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Medcon Rehab III > Oncology: Principles in Oncology Rehab 1 > Flashcards

Oncology: Principles in Oncology Rehab 1 Flashcards

1
Q

WHY do PTs need to know about pts w/ Cx

A
  • ALL systems affected
  • ALL ages affected
  • Cx and Tx affects function + mobility
    • ​ICF
      • ​Body function and Structure==Impairments
      • Activity=Limitations
      • Participation=Resstrictions on life situations
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2
Q

PT settings where you will see oncology pts

A

ALL of them!!!

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3
Q

Estimated New Cx Cases in US

A

see pics

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4
Q

Carcinogenesis Terminology:

what is Cx?

A
  • Alteration of differentiation so that malignant cells cannot be recognized by its origin parent cells
    • ​**ANAPLASTIC
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5
Q

Carcinogenesis Terminology:

Dysplasia

A
  • GENERAL disorganization of cells
  • MAY BE REVERSIBLE
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6
Q

Carcinogenesis Terminology

Metaplasia

A
  • DISORDERLY cell patterns
  • REVERSIBLE AND BENIGN
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7
Q

Carcinogenesis Terminology

Hyperplasia

A
  • INCd # of cells creating a tissue mass
  • NEOPLASTIC HYPERPLASIA
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8
Q

Tumor, Neoplasm, Malignancy

A
  • a NEW growth
  • Any abnormal mass or tissue which exceeds the growth of NORM tissue
  • SERVES NO USEFUL PURPOSE
  • Benign OR malignant
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9
Q

Cx defined:

A

A group of dis’s characterized by uncontrolled growth and spread of abnorm cells

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10
Q

Benign

Characteristics:

A
  • SLOW growing
  • Encapsulated (one area)
  • NON-invasive
  • Tumor cells are SIMILAR to originating tissue
    • ​HIGHLY differentiated
  • **can still be very serious or life-threatening depending on location or size
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11
Q

Malignant

Characteristics:

A
  • RAPID uncontrolled growth
  • NON-encapsulated (spread out)
  • Destructive to surrounding tissue
  • NOT WELL-DIFFERENTIATED
  • **Ability to metastasize
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12
Q

Dx of Cx:

S/S

A
  • PAIN
  • Fatigue
  • Palpable lump
  • Wt. Loss—-often unexplained
  • Fx***
    • iatrogenic fx’s
    • *sometimes FIRST sign of metastatic cx
  • Dis specific sx’s
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13
Q

Dx of Cx

S/S

Paraneoplastic Syndromes

A
  • Tumor producing s/s AWAY from primary or metastatic site
    • ​thru production/secretion of hormones
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14
Q

ONLY WAY TO DEFINITIVELY Dx A Cx

A

BIOPSY ***

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15
Q

Dx: Exams and Tests to detect Cx

A
  • Blood tests
  • Palpation + Clinical exam
  • Radiography
  • US
  • MRI
  • Bone Scan****
  • Lab tests
    • stool sample
    • sputum
    • cytology
  • Site specific Tests
    • ​colonoscopy
    • mammography
    • sigmoidoscopy
    • Pap smear
    • bronchoscopy
  • BIOPSY***
    • ​ONLY definitive way to Dx Cx

​

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16
Q

BIOPSY

*only way to definitively Dx Cx

Different methods:

A
  • Curettage (Pap smear)
  • fluid aspiration
  • Fine needle aspiration
  • Core needle biopsy
  • Dermal punch
  • Endoscopy
  • open excision
  • Sentinel lymph node biopsy
  • stereotactic biopsy
  • robotic needles
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17
Q

Dx of Cx and Genetics???

