Oncology: Principles of Onco Rehab Pt. 2 Flashcards
MOST COMMON Cx IN WOMEN***
Breast Cx
Breast Cx
S/S
Cx cells originate in breast tissue
- lump in breast
- puckering/dimpling
- rough/dry scaly skin
- erythema or local rash
- nipple discharge
- nipple retraction
- lymphadenopathy
Types of Breast Cx
3:
- Ductal –MAIN
- Lobular–MAIN
- Inflammatory
Types of Breast Cx
Ductal
- Origin: Milk ducts
- 85% of all breast cx’s
-
TYPES:
- in situ (DCIS) —-remains w/in area orig. dx’d
- Invasive—-outside area
Types of Breast Cx
Lobular
- Origin: Milk Lobules
- 10-15% all breast cx’s
-
TYPES:
- in situ (LCIS)
- Invasive
Breast Cx Dx
4 Methods:
- Self exam
- Clinical exam
-
Imaging
- mammogram
- US
-
**BIOPSY— ONLY definitive way to dx cx
- needle
- open
- **Staging — TNM
- *Sentinel Node Mapping*
Sentinel Node Biopsy
Why is this beneficial?
More discriminating in what needs to be removed
*only take what they have to
Sentinel Node Biopsy
Breast Cx
What is it and what do they do?
- Inject radioisotope blue dye INTO tumor
-
Sentinel nodes ID’d and biopsied
- __ONLY WHERE Cx is ID’d
-
Sentinel nodes + axillary node dissection
- ==> take ADD. lvls of tissue
Sentinel Node Biopsy
In general
Looking for Sentinel nodes (only nodes ID’d w/ Cx) and removing them so they don’t have to remove EXTRA tissue
Breast Cx
Axillary Node Dissection
- Removal of lymph nodes in AXILLA
- PREVENT further spread of dis.
-
INCd risk for lymphedema
- IF higher amt taken OUT
Breast Cx
Tx Options: 4
- Sx
- Radiation
- Chemo
- Hormone Tx
Breast Cx Tx Options
Surgery
- Breast Salvage
- Lumpectomy
- Partial mastectomy
- Breast Removal
- TOTAL mastectomy
- Modified radical mastectomy
- Radical mastectomy
Breast Cx Tx Options
Hormone Therapy
- Anti-estrogen
- Anti-progesterone
-
Herceptin
- ability of hormones to effect growth w/in breast tissue
Breast Sx
Mastectomy
Radical Mastectomy
- ALL lymph nodes taken OUT
- ALL lymph, ALL breast, cuts thru mm’s
Breast Sx
Mastectomy
Modified Radical Mastectomy
- Mastectomy W/ lymph node dissection
- lymph nodes taken OUT
Breast Sx
Mastectomy
Simple/Total
Total Mastectomy w/ Sentinel Node Biopsy
REGULAR MASTECTOMY
- removal of breast tissue W/OUT ANY lymph nodes effected
- == Total mastectomy w/ Sentinel Node Biopsy
Breast Cx
Reconstructive Sx broken down:
see pics
Breast Cx
Reconstructive Sx
Tissue Expander
- TEMPORARY prosthesis
- expand w/ saline 4-8wks
- THEN replace w/ implant
-
alloderm graft
- acellular tissue matrix
- inf. border
Breast Cx
Reconstructive Sx
Latissimus Flap
- INDICATION: decd viable skin to create breast
- PROCEDURE:
- transfer of overlying fat, skin, part of Lat mm to ipsilat wall
Breast Cx
Reconstructive Sx
Pedicle TRAM
- TRAM==Transverse Rectus Abdominal Myocutaneous
- Transfer of rectus abdominis mm, blood supply (sup epigastric aa and vein), fat, and skin TO mastectomy site
- One end remains attached and OTHER END is rotated UP and tunneled to mastectomy site
- NOT ideal for obese, smokers—-> DECd blood supply
Breast Cx
Reconstructive Sx
Free/Muscle Sparing TRAM
- MICRO-vascular sx —reconnect blood vessels
- COMPLETE TRANSFER of skin, mm, blood vessels TO mastectomy site w/ reconnection of blood supply
- Muscle sparing==> optimal to remove LEAST amt of mm fibers
Breast Cx
Reconstructive Sx
DIEP TRAM
*NEW STANDARD*
- DIEP= Deep Inf. Epigastric Perforators (Flap blood supply)
-
Donor tissue= removal of abdominal skin, fat, blood supply
- rectus mm spared*
- Blood vessels reconnected to internal mammary aa/vein
- Donor tissue inserted INTO mastectomy skin pocket
Breast Cx
Reconstructive Sx
Rehab Implications
- Activity restrictions/guidelines
- Progressive ROM/strengthening
- Postural re-ed
- core stab, scapular stab, bra fitting
- Manual therapy—-scars
Breast Cx as a Metastatic Dis
COMMON SITES?
