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Medcon Rehab III > Oncology: Principles of Onco Rehab Pt. 2 > Flashcards

Oncology: Principles of Onco Rehab Pt. 2 Flashcards

1
Q

MOST COMMON Cx IN WOMEN***

A

Breast Cx

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2
Q

Breast Cx

S/S

A

Cx cells originate in breast tissue

  • lump in breast
  • puckering/dimpling
  • rough/dry scaly skin
  • erythema or local rash
  • nipple discharge
  • nipple retraction
  • lymphadenopathy
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3
Q

Types of Breast Cx

3:

A
  1. Ductal –MAIN
  2. Lobular–MAIN
  3. Inflammatory
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4
Q

Types of Breast Cx

Ductal

A
  • Origin: Milk ducts
  • 85% of all breast cx’s
  • TYPES:
    • ​in situ (DCIS) —-remains w/in area orig. dx’d
    • ​Invasive—-outside area
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5
Q

Types of Breast Cx

Lobular

A
  • Origin: Milk Lobules
  • 10-15% all breast cx’s
  • TYPES:
    • ​in situ (LCIS)
    • Invasive
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6
Q

Breast Cx Dx

4 Methods:

A
  1. Self exam
  2. Clinical exam
  3. Imaging
    1. ​mammogram
    2. US
  4. **BIOPSY— ONLY definitive way to dx cx
    1. ​needle
    2. open
  5. **Staging — TNM
    1. ​*Sentinel Node Mapping*
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7
Q

Sentinel Node Biopsy

Why is this beneficial?

A

More discriminating in what needs to be removed

*only take what they have to

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8
Q

Sentinel Node Biopsy

Breast Cx

What is it and what do they do?

A
  • 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
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9
Q

Sentinel Node Biopsy

In general

A

Looking for Sentinel nodes (only nodes ID’d w/ Cx) and removing them so they don’t have to remove EXTRA tissue

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10
Q

Breast Cx

Axillary Node Dissection

A
  • Removal of lymph nodes in AXILLA
  • PREVENT further spread of dis.
  • INCd risk for lymphedema
    • ​IF higher amt taken OUT
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11
Q

Breast Cx

Tx Options: 4

A
  1. Sx
  2. Radiation
  3. Chemo
  4. Hormone Tx
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12
Q

Breast Cx Tx Options

Surgery

A
  • Breast Salvage
    • ​Lumpectomy
    • Partial mastectomy
  • Breast Removal
    • ​TOTAL mastectomy
    • Modified radical mastectomy
    • Radical mastectomy
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13
Q

Breast Cx Tx Options

Hormone Therapy

A
  • Anti-estrogen
  • Anti-progesterone
  • Herceptin
    • ​ability of hormones to effect growth w/in breast tissue
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14
Q

Breast Sx

Mastectomy

Radical Mastectomy

A
  • ALL lymph nodes taken OUT
  • ALL lymph, ALL breast, cuts thru mm’s
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15
Q

Breast Sx

Mastectomy

Modified Radical Mastectomy

A
  • Mastectomy W/ lymph node dissection
    • ​lymph nodes taken OUT
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16
Q

Breast Sx

Mastectomy

Simple/Total

Total Mastectomy w/ Sentinel Node Biopsy

A

REGULAR MASTECTOMY

  • removal of breast tissue W/OUT ANY lymph nodes effected
  • == Total mastectomy w/ Sentinel Node Biopsy
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17
Q

Breast Cx

Reconstructive Sx broken down:

A

see pics

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18
Q

Breast Cx

Reconstructive Sx

Tissue Expander

A
  • TEMPORARY prosthesis
  • expand w/ saline 4-8wks
  • THEN replace w/ implant
  • alloderm graft
    • ​acellular tissue matrix
    • inf. border
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19
Q

Breast Cx

Reconstructive Sx

Latissimus Flap

A
  • INDICATION: decd viable skin to create breast
  • PROCEDURE:
    • ​transfer of overlying fat, skin, part of Lat mm to ipsilat wall
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20
Q