A

Only a SMALL portion of cx’s linked to a single gene are inherited

*only 5-10%

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18
Q

Dx of Cx: Genetics

MOST COMMON Cx WITH A FAMILIAL PATTERN:

PBOC

A
  • Prostate
  • Breast
  • Ovarian
  • Colon
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19
Q

Dx of Cx: Genetics

Oncogenes

A
  • Ability to transform norm cells INTO malignant cells by hyperactivation
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20
Q

Dx of Cx: Genetics

Tumor suppressive genes

A
  • Regulate growth and inhibit carcinogenesis
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21
Q

Dx of Cx: Genetics

What leads to aggressive cell proliferation? (dividing and spreading of cx cells)

A
  • Defects in BOTH oncogenes and tumor suppressive genes leads to aggressive cell proliferation
    • ​MORE oncogenes and LESS tumor suppressive genes==> Aggressive cell proliferation
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22
Q

Research ID and cataloguing genes that are assoc’d w/ Cx

A
  • BRCA 1, BRCA2
    • Cx suppressor is mutated
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23
Q

Dx of Cx: Genetics

In contrast to genetics, ________ all cx may be caused by environmental agents (carcinogens) OR viruses

A

50%

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24
Q

NON-modifiable risk factors for Cx

A

Age

Genetics+Family Hx

Gender

Race

Ethnicity

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25
MODIFIABLE Risk Factors for Cx
* **Dietary improvements** * **​HIGH fruits+veggies** * **limtd animal meat/fat** * **multivitamin w/ _folate_--\> DNA repair** * Limtd alcohol intake * safe sex * wt. control + obesity prevention * Phys activity * tobacco prevention+cessation * environmental exposure including **sun protection** * participating in **screenings**
26
Staging of Cx ## Footnote **What is Staging used for?**
Process to **describe extent of disease** * aids in **Tx planning** * Predicts **clinical prognosis** * Compares **results of tx**
27
2 types of staging in terms of clinical vs. disease state
**Clinical staging vs. Pathologic staging**
28
Types of Staging
* **I-IV** * **TNM** * **Grades** * **In situ-distant spread**
29
Staging Cx
See pics for ENTIRE CHART
30
Staging Cx I-IV ## Footnote **Stage 0**
In situ, **pre-malignant**
31
Staging Cx: I-IV ## Footnote **Stage I**
* **\<2 cm** * **LIMTd to LOCAL site therefore easily resectable** * **\*BEST CHANCE OF SURVIVAL-- 70-90%**
32
Staging Cx: I-IV ## Footnote **Stage II**
* 2-4/5cm * **Invasion to organ OR adjacent tissue** * Microinvasion to **lymphatic system** * Resectable BUT **uncertain of clear margins** * Survival rate ~50%
33
Staging Cx: I-IV ## Footnote **Stage III**
* 5 cm * **Invasion INTO lymphatic system** * Operable **but not resectable** * **Survival ~20-25%**
34
Staging Cx: I-IV ## Footnote **Stage IV**
* 10cm * **Metastatic lesions (regional OR distant)** * **Inoperable for resection** * **\*Survival 5%**
35
**MOST commonly used system for Staging** **Particularly for _Solid Tumors_**
TNM * **T=**_T_**umor size** * **N=absence of presence of Lymph **_N_**odes** * **M=absence or presence of **_M_**etastases**
36
TNM Staging ## Footnote **T=Tumor size**
Tumor size * **Tx:** primary tumor cannot be assessed * **T0:** NO evidence of primary tumor * **T1-T4:** Progressive INC in tumor size
37
TNM Staging ## Footnote **N= regional Lymph Node involvement**
N=Lymph Node involvment * **Nx:** nodes cannot be assessed * **N0:** No metastases to local lymph nodes * **N1-3:** Progressive involvement to regional lymph nodes
38
TNM Staging ## Footnote **M=presence of distant Metastases**
M=distant Metastases * **Mx:** presence of distant mets cannot be assessed * **M0:** No distant metastases * **M1:** Presence of distant metastases
39
Grades of Tumor or Cx Explain...
