Treatments, Toxicities and CRF Flashcards
What are the primary treatments for cancer?
Surgery, radiation, chemotherapy and other(hormone and immuno)
What is the aim of surgery?
Remove the cancerous cells
What grade of tumors is surgery typically very successful at treating?
Lower grades
How does surgery benefit the patient?
Reduces bulk of disease and allows for chemo to be more effective
What type of emergency would result in surgery for a cancer patient?
Oncological emergencies
How does surgery improve the quality of life for cancer patients?
Relief of pain
Reconstruction promoting “normal” structure
Rehabilitation
Can surgery be done preventatively for cancer patients?
Yes, to remove organ or growth which could become malignant(based off of family hx, gene presence etc..)
How does radiotherapy work?
Charged particles or photons(x rays, gamma rays) are administered to the cancerous site to destroy the malignant cancer cells
What cells does radiation therapy target?
All! Will kill all cells
What types of radiation are there?
external beam and internal
What types of internal radiation are there?
systemic(oral), IMRT, 3D Conformal etc…
What stages of cancer is radiation most beneficial for?
3 or 4( but can be used for all)
What are chemotherapy drugs?
Anti-tumor drugs that target malignant tumor cells
What would be a research objective regarding chemotherapy?
To be able to target cancer cells to be destroyed while preserving healthy/normal cells
How do chemotherapy drugs work?
Alter the cell life cycle and stop growth
What categories of chemotherapy drugs are there?
Alkylating agents, antimetabolites, anti-tumor antibiotics(anthracyclines) and mitotic inhibitors(alkaloids)
What part of the cell cycle does an alkylating agent target?
All phases. Directly damages the DNA.
What part of the cell cycle does an antimetabolite target?
S phase specifically. Interferes w/ DNA and RNA by substituting themselves in its place
What part of the cell cycle does an Anthracycline target?
All phases. Interfere w/ enzymes involved in DNA replication
What part of the cell cycle does a Mitotic Inhibitor target?
Mitosis. Stop mitosis or inhibit enzymes needed for protein synthesis.
What structure do alkylating agents damage?
Bone marrow
What is a known side effect of an alkylating agent?
Peripheral neuropathy
What are examples of an alkylating agent?
cytoxan, temodar and platinum drugs
What is an example of an antimetabolite?
5-FU, Xeloda, Floxuridine and Gemzar
What is the main side effect of anthracyclines?
extremely cardiotoxic
What are examples of anthracyclines?
doxorubicin and daunorubicin
What is a known side effect of mitotic inhibitors?
Peripheral neuropathy
What are examples of mitotic inhibitors?
Taxol, Taxotere, Velban and Oncovin
Other treatments include
Immunotherapies, hormonal therapies, bone marrow and blood stem cell transplantation
How does immunotherapy work?
Activates own immune system to fight disease. MAB(monoclonal antibodies) block activation of known receptors to limit cell gene expansion and cell proliferation
Is hormonal therapy gender specific?
Yes, and based on the type of cancer which is induced by hormones
What is an example of male hormonal therapy and the coinciding cancer?
Androgren deprivation therapy for prostate cancer
What is an example of female hormonal therapy and the coinciding caner?
Estrogen blocking therapy for breast cancer
What is a possible side-effect with hormonal therapies?
Inducing physical changes associated with the hormone. Example: Females may have induced menses d/t estrogen blocking therapy
How is treatment determined?
TNM classification, Tumor grade, Pathologic classification and Personal factors(age, co-morbidities, tolerance of side effects and patient, family and physician opinion)
What age would likely be more tolerable to aggressive treatments?
Younger age groups
What is cardiotoxicity in terms of chemotherapy?
Direct damage to the heart
Cardiotoxicity may include inflammation of the sac surrounding the heart, what is this called?
Pericarditis
How may cardiotoxicity present its self in a measurable form?