Breast Cx

Reconstructive Sx

Pedicle TRAM

A
  • 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
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21
Q

Breast Cx

Reconstructive Sx

Free/Muscle Sparing TRAM

A
  • 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
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22
Q

Breast Cx

Reconstructive Sx

DIEP TRAM

*NEW STANDARD*

A
  • 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
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23
Q

Breast Cx

Reconstructive Sx

Rehab Implications

A
  • Activity restrictions/guidelines
  • Progressive ROM/strengthening
  • Postural re-ed
    • core stab, scapular stab, bra fitting
  • Manual therapy—-scars
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24
Q

Breast Cx as a Metastatic Dis

COMMON SITES?

A
  • REGIONAL:
    • ​Axillary lymph nodes
  • DISTANT:
    • ​Bone
    • Brain
    • Lung
    • Pleura
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25
Q

Breast Cx as Metastatic Dis.

Crucial to know!!!

How long Mets can dev….

A

Metastases may develop 10+ yrs AFTER primary Tx !!!

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26
Q

Breast Cx as Metastatic Dis

PT implications?

A
  • WB status—IF mets to bone
  • pulm status
  • cognition
  • safety awareness
  • reg. testing strength
  • sensation
  • chemo/radiation SEs
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27
Q

Prostate Cx

Typ affects ______, _______

A

TYP affects MEN >50 yrs old

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28
Q

Prostate Cx

5yr survival

A

98.2%

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29
Q

Prostate Cx

S/S

A
  • Weak or interrupted urinary flow
  • INCd urinary urge/freq
  • Pain/burn w/ urination
  • Blood in urine or semen
  • Incomplete emptying
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30
Q

Prostate Cx

Dx

A
  • Rectal exam
  • PSA—-Prostate Specific Antigen blood test
  • Transrectal US
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31
Q

Prostate Cx

How is it Staged ?

A

I-IV

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32
Q

Prostate Cx Tx

In general…

A

Active surveillance until s/s appear OR (+) tests

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33
Q

Prostate Cx Tx

Options?

A
  • Sx
  • Radiation
  • Radiopharma. Tx (Bone mets)
  • Chemo
  • Hormone tx
  • Biologic tx
  • Biphosphonate therapy (Bone mets)
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34
Q

Prostate Cx Tx

Sx: 3 options

A
  • Radical prostatectomy
    • removal
    • Retropubic or Perineal
  • TURP (Transurethral Resection of Prostate)
  • Pelvic Lymph Node resection
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35
Q

Testicular Cx

5 yr survival

A

95.3%

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36
Q

Testicular Cx

Typ affects _____, ______

A

MEN; 20-35

YOUNG MEN

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37
Q

Testicular Cx

S/S

A
  • Painless lump or swelling in testicle
  • Dull ache in lower ab or groin
  • Fluid in scrotum
  • Pain or discomfort in testicle or scrotum
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38
Q

Testicular Cx

Dx

A
  • Self-exam
  • US
  • Serum Tumor Markers
    • ​AFP
    • B-hCG
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39
Q

Testicular Cx

How is it Staged ?

A

Stage 0-III

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40
Q

Testicular Cx Tx

Options?

A
  • Sx
  • radiation
  • chemo
  • surveillance for reoccurrence
  • Chemo in HIGH DOSES followed by Stem Cell Transplant****** COMMON
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41
Q

Testicular Cx Tx

Surgery: 2

A
  • Inguinal orchiectomy
    • remove testicle
  • Retroperitoneal lymph node dissection
    • exacly what it sounds like
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42
Q

Lung Cx

ORIGIN:

A

LUNG TISSUE

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43
Q

LEADING CAUSE OF Cx DEATH IN MEN AND WOMEN****

A

LUNG Cx

25.3% ALL Cx deaths

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44
Q

Lung Cx

5yr survival and WHY?