* Provides **measure of differentiation** * Information on **size, shape, rate of cell division** * **​indicates _Aggressiveness_**
40
Grades of Tumor or Cx 3:
* **LOW:** Better **predictive** and **prognostic outcome** * **INTERMEDIATE** * **HIGH:** Poor cellular differentiation, **likely to metastasize EARLY**
41
In Situ to Distant Spread ## Footnote **Broken down into 5 categories**
* In-Situ * Local spread * Regional spread * Distant spread * **Carcinomatosis**
42
In situ to Distant spread ## Footnote **In-situ**
**Orig layer of cells** which are **contained w/in tissue**
43
In situ to Distant spread ## Footnote **Local spread**
* Penetration OUTSIDE **orig layer of tissue**
44
In situ to Distant spread ## Footnote **Regional spread**
* Spread to **nearby tissue or lymph nodes in area of origin**
45
In situ to Distant spread **Distant spread**
* Spread to **other organs or areas of body**
46
In situ to Distant spread ## Footnote **Carcinomatosis**
* **WIDESPREAD end-stage disease**
47
Mechanisms of Metastasis ## Footnote **Primary Disease**
* cells CAN BE ID'd from **primary organ**
48
Mechs of Metastasis ## Footnote **When does Metastases occur?**
* occurrs when cells **break from primary tumor** and travel by **circulatory OR lymphatic system** to DISTANT AREAS of the body * **tumor cells become trapped in the capillaries of distant organs**
49
Metastases occurs in other ways:
* Growth extension and **invasion into _adjacent_** **tissue**
50
Metastasis is often to body areas of \_\_\_\_\_\_\_\_\_ Examples?
**High blood flow** * Lungs * Liver * Brain and CNS * Lymphatic system * Skeletal system
51
Pts found w/ and w/out metastases
* 30% pts found **w/ metastases on Dx** * 30-40% pts w/ **hidden mets @ Dx**
52
Eval of **Metastases** ## Footnote **Methods:**
* Radiograph * Bone scans * CT * MRI * \***particularly for spinal involvement** * **PET scan** * **​\*for cells that metabolize glucose unusually fast** * Lab tests * **Ca\* lvls** * **Serum markers**
53
Eval of **Mets** ## Footnote **\*PET scans** **what should you know??**
BEST to eval **loc and size of mets in pts w/ _advanced mets disease_**
54
Brain Mets
30% of all brain tumors
55
Brain Mets ## Footnote **Common Cx's that metastasize to brain**
Lung Breast Melanoma Kidney
56
Brain mets prognosis
3-6mos
57
Brain Mets **S/S**
* HA * nausea/vom * fatigue * seizures * confusion * diff concentrating * falls * double vision * other neuro deficits
58
Brain Mets ## Footnote **Leptomeningeal Disease** **what is this?**
* Spread INTO **meninges and CSF** * **Often FROM:** * **​Breast cx, lung cx, melanoma**
59
Approx ____________ of all cx will metastasize to **BONE**
50%
60
Bone Mets ## Footnote **Common Cx's**
see chart
61
Bone Mets **S/S**
* PAIN * swelling * palpable mass * sensory and/or motor changes * functional changes * Gait disturbs * Fx * Systemic sx's
62
Metastatic Bone Dis what is COMMON?
PAIN @ NIGHT
63
Metastatic Bone Disease ## Footnote **OsteoLYTIC Mets**
* Cx cells cause **bone DESTRUCTION** * **​renal cell cx** * **lung cx (NON SMALL CELL)** * **melanoma** * **thyroid cx**
64
Metastatic Bone Dis ## Footnote **OsteoBLASTIC mets**
* Cx cells cause **BONE FORMATION** * **​prostate cx** * **lung cx (SMALL CELL)**
65
This **Lung Cx is osteoLYTIC**
NON-small cell
66
This Lung Cx is **osteoBLASTIC**
SMALL-cell
67
Metastatic bone disease **Mixed (osteolytic + blastic)**
* causes **bone destruction AND formation** * **​Breast Cx \*\*\*\*\***
68
This type of Cx is MIX of **osteolytic and osteoblastic**
Breast Cx
69
Evaluation of Fx Risk ## Footnote **Mirel's Scoring System (see pics)** **What else are we looking for?**
* Immobility vs. ambulation/limtd WB * compression fx's and cord compression * **Tx:** * **​Sx** * **Radiation** * **Protected WB**
70
Lung Mets ## Footnote **Lung tumors originate where ?**
OUTSIDE lung tissue
71
Lung Mets **Tumors commonly metastasize from:**
* Primary breast * Primary bone * Primary renal * Primary colorectal * Primary testicular cx's
