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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
Breast Cx as **Metastatic Dis.** ## Footnote **Crucial to know!!!** **How long Mets can dev....**
Metastases may develop **10+ yrs AFTER primary Tx !!!**
26
Breast Cx as **Metastatic Dis** ## Footnote **PT implications?**
* WB status---**IF mets to bone** * pulm status * cognition * safety awareness * **reg. testing strength** * sensation * chemo/radiation SEs
27
Prostate Cx ## Footnote **Typ affects \_\_\_\_\_\_, \_\_\_\_\_\_\_**
TYP affects MEN \>50 yrs old
28
Prostate Cx 5yr survival
98.2%
29
Prostate Cx **S/S**
* Weak or interrupted **urinary flow** * INCd **urinary urge/freq** * Pain/burn w/ **urination** * Blood in **urine or semen** * Incomplete emptying
30
Prostate Cx **Dx**
* Rectal exam * **PSA----Prostate Specific Antigen blood test** * Transrectal US
31
Prostate Cx **How is it _Staged ?_**
I-IV
32
Prostate Cx Tx In general...
Active surveillance until s/s **appear OR (+) tests**
33
Prostate Cx Tx **Options?**
* Sx * Radiation * **Radiopharma. Tx (Bone mets)** * Chemo * Hormone tx * Biologic tx * **Biphosphonate therapy (Bone mets)**
34
Prostate Cx Tx ## Footnote **Sx: 3 options**
* Radical prostatectomy * removal * **Retropubic or Perineal** * **TURP (**Transurethral Resection of Prostate) * _Pelvic_ Lymph Node resection
35
Testicular Cx **5 yr survival**
95.3%
36
Testicular Cx Typ affects \_\_\_\_\_, \_\_\_\_\_\_
MEN; 20-35 YOUNG MEN
37
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
38
Testicular Cx ## Footnote **Dx**
* Self-exam * US * **Serum Tumor Markers** * **​AFP** * **B-hCG**
39
Testicular Cx ## Footnote **How is it _Staged ?_**
Stage 0-III
40
Testicular Cx Tx ## Footnote **Options?**
* Sx * radiation * chemo * **surveillance for reoccurrence** * **Chemo in HIGH DOSES _followed by_ Stem Cell Transplant\*\*\*\*\*\* COMMON**
41
Testicular Cx Tx ## Footnote **Surgery: 2**
* Inguinal orchiectomy * **remove testicle** * Retroperitoneal lymph node dissection * **exacly what it sounds like**
42
Lung Cx ## Footnote **ORIGIN:**
LUNG TISSUE
43
LEADING CAUSE OF Cx DEATH IN **MEN AND WOMEN\*\*\*\***
LUNG Cx 25.3% ALL Cx deaths
44
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**
45
Lung Cx **Risk Factors**
* tobacco * 2nd hand smoke * environment (asbestos\*\*\*) * radiation * TB
46
Lung Cx **Clinical S/S**
* Persistent cough * SOB * Wheezing * Chest pain * Hemoptysis (coughing up blood) * Blood in sputum
47
Types of Lung Cx ## Footnote **2:**
1. NON-Small Cell Lung Cx--**NSCLC** 2. Small Cell Lung Cx--**SCLC**
48
NON-Small Cell Lung Cx NSCLC **3 types:**
1. Squamous Cell Carcinoma 2. AdeNOcarcinoma 3. Large cell
49
NON-Small Cell Lung Cx (NSCLC) ## Footnote **Explain**
* LESS aggressive * **Peripheral** location * **Sx BEST tx option**
50
Small Cell Lung Cx SCLC **Explain**
* 10% all lung tumors * **STRONGEST ASSOC. W/ SMOKING** * **Central** location * AGGRESSIVE * **HIGHLY Sn to chemo and RT**
51
Types of Lung Cx
EXAMPLES
52
Metastatic Lung Cx ## Footnote **Local vs. Distant**
* **LOCAL:** * **​**Liver + adrenal glands * **DISTANT:** * **​**Brain * Bone * Contralat lung ---**thru circulation**
53
Metastatic Lung Cx ## Footnote **PT implications???**
* WB status * pulm status * cognition * safety * reg. test strength * chemo/radiation SEs
54
Lung Cx ## Footnote **Dx**
* Imaging * **mostly endoscopic** * Sputum cytology, labs, **needly biopsy (only definitive)** * Bronchoscopy * Thoracoscopy * Thoracentesis
55
Lung Cx ## Footnote **Tx Options:**
* Sx * **Thoracotomy** * **radiation** * **chemo** * **Biologic therapies**
