ROM restrictions
Teach log rolling with a TRAM flap
Screen for cellulitis, flap necrosis, and brachial plexus injury
What are the signs to look for for flap necrosis following breast reconstruction?
Muddled, pale, or even gray skin
What is UE morbidity?
Problems with UE strength, pain, or ROM
There is a significant risk for lymphedema following what breast cancer surgeries?
ALND
Modified radical mastectomy
T/f: breast cancer surgeries often result in UE impairments
True
What are the highly recommended assessments for UE morbidity following breast cancer surgery?
DASH, SPADI, SRQ, PSS
What conditions contribute to UE morbidity following breast cancer surgery?
Radiation fibrosis
Abdominal tightness
Post op guarding in protraction
Pecs tightness secondary to expander/implant
What are the MSK implications of radiation fibrosis, abdominal tightness, post op guarding in protraction, pecs tightness?
Forward head, protracted shoulder, tight pecs, weak scap, tightness/pain/spasms of subscap, and thoracic breathing pattern
What UE conditions result from UE morbidity?
Impingement syndrome, adhesive capsulitis, and other shoulder dysfunctions
What is the most common cancer in men?
Prostate cancer
T/f: prostate cancer has almost 100% 5 year survival
True
What are the risk factors for prostate cancer?
Age
Family hx
BRCA1 and BRCA2 gene mutations
African American descent
Obesity
Height animal fat diet
Viruses
Occupational exposures
Multiple sex partners
When are men screened for prostate cancer?
Age 55-69
T/f: prostate screening is not recommended over age 70
True
What is involved in prostate cancer screening?
Digital rectal exam
PSA blood test
Transrectal US guided biopsy
CT/PET scan
What are treatment options for prostate cancer?
Watchful waiting
Surgery
XRT
Hormonal therapy
What is the most common treatment for prostate cancer?
Watchful waiting
Why is watchful waiting usually the go to treatment for prostate cancer?
Bc it is a slow progressing cancer that is slow to metastasize
Why are there so many complications with surgery to remove prostate cancer?
Bc the prostate surrounds the urethra so when the prostate is removed, so is part of the urethra and the neck of the bladder
When are surgery, XRT, and hormonal therapy used to treat prostate cancer?
When it is faster progressing
What are the PT considerations for prostate cancer?
Urinary incontinence
Surgical restrictions
Radiation fibrosis
Diarrhea
Constipation
Bowel incontinence
Pelvic pain
Erectile dysfunction
Lymphedema in the genital area
What usually causes bowel symptoms in prostate cancer?
Disruption from radiation fibrosis or nerve damage from surgery
What is the most common cancer worldwide?
Lung cancer
What is the most common cause of cancer related death in the US?
Lung cancer
What is the growth rate of small cell lung cancer?
Very rapid
Does small cell lung cancer metastasize early or late in the disease?
Very early
Where does small cell lung cancer tend to metastasize?
The mediastenum and lung
What is the treatment for small cell lung cancer?
Combo chemo
What is the most common lung cancer in the US?
Adenocarcinoma
What lung cancer type makes up. 80-85% of all lung cancers?
Non small cell lung cancer
What are the 3 types of non small cell lung cancers?
Squamous cell
Adenocarcinoma
Large cell
Is the growth rate of squamous cell non small cell lung cancer fast or slow?
Slow
Does metastasis in squamous cell lung cancer occur early or late in the disease?
Late
What are the common areas of metastasis in squamous cell lung cancer?
Lung, lymph nodes, adrenals, liver
What are the treatment options for squamous cell lung cancer?
Surgical resection for stage 1/2
Is the growth rate of Adenocarcinoma fast or slow?
Slow to moderate
Does metastasis occur early or late in the disease with Adenocarcinoma?
Early
What are the common areas of metastasis with Adenocarcinoma?
Lung, brain, and other areas
What are the treatment options for Adenocarcinoma?
Surgical resection with stage 1/2
Chemo for stage 3
Is the growth rate of large cell lung cancer fast or slow?
Rapid
Does metastasis occur early or late in large cell lung cancer?