-
REGIONAL:
- Axillary lymph nodes
-
DISTANT:
- Bone
- Brain
- Lung
- Pleura
Breast Cx as Metastatic Dis.
Crucial to know!!!
How long Mets can dev….
Metastases may develop 10+ yrs AFTER primary Tx !!!
Breast Cx as Metastatic Dis
PT implications?
- WB status—IF mets to bone
- pulm status
- cognition
- safety awareness
- reg. testing strength
- sensation
- chemo/radiation SEs
Prostate Cx
Typ affects ______, _______
TYP affects MEN >50 yrs old
Prostate Cx
5yr survival
98.2%
Prostate Cx
S/S
- Weak or interrupted urinary flow
- INCd urinary urge/freq
- Pain/burn w/ urination
- Blood in urine or semen
- Incomplete emptying
Prostate Cx
Dx
- Rectal exam
- PSA—-Prostate Specific Antigen blood test
- Transrectal US
Prostate Cx
How is it Staged ?
I-IV
Prostate Cx Tx
In general…
Active surveillance until s/s appear OR (+) tests
Prostate Cx Tx
Options?
- Sx
- Radiation
- Radiopharma. Tx (Bone mets)
- Chemo
- Hormone tx
- Biologic tx
- Biphosphonate therapy (Bone mets)
Prostate Cx Tx
Sx: 3 options
- Radical prostatectomy
- removal
- Retropubic or Perineal
- TURP (Transurethral Resection of Prostate)
- Pelvic Lymph Node resection
Testicular Cx
5 yr survival
95.3%
Testicular Cx
Typ affects _____, ______
MEN; 20-35
YOUNG MEN
Testicular Cx
S/S
- Painless lump or swelling in testicle
- Dull ache in lower ab or groin
- Fluid in scrotum
- Pain or discomfort in testicle or scrotum
Testicular Cx
Dx
- Self-exam
- US
-
Serum Tumor Markers
- AFP
- B-hCG
Testicular Cx
How is it Staged ?
Stage 0-III
Testicular Cx Tx
Options?
- Sx
- radiation
- chemo
- surveillance for reoccurrence
- Chemo in HIGH DOSES followed by Stem Cell Transplant****** COMMON
Testicular Cx Tx
Surgery: 2
- Inguinal orchiectomy
- remove testicle
- Retroperitoneal lymph node dissection
- exacly what it sounds like
Lung Cx
ORIGIN:
LUNG TISSUE
LEADING CAUSE OF Cx DEATH IN MEN AND WOMEN****
LUNG Cx
25.3% ALL Cx deaths
Lung Cx
5yr survival and WHY?
- 18.6%
- Lets say you are already a smoker, you are going to likely have very similar sx’s to someone w/ lung cx.