A
  • 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
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45
Q

Lung Cx Risk Factors

A
  • tobacco
  • 2nd hand smoke
  • environment (asbestos***)
  • radiation
  • TB
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46
Q

Lung Cx

Clinical S/S

A
  • Persistent cough
  • SOB
  • Wheezing
  • Chest pain
  • Hemoptysis (coughing up blood)
  • Blood in sputum
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47
Q

Types of Lung Cx

2:

A
  1. NON-Small Cell Lung Cx–NSCLC
  2. Small Cell Lung Cx–SCLC
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48
Q

NON-Small Cell Lung Cx

NSCLC

3 types:

A
  1. Squamous Cell Carcinoma
  2. AdeNOcarcinoma
  3. Large cell
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49
Q

NON-Small Cell Lung Cx (NSCLC)

Explain

A
  • LESS aggressive
  • Peripheral location
  • Sx BEST tx option
50
Q

Small Cell Lung Cx

SCLC

Explain

A
  • 10% all lung tumors
  • STRONGEST ASSOC. W/ SMOKING
  • Central location
  • AGGRESSIVE
  • HIGHLY Sn to chemo and RT
51
Q

Types of Lung Cx

A

EXAMPLES

52
Q

Metastatic Lung Cx

Local vs. Distant

A
  • LOCAL:
    • ​Liver + adrenal glands
  • DISTANT:
    • ​Brain
    • Bone
    • Contralat lung —thru circulation
53
Q

Metastatic Lung Cx

PT implications???

A
  • WB status
  • pulm status
  • cognition
  • safety
  • reg. test strength
  • chemo/radiation SEs
54
Q

Lung Cx

Dx

A
  • Imaging
    • mostly endoscopic
  • Sputum cytology, labs, needly biopsy (only definitive)
  • Bronchoscopy
  • Thoracoscopy
  • Thoracentesis
55
Q

Lung Cx

Tx Options:

A
  • Sx
    • Thoracotomy
  • radiation
  • chemo
  • Biologic therapies
56
Q

Lung Cx Tx

Thoracotomy approach

A

see pics

57
Q

Lung Cx Sx Types

A

see pics

58
Q

Leukemia

What is it ?

A

Body makes abnormal WBCs which DO NOT DIE when they SHOULD and do NOT function to fight infection

*serve no purpose

59
Q

Leukemia 5yr survival

A

61.4%

60
Q

Leukemia typ age

A

60-70yo

61
Q

Leukemia

Types: 5

A
  1. Acute Lymphoblastic Leukemia
    1. TOO MANY lymphocytes
  2. Acute Myeloid Leukemia
    1. myeloid stem cells do not fully mature
  3. Undifferentiated and Biphenotypic Acute Leukemia; Mixed Phenotypic Acute Leukemias (MPALs)
  4. Chronic Lymphocytic Leukemia
  5. Chronic Myelogenous Leukemia
62
Q

Leukemia

How is it Staged ?

A

NO STANDARD STAGING

  • Untreated
  • Remission (DECd or disappearance S/S)
  • Recurrent
63
Q

Leukemia

Dx

A
  • CBC
  • Bone marrow aspiration and Biopsy***
    • ​ONLY DEFINITIVE WAY
64
Q

Leukemia

S/S

A
  • 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*
65
Q

Leukemia

Tx

A
  • Chemo
  • Radiation
  • Chemo (high dose) w/ Stem Cell Transplant
  • Targeted Therapy
66
Q

Multiple Myeloma is a Cx of the

A

BONE MARROW

67
Q

Multiple Myeloma (MM)

5 yr survival

A

50.7%

68
Q

Multiple Myeloma

What is it?

A

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
69
Q

Multiple Myeloma

S/S

A
  • Bone pain
    • ESP back + ribs
  • bones that break easily
  • Fever
  • easy bruising or bleeding
  • Weakness of arms or legs
  • Fatigue
  • Diff breathing
70
Q

Multiple Myeloma

Dx

A
  • Blood tests
  • Bone marrow aspiration and biopsy—-ONLY DEFINITIVE
  • Skeletal bone survey
71
Q

Multiple Myeloma

How is it Staged?

