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