72
Lung Mets ## Footnote **Tx**
depends on **primary tumor AND prognosis**
73
Lung Mets ## Footnote **Sx's**
SOB Hemoptysis--coughing up blood dry, persistent cough
74
Lung Mets ## Footnote **PT implications**
* Asses/monitor **HR** * **PulseOX** * **RPE--Borg**
75
Tx of Cx's Various tx's
* Sx * Chemo * Radiation * Biologic therapies * **Hemapoietic Stem Cell Transplant** * Supportive Tx; **complementary vs alternative therapies** * **Tx may be in Combination** * **​Adjuvant vs. Neoadjuvant**
76
Tx of Cx ## Footnote **Factors in determining Tx:**
* Type/Stage of Cx * Gen health of Pt * QOL * Effectiveness of Tx * Financial strains * Social supports
77
**MOST COMMON TYPE OF Cx Tx**
Surgery!!!
78
Cx Tx ## Footnote **Sx**
* Determined by: * **Cx type** * **Cx location** * **Pts functional status**
79
Cx Tx ## Footnote **Sx GOALS:**
* Biopsy-----**only definitive way to dx cx** * Removal of tumor * **complete resection or tumor _debulking_** * Correction of **life threatening condition** * Pain relief and palliation
80
Chemotherapy ## Footnote **More useful for tx of what???**
WIDESPREAD or **Metastatic disease** **\*\*SYSTEMIC (whole body) Tx**
81
Chemotherapy
* WIDESPREAD or **METASTATIC DIS** * Affects **cell DNA synthesis** * SINGLE agent or COMBO therapy * Delivery * **PO** * **subcutaneously** * **IM** * **IV** * **injection** * **wafers** * Single dose or Multiple doses in rounds to **min. SEs** * **Affects tissue w/ high rate of cell division** * **​GI** * **Hair**
82
Cx Tx ## Footnote **Chemotherapy GOALS**
* DESTROY or SHRINK tumors * **Slow progression** of dis. * **Palliation** * **Reduction of tumor size to allow for sx resection**
83
Common **Chemotherapy agents**
* Cisplatin * Ifosfamide * Cytarabine * **Methotrexate\*\*\*\*** * Doxorubicin * **Vincristine\*\*\*\*** * Tamoxifen * B-interferon
84
Cx Tx ## Footnote **Radiation** **MORE USEFUL TO WHAT**
LOCALIZED lesions
85
Cx Tx ## Footnote **Radiation**
* LOCALIZED lesions * destroys cells by **damaging DNA to impair cell replication** * attempt to minimize damage to healthy tissue * **affects tissues w/ high rate cell division** * **​skin** * **GI** * **hair** * **\*\*Hyperfractionation** * **​**SMALLER doses @ HIGHER freq
86
Cx Tx ## Footnote **Radiation** **GOALS:**
* DESTROY or SHRINK tumors * **Curative OR Palliative** * **Reduction in tumor size to allow for complete sx resection OR reduced amt of sx intervention**
87
Types of Radiation
* Teletherapy--**external beam radiation** * Sealed source--**brachytherapy (radioactive implants)** * Intensity Modulated Radiation Therapy--**IMRT** * **​3D beams** * Cyberknife---robotic/precision mapping
88
Biologic Therapies (**Targeted Therapies)** ## Footnote **4 types**
1. Monoclonal antibodies 2. Small molecules 3. Antiangiogenic Therapy 4. Hormonal Therapy
89
Biologic Therapies (Targeted Therapies) ## Footnote **Monoclonal antibodies**
* Pharmaceutical antibodies that specifically act against particular antigen * Marks the cells so that other components from bodys own immune system will attack it * Antibodies can be carriers for chemotherapies---**minimizes SE's**
90
Biologic Therapies (Targeted Therapies) ## Footnote **Small Mc's**
BLOCK enzymes and receptors to PREVENT growth and proliferation
91
Biologic Therapies (Targeted Therapies) ## Footnote **Antiangiogenic Therapy**
BLOCKS formation of new blood vessels supplying the tumor
92
Biologic Therapies (Targeted Therapies) ## Footnote **Hormonal Therapy**
BLOCKS hormone receptors for hormone that supplies tumor
93
Hemopoietic Stem Cell Transplant **Used for Tx of what ?**
* Leukemia, * MDS (**Myelodysplastic Syndrome)** * Lymphoma * Aplastic anemia
94
Hemopoietic Stem Cell Transplant
* leukemia, MDS, lymphoma, aplastic anemia * **High Dose chemotherapy** AND whole body radiation kills cx **but creates bone marrow destruction** * **​Stem Cell transplantation to REBUILD marrow found in bone marrow and circulating blood** * Autologous--pts own body OR Allogenic--donor
