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OMM M1T3E5 > Osteopathic approach to the patient with cancer > Flashcards

Osteopathic approach to the patient with cancer Flashcards

1
Q

What are the common neuromusculoskeletal manifestations of cancer?

A
  • Musculoskeletal - back pain, joints, muscle, skin
  • CNS - direct cerebral malignancy, indirect paraneoplastic
  • Lymphatic system - lymphedema
  • Peripheral nervous system - peripheral manifestations
  • spinal cord compression
  • Viscerosomatic-type response - TNF - enchanced cytolysis (tissue destruction), infection, tumor vascular damage, inflammatory responses (fever induction)
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2
Q

How would you appropriately present a cancer diagnosis to a patient?

A
  • Ethical - tell the truth, offer optimism and reassurance
  • Cure vs. Control of Disease
  • Give opportunity to think and ask questions
  • Treat the patient
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3
Q

When is OMT contraindicated in a cancer patient?

A
  • area immediately surrounding cancer
  • HVLA&raquo_space; pathologic fracture of bone weakened by primary/metastic tumor
  • lymphatic pumps/effleurage due to lymphogenous spread
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4
Q

When are OMT treatments indicated for use in a cancer patient?

A
  • pain, somatic dysfunctions secondary to surgery, viscerosomatic reflexes
  • prevent/treat complications d/t immobility
  • atelectasis&raquo_space; pneumonia or constipation
  • lympedema
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5
Q

What is the second leading cause of death in the US?

A

cancer

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6
Q

What are the traditional allopathic approaches to cancer?

A
  • surgery
  • radiation therapy
  • chemotherapy
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7
Q

How does renal cell cancer present?

A
  • hematuria
  • flank pain
    -abdominal mass
    (2-3% of all cancers)
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8
Q

What are the systemic manifestations of renal cell cancer?

A
  • anemia or erythrocytosis
  • FUO (fever of unknown origin)
  • weight loss
  • hypercalcemia
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9
Q

What are signs of renal cell cancer NMS metastasis?

A
  • spine&raquo_space; back pain
  • soft tissue&raquo_space; mass
  • compression of spinal cord/nerve root&raquo_space; peripheral neuropathic sxs
  • direct metastasis&raquo_space; CNS s/s
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10
Q

How is Renal cell cancer diagnosed?

A
  • CT
  • MRI
  • IVP
  • U/S
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11
Q

What are the treatments for renal cell cancer?

A
  • surgery when localized

- radiation and chemotherapy - palliative

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12
Q

What is the most common cancer?

A

lung

- also most common cancer death

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13
Q

What percent of cancer deaths are tobacco products responsible for?

A
  • 30% cancer deaths

- 80-85% of lung and laryngeal cancers

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14
Q

What are 4 types of lung cancer?

A
  • small cell (oat cell) - aggressive
  • squamous cell (epidermoid)
  • adenocarcinoma
  • large cell
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15
Q

In bronchogenic carcinoma, pain may present in what areas?

A
  • neck
  • axilla
  • anterior lower ribs
  • scapular region
  • thoracic paraspinal muscle spasm
  • paresthesia in upper extremity
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16
Q

What are some paraneoplastic syndromes?

A
  • Cushing syndrome
  • SIADH
  • hpercalcemia (nonmetastic)
  • subacute cerebellar degeneration
  • demenia syndromes
  • peripheral neuropathies
  • polymiositis
  • dermatomyositis
17
Q

What symptoms would lead you to diagnose lung cancer?

A
  • altered CNS function
  • hypertropic pulmonary osteroarthropathy
  • endocrine syndromes
  • paraneoplastic syndromes
18
Q

Formal diagnosis requires tissue confirmation obtained via?

A
  • biopsy
  • surgical resection
  • sputum cytology
  • brochial washings
19
Q

What is the overall survival for lung cancer?

A

5 year survival is 30 - 80%

- small cell is negligible

20
Q

What is multiple myeloma?

A
  • neoplasm of B-lymphocytes of monoclonal origin
21
Q

What does multiple myeloma look like on xray?

A

diffuse osteoporosis pattern may be seen

- lytic “punched out” lesion is absent

22
Q

Where is the most frequent extramedullary sites for multiple myeloma?

A
  • nasal sinuses
  • nose
  • nasopharynx
  • tonsil
23
Q

What percentage of patients complain of bone pain in multiple myeloma?

A

2/3

24
Q

What is commonly seen in multiple myeloma?

A
  • pathologic fractures common
  • spinal cord and nerve root compression&raquo_space; radicular pain
  • hypercalcemia
  • GI symptoms - nausea/vomiting/C + polyuria&raquo_space;hypercalcemia
  • progressive confusion
  • drowsiness
  • hyperviscosity syndrome
25
Q

What is the treatment for hyperviscosity syndrome?

A

plasmapheresis and chemo (steroids and alkylating agents

-

26
Q

What treatments are used for the chronic phase of multiple myeloma?

A
  • steroids & alkylating agents
  • pathologic fractures pinned
  • activity & ambulation
  • fluid hydration
27
Q

What treatments are used for the acute phase of multiple myeloma?

A
  • packing marrow with plasma cells&raquo_space;>infection
28
Q

What are the terminal events of multiple myeloma?

A

infection and renal failure

29
Q

What are the two types of breast cancer?

A
  • ductal

- lobular

30
Q

What is lymphedema?

A

-protein rich interstitial fluid in the skin or subcutaneous tissue

31
Q

When can lymphedema occur in breast cancer patients?

A
  • after removal of lymph noes

- mastectomies

32
Q

What OMT could be considered for lymphedema?

A
  • soft tissue techniques to regions proximal to side of edema
  • effleurage to extremity
  • thoracic inlet/outlet
  • scalene spasm&raquo_space; cervical SD (C3-4)
  • 1st rib (usually elevated)
33
Q

What types of supportive care can be given to cancer patients?

A
  • medical management of pain control
  • nutrition
  • infection control and treatment
  • psych and emotional support
  • OMT
34
Q

What end-of-life care can be given to a cancer patient?

A
  • Total pain (physical)
  • acute pain
  • chronic pain
  • somatic pain
  • visceral pain
  • neuropathic pain
  • Total pain (anxiety)
35
Q

Describe the type of OMT available for treatment of the cancer patient?

A
  • Indirect (myofascial release, counterstrain) for acute/severe illness or advancing age
  • Direct - rule out metastasis; stable patient
  • Rib-raising/thoracolumbar soft tissue to prevent/treat atelectasis or constipation
  • lymphedema: treat fascial diaphragms then lympatic pumps; Rule out Metastasis
36
Q

What are the common metastatic sites for breast, prostate, lung, kidney and thyroid?

A

vertebrae

37
Q

What are the common metastatic sites for lung, breast, colon and sarcoma?

A

spinal cord

38
Q

Malignancies involving bone, soft tissue structures, CNS, or peripheral nervous system include:

A
  • renal cell cancer
  • lung cancer
  • multiple myeloma
  • mastectomy sequella (lymphedema)

OMM M1T3E5 (4 decks)

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