- People @ high risk will have norml smoker s/s
- OFTEN go UNDx’d OR Dx’d LATE
Lung Cx Risk Factors
- tobacco
- 2nd hand smoke
- environment (asbestos***)
- radiation
- TB
Lung Cx
Clinical S/S
- Persistent cough
- SOB
- Wheezing
- Chest pain
- Hemoptysis (coughing up blood)
- Blood in sputum
Types of Lung Cx
2:
- NON-Small Cell Lung Cx–NSCLC
- Small Cell Lung Cx–SCLC
NON-Small Cell Lung Cx
NSCLC
3 types:
- Squamous Cell Carcinoma
- AdeNOcarcinoma
- Large cell
NON-Small Cell Lung Cx (NSCLC)
Explain
- LESS aggressive
- Peripheral location
- Sx BEST tx option
Small Cell Lung Cx
SCLC
Explain
- 10% all lung tumors
- STRONGEST ASSOC. W/ SMOKING
- Central location
- AGGRESSIVE
- HIGHLY Sn to chemo and RT
Types of Lung Cx
EXAMPLES
Metastatic Lung Cx
Local vs. Distant
-
LOCAL:
- Liver + adrenal glands
-
DISTANT:
- Brain
- Bone
- Contralat lung —thru circulation
Metastatic Lung Cx
PT implications???
- WB status
- pulm status
- cognition
- safety
- reg. test strength
- chemo/radiation SEs
Lung Cx
Dx
- Imaging
- mostly endoscopic
- Sputum cytology, labs, needly biopsy (only definitive)
- Bronchoscopy
- Thoracoscopy
- Thoracentesis
Lung Cx
Tx Options:
- Sx
- Thoracotomy
- radiation
- chemo
- Biologic therapies
Lung Cx Tx
Thoracotomy approach
see pics
Lung Cx Sx Types
see pics
Leukemia
What is it ?
Body makes abnormal WBCs which DO NOT DIE when they SHOULD and do NOT function to fight infection
*serve no purpose
Leukemia 5yr survival
61.4%
Leukemia typ age
60-70yo
Leukemia
Types: 5
- Acute Lymphoblastic Leukemia
- TOO MANY lymphocytes
- Acute Myeloid Leukemia
- myeloid stem cells do not fully mature
- Undifferentiated and Biphenotypic Acute Leukemia; Mixed Phenotypic Acute Leukemias (MPALs)
- Chronic Lymphocytic Leukemia
- Chronic Myelogenous Leukemia
Leukemia
How is it Staged ?
NO STANDARD STAGING
- Untreated
- Remission (DECd or disappearance S/S)
- Recurrent
Leukemia
Dx
- CBC
-
Bone marrow aspiration and Biopsy***
- ONLY DEFINITIVE WAY
Leukemia
S/S
- FEVER*
- Night sweats
- fatigue
- EASY bruising or bleeding
- INC lymphocytes make LESS room for RBC, plts)
- SOB
- Petechiae
- Wt. loss (unexplained), dec appetite
- pain in bones or stomach
- Painless lumps in neck, axilla, stomach, groin*
- INCd amt of infections*
Leukemia
Tx
- Chemo
- Radiation
- Chemo (high dose) w/ Stem Cell Transplant
- Targeted Therapy
Multiple Myeloma is a Cx of the
BONE MARROW
Multiple Myeloma (MM)
5 yr survival
50.7%
Multiple Myeloma
What is it?
First: Myeloma
- Myeloma: abnorm production of plasma cells
Multiple Myeloma
- abnorm plasma cells in bone marrow which form tumors in the body
- PREVENTS marrow from making healthy blood cells:
- RBC, WBC, Plts
Multiple Myeloma
S/S
- Bone pain
- ESP back + ribs
- bones that break easily
- Fever
- easy bruising or bleeding
- Weakness of arms or legs
- Fatigue
- Diff breathing
Multiple Myeloma
Dx
- Blood tests
- Bone marrow aspiration and biopsy—-ONLY DEFINITIVE
- Skeletal bone survey
Multiple Myeloma
How is it Staged?
- Stage I-III
Multiple Myeloma
Tx Options
- Chemo
- Targeted therapy
-
High dose chemo w/ Stem Cell Transplant
- often TOGETHER***
- Biologic tx
- radiation
- sx
-
Watchful Waiting**
- UNTIL S/S appear OR change
Mulitple Myeloma
Appearance and WHERE?