95
Hemopoietic Stem Cell Transplant ## Footnote **GOALS**
* Rid body of diseased marrow and replace it w/ **fresh healthy functioning marrow**
96
Cx Tx ## Footnote **Stem Cell Harvest** **MAIN POINTS**
* pt given **G-CSF** to produce **high vol of circulating stem cells** * **Collection from BONE MARROW** * **Allogenic (from donor) transplants--\> HLA (human leukocyte antigen)** * **​must be matched\*\*\***
97
Cx Tx ## Footnote **Supportive Tx: Complementary and Alternative Tx**
* **Integrative medicine** * acupuncture * reiki * hypnosis * yoga * meditation\*\*\* * massage * tai chi * Qi gong
98
Tx Outcomes ## Footnote **No Evidence of Disease** **NED:**
* ALL signs of disease have **disappeared after tx from 0-5yrs**
99
Tx Outcomes ## Footnote **Durable Remission**
**NED** for **prolooooonged period**
100
Tx Outcomes ## Footnote **Cure:**
W/out **evidence of dis @ 5 yrs POST-Dx**
101
Tx Outcomes What about **people who are cured?**
STILL REMAIN w/ **sig limitations and impairs** **affects function\*\*\***
102
Karnofsky Performance Scale ## Footnote **What is it?**
* measures ability of cx pts to **perform ordinary tasks** * **Can be used to determine:** * **​prognosis** * **participation in clinical trial** * **measure changes in pt function** **HIGHER SCORE==HIGHER lvl of function** **LOWER SCORE==LOWER chance of survival**
103
Eastern Cooperative Oncology Group Performance Scale ## Footnote **ECOG** **what is it??**
* Determines **HOW a pts disease is PROGRESSING** * **HOW dis affects ADLs** * **Determining ability of pt to _tolerate tx_** * **Assists in _prognosis_**
104
Progression of Care ## Footnote **4 Steps**
1. **Preventative** 2. **Restorative** 3. **Supportive** 4. **Palliative**
105
Progression of Care ## Footnote **Preventative** **PRIMARY PREVENTION**
* 1/2 ALL cx deaths could be prevented thru **screening tests and healthier lifestyle** * **Epigenetics:** _Block_ formation and progression of cx **​** * **Nutrigenetics**: change **gene sequencing and function AND DNA sequencing** w/ foods/beverages * **Chemo prevention:** use of agents to **inhibit and reverse cx** by eliminating pre-malig cells and **blocking progression of norm cells into tumors** * **​NSAIDs, green/black tea, Vit D/E** * **Cx vaccines:** using a persons OWN cx cells that have been **inactivated** to stimulate immune system to make antibodies which will respond in the event of reoccurrence * **HPV vaccine**
106
**Progression of Care** **Preventative** **SECONDARY PREVENTION**
* EARLY detection and QUICK tx to **reduce morbidities and mortality**
107
**Progression of Care** **Preventative** **TERTIARY PREVENTION**
* Sx mgmt * limiting comps and **preventing disability** * **Active role of PT:** GOAL to **improve and maintain**
108
Role of PT in **Prevention** Morano MT, et al
See study below
109
Progression of Care ## Footnote **RESTORATIVE**
* **GOOD** oncologic **prognosis and functional potential** * **GOAL:** MAXIMIZE phys, social, psycho, vocational **function** * **Tx:** impairment or disability\*\*\* * **Active Role of PT:** _maintain function_ and _prevent_ further impairment or disability
110
Progression of Care **SUPPORTIVE**
* **LIMITED** oncologic **prognosis and functional pot.** * **Focus:** on home and family support, QOL * **Maintaing function** thru survivorship and/or **progress of disease** * **Active Role of PT:** _PREVENTION_ of further impairment or disability
111
Progress of Care ## Footnote **Palliative Care** **What is Palliative Care?**
* approach that **improves the QOL of life of pts and their families** facing proble assoc'd w/ **life-threatening or serious illness** * Thru **prevention and relief of suffering by means of:** * **​**EARLY ID and impeccable assessment and Tx of pain and other problems, physical, psychosocial and spiritual
112