Early
What are the common sites of metastasis of large cell lung cancer?
Widespread
Kidneys, liver, adrenals
What are the treatment options for large cell lung cancer?
Surgery for stage 1/2
Palliative XRT
What are the risk factors for lung cancer?
Smoking
Second hand smoke
Occupational exposure to asbestos, silica, radon, heavy metals, vehicle exhaust
Other lung diseases like COPD and emphysema
What occupational exposure put pts at risk for lung cancer?
Asbestos, silica, radon, heavy metals, vehicle exhaust
What other lung diseases put pts at risk for lung cancer?
COPD
Emphysema
What is the #1 cause of lung cancer?
Smoking
What are the treatment options for lung cancer?
XRT
Chemo
Surgical resection
T/f: surgical resection for lung cancer is usually followed by XRT, chemo, or both
True
When is surgical resection for lung cancer typically done?
In early stages
What are the PT considerations for lung cancer?
Pts often have other lung diseases in addition to lung cancer
Pts often have poor functional performance
Pts can improve with pulmonary rehab
Radiation fibrosis
Surgical scarring and fibrosis
Effects of chemo
What can improve functioning in lung cancer, but pts often have a hard time with motivation for it?
Pulmonary rehab
What posturing results from radiation fibrosis and surgical scarring and fibrosis in lung cancer surgery?
Increased kyphosis
Protracted shoulders
Forward head
T/f: pts with lung cancer often get SOB with activity so they avoid activity then get worse SOB as a result
True
What is a large psychological factor of lung cancer?
Stigma and guilt
T/f: pts with lung cancer are often sedentary before dx and even more so after dx
True
What are the most common manifestations in lung cancer?
Decreased strength, flexibility, motivation, agility and balance, and endurance
What contributes to decreased strength in lung cancer?
Atrophy and cachexia
What contributes to decreased flexibility in lung cancer?
Surgical incisions and inactivity
What contributes to decreased motivation in lung cancer?
Stigma/guilt
Sedentary lifestyle
Dyspnea/pain
Social barriers
What contributes to decreased agility and balance in lung cancer?
CIPN
poor motor control
Disuse
What contributes to decreased endurance in lung cancer?
CRF
Poor nutrition
Cancer related lung disease
What is the 4th most common cancer in the US?
Colorectal cancer
What is the second most common cancer death in the US?
Colorectal cancer
T/f: there is likely a genetic component to colorectal cancer as black men are more prone to getting it
True
What are the risk factors for colorectal cancer?
Age
Male
Hx of polyps
IBD
family hx
Obesity
Genetics
Possibly tobacco, excess alcohol, and diet (research is mixed)
What is a protective factor against colorectal cancer?
Physical activity
T/f: if someone exercises the recommended 150 minutes/week, they are less likely to get colorectal cancer and have a better prognosis if they do get it
True
What is the relationship between physical activity and risk for colorectal cancer?
More physical activity=less risk
What are the treatment options for colorectal cancer?
Surgical resection
Adjuvant or neoadjuvant chemo
What is the primary treatment option for colorectal cancer?
Surgical resection with or without colostomy
What is a colostomy/ileostomy?
A hole made in the skin (stoma) where feces comes out into a bag
Is a colostomy permanent?
Sometimes, but it can be reversible
If physical restrictions don’t stop activity with colostomy, what may restrict activity?
Psychological impacts of the surgery
What is involved in post op inpatient management of colectomy?
Early ambulation
Abdominal precautions
Sometimes sitting precautions
Dietary restrictions
What involved in post op outpatient management of colectomy?
Abdominal precautions
Hernia risk
Why is early ambulation important post colectomy?
To prevent or reverse an Illeus
What are abdominal precautions?
Limited flexion
Limited twisting
No lifting more than 10 lbs
What are sitting precaution? When are they use post colectomy?
No sitting, so the pt must be standing or lying
Used when the anus is removed
What is an important bed mobility consideration for PTs when a pt is on sitting precautions post colectomy?
Teaching log rolling straight to standing
What can we do to decrease hernia risk in outpatient following a colectomy?
Limit bracing and abdominal work until fully healed
