Oncology: Common Cancers And Their PT Management Flashcards
1
Q
Who has the highest incidence of breast cancer? Highest mortality?
A
White and black women have the highest incidence, black women have the highest mortality
2
Q
What are the risk factors for breast cancer?
A
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
3
Q
What gene mutations put people at risk of either breast or prostate cancers?
A
BRCA1 and BRCA2
4
Q
T/f: the longer someone is exposed to estrogen, the higher their risk for breast cancer
A
True
5
Q
Does early onset mensus and late onset menopause increase or decrease breast cancer risk?
A
Increase
6
Q
Does late onset mensus and early onset menopause increase or decrease breast cancer risk?
A
Decrease
7
Q
Most breast cancers are caused by what?
A
Estrogen exposure
8
Q
What are protective factors against breast cancer?
A
Younger age of first full term pregnancy
More than 2 full term pregnancies
Longer time spent breastfeeding
Physical activity
9
Q
What are the common clinical manifestations of breast cancer?
A
Palpable mass
Significant asymmetry in shape
Change in contour
Nipple retraction/dimpling
Lymphadenopathy
10
Q
What are less common manifestations of breast cancer?
A
Breast enlargement
Heat
Orange peel skin appearance
Color changes
11
Q
What quadrants of the breast do most cases of breast cancer arise from?
A
The upper and outer quadrants
12
Q
What is the most common site of metastasis with breast cancer?
A
Local lymph nodes
13
Q
Other than the local lymph nodes, what are the common areas of metastasis with breast cancer?
A
Brain, lung, liver, bone, and adrenals
14
Q
How often should women get a mammogram? What age do they start getting them?
A
Every other year after 40
15
Q
How is breast cancer diagnosed?
A
With biopsy
16
Q
What biopsy is used for staging, prognosis, and treatment decision in breast cancer?
A
Lymph node biopsy
17
Q
What are the 2 types of lymph node biopsies for breast cancer?
A
Sentinel lymph node dissection
Axillary lymph node dissection
18
Q
What is a sentinel lymph node dissection (SLND)?
A
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
19
Q
What is an axillary lymph node dissection (ALND)?
A
Removal of the axillary lymph nodes usually performed during a lumpectomy or mastectomy
20
Q
Is there greater risk for UE morbidity with SLND or with ALND?
A
ALND
21
Q
What is stage 0 breast cancer?
A
Abnormal cells that haven’t spread
22
Q
What is stage 1 breast cancer?
A
Spread to other tissues in a small area
23
Q
What is stage 2 breast cancer?
A
A 20-50mm tumor with some lymph node involvement
OR
A 50mm tumor with no lymph nodes
24
Q
What is stage 3 breast cancer?
A
A tumor >50mm with more lymph node involvement
25
What is stage 4 breast cancer?
Distant metastasis
26
In addition to classifying breast cancer by the metastasis, what else is considered?
Biomarker status
27
What are the three different biomarkers considered in classification of breast cancer?
Estrogen status
Progesterone status
Oncogene status
28
What is ER (+) breast cancer?
The breast cancer is estrogen dependent
29
What is ER (-) breast cancer?
The cancer is not estrogen dependent
30
What is PR(+) breast cancer?
The cancer is progesterone dependent
31
What is PR (-) breast cancer?
The cancer is not progesterone dependent
32
What is HER2 (+) breast cancer?
Cancer from oncogene mutation
33
What is HER2 (-) breast cancer?
The cancer is not from an oncogene mutation
34
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
35
What are the treatment options for breast cancer?
Chemo
Radiation
Hormonal therapy
Surgery
36
What are the risks with chemo in breast cancer treatment?
CIPN and cardiotoxicity
37
What are the risks of radiation for breast cancer?
Soft tissue damage, nerve damage, lymphedema
38
What chemo drug is used to treat hormone (+) breast cancers that has significant implications for PT?
Aromatase inhibitors
39
What is the goal of aromatase inhibitors for breast cancer?
