Oncology: Multiple Myeloma Flashcards
1
Q
What IS Multiple Myeloma?
A
Blood Cx that invades BONE
- Cancerous plamsa cells that weaken bones
- *more Af. Americans
2
Q
Keep in mind w/ Multiple Myeloma…
Cx OF blood..
A
- Cancer OF blood aka Plasma Cx
-
plasma is made IN bones
- SO bones degrade QUICKLY!!!
-
plasma is made IN bones
3
Q
Multiple Myeloma defined:
A
Cx of plasma cells of bone marrow
4
Q
Multiple Myeloma has 3 Criteria:
A
- Bone marrow infiltrated w/ 10% or GREATER malignant plasma cells
- Presence of Monoclonal PRO in semen or urine
- Evidence of systemic diseases
5
Q
PT’s and involvement w/ MM
A
mostly involved w/ RED FLAGS of MM
6
Q
Etiology of MM:
A
- Unknown
- Possible link to radiation/chem exposure and AI disorders
7
Q
Pathology for MM:
aka HOW BONE MARROW IS MADE
A
SEE PICS
8
Q
Clinical Manifestation: S/S MM
ORTHOPEDIC
A
- **BONE PAIN (PT involved here)
- >75%
- Sk mm wasting
- Bone loss/osteoporosis
- Back pain
-
Bone Fx
- thoracic/lumbar vert, pelvis and ribs
- Neuropathies due to compression fx
9
Q
Clinical Manifestations: S/S MM
IMMUNE SYSTEM
A
Recurrent infections
10
Q
Clinical Manifestations: S/S MM
HEMATOLOGICAL SYSTEM
A
-
ANEMIA
- SOB
- DOE
- pallor
- fatigue
- weakness
- HypERcalcemia
11
Q
Clinical Manifestations: S/S MM
RENAL SYSTEM***
A
-
Renal Insuff’s
- INC Cr
- INC Ca+
- INC pH
- INC Na+
- INC K+
12
Q
Clinical Manifestations: S/S MM
GENERAL:
A
- Gen. weakness
-
UNINTENTIONAL Wt. Loss
- ALWAYS RED FLAG FOR Cx IF WT. LOSS ESP UNINTENTIONAL
- Fatigue
13
Q
How do we RULE OUT MM as diff. dx?
4 Criteria they COULD HAVE it
A
R/O MM as diff dx in pt w/
- >50yo
- Mod-Severe pain
- Wt. Loss (esp unintentional)
- Unexplained fatigue
14
Q
MM Dx
RED FLAGS FOR DIFF’LY DX’ING BACK PAIN
A
- Insidious onset (just crept up) of Sx’s
-
PAIN
- persistent pain, unable to relieve w/ diff pos’s
- interferes w/ sleep*** BIG ONE
- INCs w/ WB
- Gen. weakness
- Wt. Loss
- Fatigue
-
Pt demographic
- age
- race
- gender
15
Q
NOTE: PTs are instrumental in early detection AND referral to oncologist to diff dx, minimize detrimental 2* effects!!!
A
KNOW THIS!!!!!!!!!!
16
Q
MM
MEDICAL MANAGEMENT
7:
A
- Chemo
- Immunosuppressant
- Stem Cell transplant (often w/ high doses chemo)
- Radiation
- Bone Marrow transplant
- Orthosis (bracing)
- Sx: post-fx OR sig tumor
17
Q
MM
Medical Management
Immunosuppressants
2:
A
- Thalidomide
- Dexamethasone
18
Q
MM
Medical Management
Sx: post-fx OR significant tumor
types:
A
- Vertebroplasty and Kyplasty
- essentially cement INTO VB which REINFLATES VB
- ORIF
19
Q
PT Role in Oncolgy
*Follows ICF!!!
4 different areas we play a role:
A
- Preventative/Prehab
- improve + MAINTAIN
- Restorative
- maintain and PREVENT
- Supportive
- PREVENT
- Palliative
- No cure, do what you can
*NOTE: pts w/ MM will go thru ALL STAGES
20
Q
PT: Along continuum of the Disease
- Prehab or
A
Improve + Maintain
- Therex
- LOW int PRE
- SHORT-bout LOW int aerobic
- stretching
- balance
- education for S/S of Fx
- Postural training
21
Q
PT: Along continuum of the Disease
- Restorative or
A
MAINTAIN+PREVENT
- Therex to DEC fatigue and mm wasting
-
prevention of injury
- WB precautions
- NO lifting
- Maint. function, indep, QOL
22
Q
PT: Along continuum of the Disease
- Supportive or
A
PREVENT
*Do the best you can w/ their situation
- Fall prevention w/ focus on balance, AD’s, etc…
- Fx prevention
- no stretching
- no twisting
- no lifting
- WB precautions
23
Q
PT: Along continuum of the Disease
4. Palliative or
A
No cure, do what you can
- Home adaptations
- Pt/Family education
- AROM/AAROM/PROM
- Bed mobility, transfers, ADLs
24
Q
3 MOST COMMON sites of Metastasis:
A
- Lungs
- Liver
- Bone ***
25
Conceptualizing **Cx and metastasis**
**What happens when dx and down the line?**
* Cx usually metastasizes w/in **3-5 yrs of initial Dx & Tx for Dx BUT...** metastatic lesions **CAN OCCUR 15-20yrs AFTER initial dx------\> CAN COME BACK**
26
There are 3 Modes of **Dissemination**
## Footnote
**aka HOW Cx travels thru body and metastasizes**
**what are they?**
* 1. Via **Cx cells** traveling thru **blood stream**
* 2. Via **Cx cells** traveling thru **lymphatic system**
* 3. Via **Cx cells** traveling **growing into _adjacent tissues_**
* **__**Bones
* Organs
* Muscle
27
**WHERE does Cx Metastasize?**
**1st MOST COMMON LOCATION and HOW?**
* **PULMONARY SYSTEM**
* ****Venous drainage--\> Heart--\> Lungs
* S/S
* **dry persistent cough, pleural pain, SOB**
28
WHERE does Cx Metastasize?