Progress of Care **Palliative Care** **More on Palliative Care**
* **Curative options EXHAUSTED** * **Regardless of lifespan** * **\*\*Multidisciplinary approach** * **AIMS:** * **​**sx mgmt * MIN SEs from dis. or Tx * address **psychological, social, spiritual concerns**
113
Progress of Care ## Footnote **Hospice Care** **What is Hospice Care ?**
* Death is imminent, support and care given for people in the last phase of an incurable dis so they may live as fully and comfortably as possible
114
Progress of Care **Hospice Care** **More on Hospice Care**
* Focus on **QOL** rather than **length of life** * **​life expectancy \<6mos** * **Family centered** * **AIMS:** * **​**PAIN control * MAX activity w/out restricts * emotional and psycho. support for pt and fam
115
Medicare Req's for **Hospice Care**
* Phys and medical director use clinical judge. to certify pt is terminally ill w/ life expectancy \<6mos if dis runs normal course * enrolls in **Medicare approved hospice** * **PT services included**
116
Role of PT in **Palliative and Hospice Care**
* **Improve/maintain LOF\*\*** * **​**pt indep. * reduced burden on caregivers * **Max. comfort** * **Implement pain mgmt** * **Positioning\*\*** * **​**protect skin integrity * Max pulm function * **Energy conserv.** * **Home mods** * **caregiver training/edu.** * **respect goals of pt/fam**
117
Effects of PT on Pain and Mood in pts w/ terminal Cx: Pilot RCT
See study below
118
What is a **Survivor?**
\*someone who has **completed active cx tx**
119
Healthy People 2020
* INC proportion of Cx survivors who are living 5yrs or longer after Dx * Baseline- 66.2% \>5yrs survival * **TARGET:** 72.8%
120
Macmillan Cx Support
* **Survivor:** someone who is living w/ or beyond cx * completed initial cx mgmts and has **no apparent evidence of active dis.** * living w/ progressive dis and may be receiving tx but is NOT in terminal phase of illness * has had cx in past * **edu, resources, fundraising**
121
Primary Needs of **Survivors**
* prevention/detection * monitor for reoccurrence, spread, 2\* cx's * interventions for cx and tx SEs * coordination of med. team * monitor for delayed or prolonged sx's
122
Role of PT in **Survivorship**
* Address **Impairments!!!!!** * **​PAIN** * **dec ROM** * **Balance** * **Weakness** * **Limtd mobility** * **fatigue** * **Posture**
123
Cx Rehab: Overview of Current Need, Delivery Models, Lvls of Care
* Impairments + disability reduces QOL, reduces part. in society, INCs healthcare utilization * survivors have several issues that must be addressed * survivors need **continuous ex related edu from EARLY in tx, adapted thru tx and cont'd thru survivorship** * **ACSM cert for Cx exercise!!! GET IT!!!**
124
Cx Rehab ## Footnote **Delivery Models** **Prospective Surveillance Model**
Eval @ dx to deterine **baseline,** enlarged scope to cover **wellness and surivorship care,** _web-based and telemedicine_
125
Cx Rehab ## Footnote **Delivery Models** **Referral Trigger Model**
automated referral for certain dx's like **lymph node dissection, imbedded screening during onco appts**
126
Cx Rehab **Delivery Models** **Established Rehab Care Delivery Pathways**
impairments and adverse sx's bring pts to hospital or clinic and **pt is referred for tx of _functional decline_**
127
Cx Rehab ## Footnote **Delivery Models** **ICF, Disability and Health**
**mapping ICF impairments to outcome based functional measures** but little impact on clinical practice
128
Cx Rehab ## Footnote **Delivery Models** **Center Based Programs**
**Reconditioning program for pts during and after cx tx** **similar to cardiopulm rehab**
129
Cx Rehab **Delivery Models** **Exercise for Rehab and Fitness**
Conditioning **from dx** for **aerobic fit, strength/endurance,** **mitigates toxicity, optimize function, 2\* cx prevention benefit**
130

Medcon Rehab III (6 decks)

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