To improve survival and decrease local and distance recurrence
40
What are the PT implications when a pt is on aromatase inhibitors?
Arthralgia
Increased fall risk
41
What is a significant reason that pts stop aromatase inhibitors?
Bc of the arthralgia that often results
42
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
43
What is the gold standard treatment for stage 1/2 breast cancer?
Surgery
44
What is involved in breast conserving surgery for breast cancer?
Lumpectomy followed by XRT
45
What are the 3 types of mastectomies?
Simple mastectomy
Skin sparing mastectomy
Modified radical mastectomy
46
What is a simple mastectomy?
Removing all breast tissue, skin, and nipple
47
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
48
What is a modified radical mastectomy?
Removing all breast tissue, skin, nipple, lining of the pecs, and includes a ALND and SLND
49
Which type of mastectomy has the greatest risk for shoulder dysfunction after the surgery?
A modified radical mastectomy
50
T/f: a breast reconstruction can use either implants or autologous tissue
True
51
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
52
What is a deep inferior epigastric perforator (DIEP) flap?
Use of abdominal fat, skin, and tissue with the ms spared
A free flap
53
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
54
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
55
What is a pedicled flap?
When you keep the vasculature connected to its original area
56
When is a latissimus dorsi flap used?
When the TRAM or DIEP flaps fail bc of blood supply issues
57
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
58
What are the signs to look for for flap necrosis following breast reconstruction?
Muddled, pale, or even gray skin
59
What is UE morbidity?
Problems with UE strength, pain, or ROM
60
There is a significant risk for lymphedema following what breast cancer surgeries?
ALND
Modified radical mastectomy
61
62
T/f: breast cancer surgeries often result in UE impairments
True
63
What are the highly recommended assessments for UE morbidity following breast cancer surgery?
DASH, SPADI, SRQ, PSS
64
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
65
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
66
What UE conditions result from UE morbidity?
Impingement syndrome, adhesive capsulitis, and other shoulder dysfunctions
67
What is the most common cancer in men?
Prostate cancer
68
T/f: prostate cancer has almost 100% 5 year survival
True
69
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
70
When are men screened for prostate cancer?
Age 55-69
71
T/f: prostate screening is not recommended over age 70
True
72
What is involved in prostate cancer screening?
Digital rectal exam
PSA blood test
Transrectal US guided biopsy
CT/PET scan
73
What are treatment options for prostate cancer?
Watchful waiting
Surgery
XRT
Hormonal therapy
74
What is the most common treatment for prostate cancer?
Watchful waiting
75
Why is watchful waiting usually the go to treatment for prostate cancer?
Bc it is a slow progressing cancer that is slow to metastasize
76
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
77
When are surgery, XRT, and hormonal therapy used to treat prostate cancer?
When it is faster progressing
78
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
79
What usually causes bowel symptoms in prostate cancer?
Disruption from radiation fibrosis or nerve damage from surgery
80
What is the most common cancer worldwide?
Lung cancer
81
What is the most common cause of cancer related death in the US?
Lung cancer
82
What is the growth rate of small cell lung cancer?
Very rapid
83
Does small cell lung cancer metastasize early or late in the disease?
Very early
84
Where does small cell lung cancer tend to metastasize?
The mediastenum and lung
85
What is the treatment for small cell lung cancer?
Combo chemo
86
What is the most common lung cancer in the US?
Adenocarcinoma
87
What lung cancer type makes up. 80-85% of all lung cancers?
Non small cell lung cancer
88
What are the 3 types of non small cell lung cancers?
Squamous cell
Adenocarcinoma
Large cell
89
Is the growth rate of squamous cell non small cell lung cancer fast or slow?
Slow
90
Does metastasis in squamous cell lung cancer occur early or late in the disease?
Late
91
What are the common areas of metastasis in squamous cell lung cancer?
Lung, lymph nodes, adrenals, liver
92
What are the treatment options for squamous cell lung cancer?