**2nd MOST COMMON LOCATION and HOW?**
* **HEPATIC SYSTEM (**These are your abdominal cx's)
* GI/Colon/Pancreas--\> liver for filtration
* **S/S**
* **R upper quadrant pain**
* **malaise/fatigue**
* **Wt. Loss**
29
WHERE does Cx Metastasize?
## Footnote
**3RD MOST COMMON LOCATION and HOW?**
* **SKELETAL SYSTEM**
* \*Bony Mets affects 50% of Cx pt w/ Mets
* MOST **osteoLYTIC (dec bone density)**
* **BUT Prostate is osteoBLASTIC (inc scarring)**
* **Bones:** Spine, pelvis, ribs, prox femur, and prox humerus
* **S/S**
* ****DEEP persistent pain that **INCs w/ WB**
* **if Spine--\> LMN sx's**
30
WHERE does Cx Metastasize?
## Footnote
**OTHERS**
* CNS
* SC
* Lymphatic
31
**Metastatic Cx: Eval of _Bone Metastasis_**
5 Diff ways we can observe:
1. Radiograph
2. Bone Scan
3. CT Scan
4. MRI
5. Lab Tests
32
Metastatic Cx: Eval of Bone Metastasis
Radiographs
**What should you remember about metastasis and Radiographs???**
**40-50% bone loss BEFORE radiograph can pick it up\*\*\***
33
Metastatic Cx: Eval of Bone Metastasis
## Footnote
**GOLD STANDARD FOR BONE METS???**
BONE SCAN!!!
34
Metastatic Cx: Eval of Bone Metastasis
## Footnote
**MRI for....**
**Vertebral** AND **Epidural involvement**
35
Metastatic Cx: Eval of Bone Metastasis
## Footnote
**Lab Tests**
**such as.....**
Serum markers
## Footnote
**Calcium lvls**
36
**Mirels' Scoring System**
**What is it for??**
**Risk of Fx for _Bone Mets_**
**_\*_KNOW IT EXISTS!!!**
* **\>9 == VERY HIGH RISK FOR Fx**
* **Keep in mind...**
* ****What are WB precautions???
37
PT MGMT: Ortho WB Guidelines Based on Loc of Mets
see pics
* 0-25%== **Full WB**
* ****avoid lift/strain **\>5-10lbs**
* 25-50%== **PWB**
* ****avoid **twist or stretch**
* \>50%== **TTWB or NWB**
* ****amb, functional mobility, ex **performed w/ caution**
38
Immobility vs. Ambulation/Standing/WB
## Footnote
**Bennies vs. Risks**
see pics
KNOW THE BIG ONES
39
RED FLAGS FOR _ANY PATIENT_
**\*\*\***Think **Bone Metastatic OR Somatic Referral patterns\*\*\***
**PAIN**
* Pain w/ **valsalve maneuvers**
* **laugh, cough, sneeze**
* Pain that is **NOT responsive to therapy OR worsens w/ therapy**
* **Persistent pain---**unable to relieve w/ **diff pos's**
* Pain that:
* **interferes w/ sleep**
* **INC w/ WB**
* **\*Pain in a band around T/S**
40
RED FLAGS FOR ANY PATIENT
\*\*\*Think Bone Metastatic OR Somatic Referral patterns\*\*\*
**PAIN W/ NEUROLOGICAL SIGNS**
**PAIN W/ LMN SX'S**
* Numb/tingling
* MM weakness or paralysis
* Loss of B&B control
41
PTs role in **Oncology**
## Footnote
**4:**
1. **Preventative**
2. **Restorative**
3. **Supportive**
4. **Palliative**
42
PT Role in **Oncology**
**explain Palliative**
* curative measures **exhausted** and cure **no longer poss/avail**
* **symptom mgmt _regardless of how long they have_**
* **_Benefits:_**
* **__**self-directed medical care
* LESS LIKELY to exp untreated pain
* Better psychosocial and spiritual support
* **Prioritizes QOL**
43
When **Prevention** is NO LONGER an option.....
**Tx becomes _intervention_**
44
Benefits of **Hospice**
* Live out remaining time w/ **QOL and _as pain free as possible_**
45