56
Lung Cx Tx ## Footnote **Thoracotomy approach**
see pics
57
Lung Cx Sx **Types**
see pics
58
Leukemia **What is it ?**
Body makes **abnormal WBCs which DO NOT DIE when they SHOULD and do NOT function to fight infection** ## Footnote **\*serve no purpose**
59
Leukemia 5yr survival
61.4%
60
Leukemia typ age
60-70yo
61
Leukemia ## Footnote **Types: 5**
1. Acute Lympho**blastic** 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
Leukemia ## Footnote **How is it _Staged ?_**
NO STANDARD STAGING * **Untreated** * **Remission (DECd or disappearance S/S)** * **Recurrent**
63
Leukemia **Dx**
* CBC * **Bone marrow aspiration and Biopsy\*\*\*** * **​ONLY DEFINITIVE WAY**
64
Leukemia ## Footnote **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\***
65
Leukemia ## Footnote **Tx**
* Chemo * Radiation * **Chemo (high dose) w/ Stem Cell Transplant** * Targeted Therapy
66
Multiple Myeloma **is a Cx of the**
BONE MARROW
67
Multiple Myeloma (MM) 5 yr survival
50.7%
68
Multiple Myeloma ## Footnote **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**
69
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
70
Multiple Myeloma ## Footnote **Dx**
* Blood tests * **Bone marrow aspiration and biopsy----ONLY DEFINITIVE** * Skeletal bone survey
71
Multiple Myeloma ## Footnote **How is it _Staged?_**
* Stage I-III
72
Multiple Myeloma ## Footnote **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**
73
Mulitple Myeloma ## Footnote **Appearance and WHERE?**
"**Moth-Eaten" appearance** **\*Disease IN bone marrow**
74
Primary Brain Tumors ## Footnote **ORIGIN:**
IN Brain tissue
75
**_HALLMARK_** CLINICAL SIGN OF **PRIMARY BRAIN TUMORS**
HA that is **WORSE IN AM**
76
PRIMARY BRAIN TUMORS ## Footnote **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
77
Primary Brain Tumor ## Footnote **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
78
Primary Brain Tumor Types ## Footnote **Grade III** **Growth rate and Classification**
* Growth Rate==**FAST** * Classification==**Anaplastic Astrocytoma**
79
Primary Brain Tumor Types ## Footnote **Grade IV** **Growth Rate and Classification:**
* Growth Rate==**VERY FAST** * **​quick s/s** * Classification== **Glioblastoma Multiform (GBM)**
80
Brain tumors ## Footnote **Dx**
* Imaging * **Preferably MRI\*\*\*\*\*** * Angiography * **BIOPSY-----ONLY DEFINITIVE WAY** * ​Craniotomy * Stereotactic needle biopsy
81
Brain Tumor ## Footnote **Tx Options**
* Sx * **stereotactic sx** * **craniotomy** * Radiation * **​EXT beam** * **Whole brain---brain mets** * chemo * meds
82
Brain tumor sx **Stereotactic sx**
Needle guided by MRI
83
Brain tumor Sx ## Footnote **Craniotomy**
* Resection of skull, **remove tumor,** replace bone flap
84
Brain tumor Sx **Shunt Placement**
* Bypass CSF blockage
85
Primary Brain Tumors ## Footnote **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****​**
86
Primary Brain Tumors ## Footnote **PT Considerations** **RED FLAGS**
* INCd ICP * **---\> elevation in BP, nausea, vomiting, HA**
87
Primary BONE Tumor ## Footnote **3 Types:**
* Osteosarcoma (bone) * Chondrosarcoma (joint) * Multiple Myeloma * **Blood-borne tumor** * **Bone marrow**
88
Primary BONE Tumor ## Footnote **Prognosis**
* Stage/type lesion * Pt age----**MORE COMMON Ado's 13-25 (better prognosis here)** * **Tx options**
89
Orthopedics Cx ## Footnote **Dx**
* Imaging * **BIOPSY---ONLY DEFINITIVE WAY** * BLOOD TEST (**Primary bone tumor)** * **​What you'll see:** * **​**INCd **alkaline phosphates** * INCd **calcium**
90
Orthopedics Cx **Tx Options**
* \*\***Excision** * **Sx** * **chemo** * **radiation** * **PROTECTED WB** * **pain mgmt** * **\*Bisphosphonates\*\***