A
  • Stage I-III
72
Q

Multiple Myeloma

Tx Options

A
  • Chemo
  • Targeted therapy
  • High dose chemo w/ Stem Cell Transplant
    • ​often TOGETHER***
  • Biologic tx
  • radiation
  • sx
  • Watchful Waiting**
    • ​UNTIL S/S appear OR change
73
Q

Mulitple Myeloma

Appearance and WHERE?

A

“Moth-Eaten” appearance

*Disease IN bone marrow

74
Q

Primary Brain Tumors

ORIGIN:

A

IN Brain tissue

75
Q

HALLMARK CLINICAL SIGN OF PRIMARY BRAIN TUMORS

A

HA that is WORSE IN AM

76
Q

PRIMARY BRAIN TUMORS

Clinical Signs

A
  • 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
77
Q

Primary Brain Tumor

Grade I-II

Growth Rate and Classification

A

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

78
Q

Primary Brain Tumor Types

Grade III

Growth rate and Classification

A
  • Growth Rate==FAST
  • Classification==Anaplastic Astrocytoma
79
Q

Primary Brain Tumor Types

Grade IV

Growth Rate and Classification:

A
  • Growth Rate==VERY FAST
    • ​quick s/s
  • Classification== Glioblastoma Multiform (GBM)
80
Q

Brain tumors

Dx

A
  • Imaging
    • Preferably MRI*****
  • Angiography
  • BIOPSY—–ONLY DEFINITIVE WAY
    • ​Craniotomy
    • Stereotactic needle biopsy
81
Q

Brain Tumor

Tx Options

A
  • Sx
    • stereotactic sx
    • craniotomy
  • Radiation
    • ​EXT beam
    • Whole brain—brain mets
  • chemo
  • meds
82
Q

Brain tumor sx

Stereotactic sx

A

Needle guided by MRI

83
Q

Brain tumor Sx

Craniotomy

A
  • Resection of skull, remove tumor, replace bone flap
84
Q

Brain tumor

Sx

Shunt Placement

A
  • Bypass CSF blockage
85
Q

Primary Brain Tumors

PT Considerations

A
  • 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​
86
Q

Primary Brain Tumors

PT Considerations

RED FLAGS

A
  • INCd ICP
    • —> elevation in BP, nausea, vomiting, HA
87
Q

Primary BONE Tumor

3 Types:

A
  • Osteosarcoma (bone)
  • Chondrosarcoma (joint)
  • Multiple Myeloma
    • Blood-borne tumor
    • Bone marrow
88
Q

Primary BONE Tumor

Prognosis

A
  • Stage/type lesion
  • Pt age—-MORE COMMON Ado’s 13-25 (better prognosis here)
  • Tx options
89
Q

Orthopedics Cx

Dx

A
  • Imaging
  • BIOPSY—ONLY DEFINITIVE WAY
  • BLOOD TEST (Primary bone tumor)
    • ​What you’ll see:
      • ​INCd alkaline phosphates
      • INCd calcium
90
Q

Orthopedics Cx

Tx Options

A
  • **Excision
  • Sx
  • chemo
  • radiation
  • PROTECTED WB
  • pain mgmt
  • *Bisphosphonates**
91
Q

Ortho Cx’s

Jt Resection and Replacement

A

*remember this may NOT look like your avg joint replacement***

  • Resection w/ prosthetic stabilization
  • Partial OR Total jt replace.
92
Q

Ortho Cx’s Tx

Sacrectomy

A

*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!!!

93
Q

INTERNAL VS. EXTERNAL HEMI-PELVECTOMY

INTERNAL

A
  • INTERNAL ​
    • Limb salvage for LOWER portion of leg
    • resection of portion of hemipelvis and prox femur w/ reconstruction

​

94
Q

INTERNAL VS. EXTERNAL HEMI-PELVECTOMY

EXTERNAL

A
  • AMPUTATION of entire LE AND hemipelvis w/ disarticulation of SI jt AND pubic symphysis
  • MORE FUNCTIONAL***
95
Q

Tikhoff-Lindberg Resection

First of all…it includes WHAT ?

