osteopathy in oncology lec

Question 1

adult primary cancers that lead to bone metastasis

Answer 1

breast
prostate
lung
kidney
thyroid

BLT with Kosher Pickle

Question 2

what adult cancers metastasize to spinal cord

Answer 2

lung breast colon sarcoma

Question 3

what adult cancers aris in marrow

Answer 3

multiple myeloma
lymphoma
leukemia

Question 4

what are the matrix fibrous tumors of adulthood

Answer 4

osteosarcoma
chondrosarcoma
ewing sarcoma

Question 5

where do majority osteosarcomas arise

Answer 5

metaphysis around the knee either at distal femur or proximal tibia

Question 6

where do most chondrosarcomas start

Answer 6

trunk, limb girdles and proximal long bones

Question 7

where do ewings sarcomas arise

Answer 7

diaphysis of bone

Question 8

what cancer looks like Rheumatoid arthritis

Answer 8

hypertrophis osteoarthropathy from bronchogenic carcinoma

Question 9

dermatomyositis and polymyositis are associated with what CA

Answer 9

lung and gastric

Question 10

skin manifestations of dermatomyositis and polymyositis and Dx?

Answer 10

purplish erythema

Dx with muscle Bx, increased ESR and muscle enzymes

Question 11

acanthosis nigricans is what and associated with what CA

Answer 11

hyperpigmented hyperkeratotic skin lesion in flexor areas of axilla, neck of anogenital areas
assoc with gastric or abdominal CA

Question 12

most common pediatric cancers

Answer 12

leukemias (ALL)
CNS tumors
lymphomas
soft tissue sarcoma
germ cell
bone tumor
neuroblastoma
renal tumor
thyroid, melanoma and other

Question 13

how does leukemia present

Answer 13

bone pain from marrow hyperplasia

fatigue, pallor, eccymoses, infection, fever, anorexia and weight loss

Question 14

cNS tumor presentation

Answer 14

HA, ataxia and gait abnormalities, seizures or cranial nerve palsies
sudden onset back pain that worsens when supine

Question 15

most common extracranial solid tumor in childhood

Answer 15

neuroblastoma

Question 16

worry about metastasis where in neuroblastoma

Answer 16

skull

Question 17

what are the most common malignant MSK tumors in childhood

Answer 17

osteosarcoma - knee pain
ewings sarcoma - diaphysis of bone
rhabdomyosarcoma

Question 18

most common Sx of osteosarcoma, ewings and rhabdomyosarcoma

Answer 18

pain

Question 19

which pediatric cancers metastasize to bone

Answer 19

neuroblastoma - skull
wilms
osteosarcoma
ewing sarcoma
rhabdomyosarcoma

Question 20

which ped CA cause bone or muscle pain

Answer 20

leukemia, bone tumore, neuroblastomas

Question 21

CA patient with back pain, what to look for?

Answer 21

metastasis!!

Question 22

hallmark of bone metastasis

Answer 22

localized constant bone pain

or resting pain and pain at night

Question 23

common sites bone metastasis

Answer 23

vertebral column (thorax), skull, humerus, ribs, pelvis, femur

has good blood supply

Question 24

red flags for bone pain

Answer 24

unexplained MSK pain
pain in spine or proximal extremities (hips, thighs, shoulders)
night or rest pain

Question 25

pain referral patterns:

• posterior HA?
• interscapular pain?
• flank?
• saddle distribution?

Answer 25

posterior HA- high cervical spine mets
interscapular pain- C7-T1
flank, iliac crest SI joint- T12-L1
saddle distribution- sacral destruction

Question 26

PE if suspect metastasis

Answer 26

differentiat bone and joint pain
if passive motion of adjacent joint isnt painful then more alert to CA
specific exam of common neoplastic primary sites :breast, lung, prostate etc..

Question 27

most specific imaging for metastasis

Answer 27

plain film radiography

to see met on xray - 40-50% of bone

follow up with bone scan - can see much smaller mets

Question 28

which CA have lytic lesions

Answer 28

lung thyroid and kidney

Question 29

which CA has blastic lesions

Answer 29

prostate

Question 30

which CA have mixed lesions

Answer 30

breast, cervical, testicular and ovarian

Question 31

why do long bones facilitate tumor growth

Answer 31

rich capillary network and slow blood flow

Question 32

Dx labs for metastatic disease

Answer 32

-immunoelectrophoresis for multiple myeloma
-PSA for prostate CA
-CBC anemia and thrombocytopenia
-ALP (alk phos) bone turnover
-serum creatinine
calcium

Question 33

hypercalcemia from bone metastasis is worrisome why

Answer 33

can lead to cardiac arrythmia and sudden death

Question 34

why do you biopsy tumors

Answer 34

confirm or restage

obtain tissue for hormonal and immunohistochem

Question 35

is biopsy helpful in determinieng unknown primary tumor?

Answer 35

no

Hx, PE and imaging are key

Question 36

Tx bone CA

Answer 36

pain management
assessment for fracture
chemo, radiation, radionucleotides, hormone Tx, bisphosphonate therapy
surgery
emotional/spiritual support
nutritional
OMT

Question 37

bone pain thought to result from what

Answer 37

stimulation of endosteal nerve endings, microfactures or periosteal stretching from tumor growth

Question 38

Why OMT helpful in CA patient

Answer 38

empowering
comfort of touch
emotional support
pain reduction
optimization of function especially visceral

Question 39

Indications for OMT in CA

Answer 39

SD
pain including post surgery
prevention or Tx of immobility related complications in bed-ridden patient
Tx of extremity lymphedema

Question 40

contraindications OMT in CA patient

Answer 40

Tx in immediate vicinity of CA causing spread
HVLA- weakend bones
lymph pumps? (passive techniques are okay

Question 41

OMT before/after chemo

Answer 41

before - don’t want to spread cancer cells?

after - want to spread chemo drugs?

Question 42

child with MSK complaints

Answer 42

will treat quickly

-if doesn’t get better or it gets worse - red flag goes up

Question 43

wilms tumor

Answer 43

kidney cancer in kids