“Moth-Eaten” appearance
*Disease IN bone marrow
Primary Brain Tumors
ORIGIN:
IN Brain tissue
HALLMARK CLINICAL SIGN OF PRIMARY BRAIN TUMORS
HA that is WORSE IN AM
PRIMARY BRAIN TUMORS
Clinical Signs
- HA—Worse in AM
- HALLMARK SIGN
- laying Supine overnight==INC blood to brain
- fatigue
- seizures
- personality changes
- memory changes
- nausea/vom
- vision changes
- pressure near tumor site
Primary Brain Tumor
Grade I-II
Growth Rate and Classification
Growth Rate==SLOW
Classification==Low-grade Astrocytoma
NOTE: growth rate is SLOW so because of Neuroplasticity…the body will accomodate to these changes BEFORE sx’s start to appear
Primary Brain Tumor Types
Grade III
Growth rate and Classification
- Growth Rate==FAST
- Classification==Anaplastic Astrocytoma
Primary Brain Tumor Types
Grade IV
Growth Rate and Classification:
- Growth Rate==VERY FAST
- quick s/s
- Classification== Glioblastoma Multiform (GBM)
Brain tumors
Dx
- Imaging
- Preferably MRI*****
- Angiography
-
BIOPSY—–ONLY DEFINITIVE WAY
- Craniotomy
- Stereotactic needle biopsy
Brain Tumor
Tx Options
- Sx
- stereotactic sx
- craniotomy
- Radiation
- EXT beam
- Whole brain—brain mets
- chemo
- meds
Brain tumor sx
Stereotactic sx
Needle guided by MRI
Brain tumor Sx
Craniotomy
- Resection of skull, remove tumor, replace bone flap
Brain tumor
Sx
Shunt Placement
- Bypass CSF blockage
Primary Brain Tumors
PT Considerations
- GLOBAL neuro deficits
- sensory, memory, vision, etc
- NOT necessarily specific deficits
- Assess/monitor sensation
- light touch
- proprio.
- strength
- coord
- cognition
- functional mobility
-
VITAL SIGNS!!!
- any INC in ICP will INC BP, HA etc…
- Monitor for seizure act.
- Pt Eductation
- KEEP head ELEVATED to 30deg or HIGHER when Supine—-AVOID bending forward
Primary Brain Tumors
PT Considerations
RED FLAGS
- INCd ICP
- —> elevation in BP, nausea, vomiting, HA
Primary BONE Tumor
3 Types:
- Osteosarcoma (bone)
- Chondrosarcoma (joint)
- Multiple Myeloma
- Blood-borne tumor
- Bone marrow
Primary BONE Tumor
Prognosis
- Stage/type lesion
- Pt age—-MORE COMMON Ado’s 13-25 (better prognosis here)
- Tx options
Orthopedics Cx
Dx
- Imaging
- BIOPSY—ONLY DEFINITIVE WAY
- BLOOD TEST (Primary bone tumor)
-
What you’ll see:
- INCd alkaline phosphates
- INCd calcium
-
What you’ll see:
Orthopedics Cx
Tx Options
- **Excision
- Sx
- chemo
- radiation
- PROTECTED WB
- pain mgmt
- *Bisphosphonates**
Ortho Cx’s
Jt Resection and Replacement
*remember this may NOT look like your avg joint replacement***
- Resection w/ prosthetic stabilization
- Partial OR Total jt replace.
Ortho Cx’s Tx
Sacrectomy
*Atypical Sx
*Central loc tumor in Sacrum
- Partial OR complete resection of sacrum @ SI jts
- Resection S3, S2, possibly S1
- spino-pelvic reconstruction
INTENSE!!!!!
NO SITTING!!!
INTERNAL VS. EXTERNAL HEMI-PELVECTOMY
INTERNAL
- INTERNAL
- Limb salvage for LOWER portion of leg
- resection of portion of hemipelvis and prox femur w/ reconstruction
INTERNAL VS. EXTERNAL HEMI-PELVECTOMY
EXTERNAL
- AMPUTATION of entire LE AND hemipelvis w/ disarticulation of SI jt AND pubic symphysis
- MORE FUNCTIONAL***
Tikhoff-Lindberg Resection
First of all…it includes WHAT ?