A

PROX HUMERUS

SCAPULA

CLAVICLE

96
Q

Tikhoff-Lindberg Resection

What is it?

A
  • Resection of distal clavicle, prox humerus, scapula, mm transfer, AND skeletal reconstruction
  • Preservation of neurovascular pedicle of arm
97
Q

Tikhoff-Lindberg Resection

A

Elbow + Hand are functional here

98
Q

Forequarter Amputation

*Postural re-ed and BALANCE!!!

A

Excision of ENTIRE UE, clavicle, scapula

99
Q

Van Ness Rotationplasty

A
  • 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
100
Q

Ortho-Rehab Implications

A
  • PAIN control
  • WB status/Activity restrictions
  • Progressive ROM and strength
  • Functional training
  • Gait training
  • Neuro-muscular re-ed
  • ADLs ​
101
Q

Colorectal Cx

5 yr survival

A

64.5%

102
Q

Colorectal Cx

Risk Factors

A
  • hx of colon polyps
  • hx of chronic ulcerative colitis
  • 3+ alcoholic drinks/day
  • smoking
  • Obesity***
103
Q

Colorectal Cx

S/S

A
  • Blood in stool
  • change in bowel habits
  • narrow stools
  • vomiting
  • bloating**
  • fatigue
  • wt. loss (UNEXPLAINED)
104
Q

COLORECTAL Cx

Dx

A
  • rectal exam
  • colonoscopy
  • fecal occult blood test
  • Lower GI series
  • sigmoidoscopy
105
Q

Colorectal Cx

How is it Staged?

A
  • Stage I-IV
106
Q

Colorectal Cx Tx Options

A
  • Sx
  • CryoSx
  • Radiofreq Ablation
  • Systemic Colorectal Cx Tx
    • ​chemo
    • radiation
    • targeted therapy
107
Q

Colorectal Cx Tx

Sx: resection w/ anastomosis vs. resection w/ colostomy

A
  • Resection w/ anastomosis
    • ​portion of colon
  • Resection w/ colostomy
    • ​whole colon OR term-end colon
108
Q

Colorectal cx

Cryosurgery

A

Freeze and destroy abnorm tissue

109
Q

Colorectal Cx Sx

Radiofreq Ablation

A

Probe w/ electrode to kill cx cells

110
Q

Pancreatic Cx

5 yr survival

A

8.5%

LOW

111
Q

Pancreatic Cx

Risk factors

A

Obesity

smoking

DM

Chronic pancreatitis

112
Q

Pancreatic Cx

S/S

A

jaundice**

pain

wt. loss (unexplained)

fatigue

loss of appetite

113
Q

Pancreatic Cx

Difficult Detection….WHY???

A
  • GEN s/s
  • pancreas hidden behind other organs
114
Q

LOW survival rate of Pancreatic Cx …..WHY?

A
  • Dx’s include
    • ​ERCP (endoscopic retrograde cholangiopancreatography)
    • PTC (percutaneous transhepatic cholangiography)
  • Dx’d IN LATE STAGE====LOW SURVIVAL RATE***
115
Q

PANCREATIC Cx

How is it Staged?

A

Stage I-IV

116
Q

Pancreatic Cx

Tx Options:

A
  • Sx
  • Radiation
  • Chemo
  • Targeted therapy
117
Q

Pancreatic Cx Tx

Sx: 3 types

A
  1. Whipple Procedure
  2. Total pancreatectomy
  3. Distal Pancreatectomy
118
Q

Pancreatic Cx Tx

Sx

Whipple Procedure

A
  • 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***
119
Q

PANCREATIC Cx Tx

Sx

TOTAL Pancreatectomy

A
  • Removal of the WHOLE PANCREAS, part of stomach, part of sm intestine, common bile duct, gallbladder, spleen, nearby lymph nodes****
120
Q

Pancreatic Cx Tx

Sx

DISTAL Pancreatectomy

A
  • Removal of the BODY and TAIL of the pancreas
  • Spleen may also be removed if cx has spread to spleen***

Medcon Rehab III (6 decks)

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