91
Ortho Cx's ## Footnote **Jt Resection and Replacement**
\*remember this may NOT look like your **avg joint replacement\*\*\*** * Resection w/ **prosthetic stabilization** * Partial OR Total **jt replace.**
92
Ortho Cx's Tx ## Footnote **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!!!**
93
INTERNAL VS. EXTERNAL HEMI-PELVECTOMY ## Footnote **INTERNAL**
* INTERNAL **​** * **Limb salvage for LOWER portion of leg** * **resection of portion of hemipelvis and prox femur w/ reconstruction** **​**
94
INTERNAL VS. EXTERNAL HEMI-PELVECTOMY ## Footnote **EXTERNAL**
* AMPUTATION of **entire LE AND hemipelvis w/ _disarticulation_ of SI jt AND pubic symphysis** * **MORE FUNCTIONAL\*\*\***
95
Tikhoff-Lindberg Resection ## Footnote **First of all...it includes WHAT ?**
PROX HUMERUS SCAPULA CLAVICLE
96
Tikhoff-Lindberg Resection ## Footnote **What is it?**
* **Resection** of **distal clavicle, prox humerus, scapula, mm transfer, AND skeletal reconstruction** * Preservation of neurovascular pedicle of arm
97
Tikhoff-Lindberg Resection
Elbow + Hand are functional here
98
Forequarter Amputation ## Footnote **\*Postural re-ed and BALANCE!!!**
**Excision of ENTIRE UE, clavicle, scapula**
99
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**
100
Ortho-**Rehab Implications**
* PAIN control * WB status/Activity restrictions * Progressive ROM and strength * **Functional training** * **Gait training** * **Neuro-muscular re-ed** * **ADLs** **​**
101
Colorectal Cx 5 yr survival
64.5%
102
Colorectal Cx ## Footnote **Risk Factors**
* hx of **colon polyps** * hx of **chronic ulcerative colitis** * **3+ alcoholic drinks/day** * **smoking** * **Obesity\*\*\***
103
Colorectal Cx **S/S**
* Blood in **stool** * change in **bowel habits** * narrow **stools** * vomiting * bloating\*\* * fatigue * wt. loss (UNEXPLAINED)
104
COLORECTAL Cx ## Footnote **Dx**
* rectal exam * colonoscopy * fecal occult blood test * Lower GI series * sigmoidoscopy
105
Colorectal Cx ## Footnote **How is it _Staged?_**
* Stage I-IV
106
Colorectal Cx **Tx Options**
* Sx * CryoSx * Radiofreq Ablation * **Systemic Colorectal Cx Tx** * **​**chemo * radiation * targeted therapy
107
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
108
Colorectal cx ## Footnote **Cryosurgery**
Freeze and destroy abnorm tissue
109
Colorectal Cx Sx ## Footnote **Radiofreq Ablation**
Probe w/ **electrode** to kill cx cells
110
Pancreatic Cx 5 yr survival
8.5% LOW
111
Pancreatic Cx ## Footnote **Risk factors**
Obesity smoking DM **Chronic pancreatitis**
112
Pancreatic Cx **S/S**
**jaundice\*\*** pain wt. loss (unexplained) fatigue loss of appetite
113
Pancreatic Cx ## Footnote **Difficult Detection....WHY???**
* GEN s/s * **pancreas hidden behind other organs**
114
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\*\*\***
115
PANCREATIC Cx ## Footnote **How is it _Staged?_**
Stage I-IV
116
Pancreatic Cx ## Footnote **Tx Options:**
* Sx * Radiation * Chemo * Targeted therapy
117
Pancreatic Cx **Tx** **Sx: 3 types**
1. **Whipple Procedure** 2. **Total pancreatectomy** 3. **_Distal_ Pancreatectomy**
118
Pancreatic Cx Tx ## Footnote **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_\*\*\***
119
PANCREATIC Cx Tx ## Footnote **Sx** **TOTAL Pancreatectomy**
* Removal of the **WHOLE PANCREAS, part of stomach, part of sm intestine, _common bile duct,_** **gallbladder, spleen, nearby _lymph nodes_\*\*\*\***
120
Pancreatic Cx **Tx** ## Footnote **Sx** **DISTAL Pancreatectomy**
* 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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