PROX HUMERUS
SCAPULA
CLAVICLE
Tikhoff-Lindberg Resection
What is it?
- Resection of distal clavicle, prox humerus, scapula, mm transfer, AND skeletal reconstruction
- Preservation of neurovascular pedicle of arm
Tikhoff-Lindberg Resection
Elbow + Hand are functional here
Forequarter Amputation
*Postural re-ed and BALANCE!!!
Excision of ENTIRE UE, clavicle, scapula
Van Ness Rotationplasty
-
Indications:
- Tumors @ dist femur
- pt age
-
Procedure:
- Amputation of limb @ dist femur
- Rotation and re-insertion of residual limb
-
NEW KNEE is Ankle
- __DF==knee flex
- PF==knee EXT
Ortho-Rehab Implications
- PAIN control
- WB status/Activity restrictions
- Progressive ROM and strength
- Functional training
- Gait training
- Neuro-muscular re-ed
- ADLs
Colorectal Cx
5 yr survival
64.5%
Colorectal Cx
Risk Factors
- hx of colon polyps
- hx of chronic ulcerative colitis
- 3+ alcoholic drinks/day
- smoking
- Obesity***
Colorectal Cx
S/S
- Blood in stool
- change in bowel habits
- narrow stools
- vomiting
- bloating**
- fatigue
- wt. loss (UNEXPLAINED)
COLORECTAL Cx
Dx
- rectal exam
- colonoscopy
- fecal occult blood test
- Lower GI series
- sigmoidoscopy
Colorectal Cx
How is it Staged?
- Stage I-IV
Colorectal Cx Tx Options
- Sx
- CryoSx
- Radiofreq Ablation
-
Systemic Colorectal Cx Tx
- chemo
- radiation
- targeted therapy
Colorectal Cx Tx
Sx: resection w/ anastomosis vs. resection w/ colostomy
- Resection w/ anastomosis
- portion of colon
- Resection w/ colostomy
- whole colon OR term-end colon
Colorectal cx
Cryosurgery
Freeze and destroy abnorm tissue
Colorectal Cx Sx
Radiofreq Ablation
Probe w/ electrode to kill cx cells
Pancreatic Cx
5 yr survival
8.5%
LOW
Pancreatic Cx
Risk factors
Obesity
smoking
DM
Chronic pancreatitis
Pancreatic Cx
S/S
jaundice**
pain
wt. loss (unexplained)
fatigue
loss of appetite
Pancreatic Cx
Difficult Detection….WHY???
- GEN s/s
- pancreas hidden behind other organs
LOW survival rate of Pancreatic Cx …..WHY?
-
Dx’s include
- ERCP (endoscopic retrograde cholangiopancreatography)
- PTC (percutaneous transhepatic cholangiography)
- Dx’d IN LATE STAGE====LOW SURVIVAL RATE***
PANCREATIC Cx
How is it Staged?
Stage I-IV
Pancreatic Cx
Tx Options:
- Sx
- Radiation
- Chemo
- Targeted therapy
Pancreatic Cx Tx
Sx: 3 types
- Whipple Procedure
- Total pancreatectomy
- Distal Pancreatectomy
Pancreatic Cx Tx
Sx
Whipple Procedure
- Head of pancreas, gallbladder, part of stomach, part of sm. intestine, and bile duct REMOVED
- Enough of pancreas is left to produce digestive juices and INSULIN***
PANCREATIC Cx Tx
Sx
TOTAL Pancreatectomy
- Removal of the WHOLE PANCREAS, part of stomach, part of sm intestine, common bile duct, gallbladder, spleen, nearby lymph nodes****
Pancreatic Cx Tx
Sx
DISTAL Pancreatectomy
- Removal of the BODY and TAIL of the pancreas
- Spleen may also be removed if cx has spread to spleen***