Surgical resection for stage 1/2
93
Is the growth rate of Adenocarcinoma fast or slow?
Slow to moderate
94
Does metastasis occur early or late in the disease with Adenocarcinoma?
Early
95
What are the common areas of metastasis with Adenocarcinoma?
Lung, brain, and other areas
96
What are the treatment options for Adenocarcinoma?
Surgical resection with stage 1/2
Chemo for stage 3
97
Is the growth rate of large cell lung cancer fast or slow?
Rapid
98
Does metastasis occur early or late in large cell lung cancer?
Early
99
What are the common sites of metastasis of large cell lung cancer?
Widespread
Kidneys, liver, adrenals
100
What are the treatment options for large cell lung cancer?
Surgery for stage 1/2
Palliative XRT
101
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
102
What occupational exposure put pts at risk for lung cancer?
Asbestos, silica, radon, heavy metals, vehicle exhaust
103
What other lung diseases put pts at risk for lung cancer?
COPD
Emphysema
104
What is the #1 cause of lung cancer?
Smoking
105
What are the treatment options for lung cancer?
XRT
Chemo
Surgical resection
106
T/f: surgical resection for lung cancer is usually followed by XRT, chemo, or both
True
107
When is surgical resection for lung cancer typically done?
In early stages
108
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
109
What can improve functioning in lung cancer, but pts often have a hard time with motivation for it?
Pulmonary rehab
110
What posturing results from radiation fibrosis and surgical scarring and fibrosis in lung cancer surgery?
Increased kyphosis
Protracted shoulders
Forward head
111
T/f: pts with lung cancer often get SOB with activity so they avoid activity then get worse SOB as a result
True
112
What is a large psychological factor of lung cancer?
Stigma and guilt
113
T/f: pts with lung cancer are often sedentary before dx and even more so after dx
True
114
What are the most common manifestations in lung cancer?
Decreased strength, flexibility, motivation, agility and balance, and endurance
115
What contributes to decreased strength in lung cancer?
Atrophy and cachexia
116
What contributes to decreased flexibility in lung cancer?
Surgical incisions and inactivity
117
What contributes to decreased motivation in lung cancer?
Stigma/guilt
Sedentary lifestyle
Dyspnea/pain
Social barriers
118
What contributes to decreased agility and balance in lung cancer?
CIPN
poor motor control
Disuse
119
What contributes to decreased endurance in lung cancer?
CRF
Poor nutrition
Cancer related lung disease
120
What is the 4th most common cancer in the US?
Colorectal cancer
121
What is the second most common cancer death in the US?
Colorectal cancer
122
T/f: there is likely a genetic component to colorectal cancer as black men are more prone to getting it
True
123
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)
124
What is a protective factor against colorectal cancer?
Physical activity
125
126
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
127
What is the relationship between physical activity and risk for colorectal cancer?
More physical activity=less risk
128
What are the treatment options for colorectal cancer?
Surgical resection
Adjuvant or neoadjuvant chemo
129
What is the primary treatment option for colorectal cancer?
Surgical resection with or without colostomy
130
What is a colostomy/ileostomy?
A hole made in the skin (stoma) where feces comes out into a bag
131
Is a colostomy permanent?
Sometimes, but it can be reversible
132
If physical restrictions don’t stop activity with colostomy, what may restrict activity?
Psychological impacts of the surgery
133
What is involved in post op inpatient management of colectomy?
Early ambulation
Abdominal precautions
Sometimes sitting precautions
Dietary restrictions
134
What involved in post op outpatient management of colectomy?
Abdominal precautions
Hernia risk
135
Why is early ambulation important post colectomy?
To prevent or reverse an Illeus
136
What are abdominal precautions?
Limited flexion
Limited twisting
No lifting more than 10 lbs
137
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
138
What is an important bed mobility consideration for PTs when a pt is on sitting precautions post colectomy?
Teaching log rolling straight to standing
139
What can we do to decrease hernia risk in outpatient following a colectomy?
Limit bracing and abdominal work until fully healed