EKG abnormalities
Inflammation of the vasculature could lead to…
Vascular dilation, increased capillary permeability and interstitial edema. Resulting in increased HR, decreased SV and therefore decreased CO.
Does cardiotoxicity effect blood perfusion at the tissue?
Yes, by reducing perfusion
What is a possible result of pulmonary toxicity from cancer treatments?
pulmonary fibrosis. The lobes of the lungs will not expand as freely, resulting in less oxygen availability for tissues.
Certain cancer treatments can alter muscle integrity. What system would this effect?
muscoskeletal
Loss of muscle force is a common side effect. Due to what?
Cancer cachexia(wasting)
When looking at the sarcomere, what is a possible side effect of cancer treatment?
disorganization of proteins in the myofibril
Protein synthesis is an essential part of repair. What is the effect of cancer treatment on protein synthesis?
Decreased protein synthesis
What is myelosuppresion?
Injury to the cells in the bone marrow, effecting the immune system
What is leukopenia? What system is this toxicity related to?
Leukopenia is a reduction in WBC count. This toxicity is related to immune system toxicity
What is anemia and what are the effects on nutrient delivery?
Reduced hemoglobin content in the blood results in decreased oxygen saturation and less availability for cellular uptake
What is lymphocytopenia?
Reduced WBC production in the lymph system resulting in compromised immune system
What is thrombocytopenia?
A reduced number of platelets in the blood resulting in impaired healing
Intestinal fibrosis is a possible toxicity to the GI system. Why is it toxic?
Tissue of the GI system is damaged and loses function. This results in reduced surface area for nutrient absorption and therefore less nutrients to the cells in need.
If a patient is suffering from increased intestinal motility, why is this an issue?
Increased intestinal motility likely results in diarrhea. Diarrhea results in dehydration and reduced nutrient uptake.
How would altered GI tissue effect absorption of nutrients?
Impeded or altered portions of the GI block absorption and therefore reduce the efficiency of the GI system to absorb nutrients and disperse them throughout the blood stream
Malfunction of the thyroid would be a toxicity to which system?
Neuroendrocrine
How may neuroendocrine toxicity effect growth hormone release?
Abnormalities in release of GH can result in growth problems
CNS issues as a result of treatment would effect what systems?
Neuroendocrine
Peripheral neuropathy is a side effect of certain chemotherapy drugs. What is it and what system is it effecting?
Peripheral neuropathy is numbing or weakness of the periphery(arms/hands and legs/feet). This is classified as neuroendocrine toxicity.
Decreased coordination falls under which toxicity classisfication?
Neuroendocrine
Hepatic toxicity can present itself in multiple ways. What are they? What is the result of these toxicities?
Hepatic fibrosis and cytotoxic lesions can reduce the liver’s function of cleaning waste products and storing glycogen.
Radiation and chemo can can dermatologic toxicity. What are they?
Alopecia or hair loss
Skin lesions
What major long term decrements are there for cancer treatment? What can attenuate these?
Reduced cardiac function(increased HR, decreased SV) pulmonary function(decreased O2), motor function(neuropathy) and muscular strength(cachexia). Exercise is proven to attenuate these decrements
Recent incisions and sutures would be a special consideration for which type of treatment?
Surgical
What can be surgically implanted for ease of access? What considerations are needed for this?
Port, need to watch ROM and pain w/ movement
Surgery can result in a change of body___? What results?
Image. Pt may no longer feel desirable.
Pts undergoing surgery may have extreme ____. They may also be holding water, what is this called?
Fatigue. Edema.
Radiation patients have special considerations in regard to their skin. Why?
Acute and chronic skin reactions to radiation. Need to be mindful of what are is touching for exercises as well as the clothing being worn.
Leukopenia is a special consideration for those undergoing radiation, what is it and why is it a consideration?
Reduced WBC=Reduced immune function
Dehydration is a special consideration for radiation pts. What can you do to combat this?
schedule freq. water breaks
A combination of fragile skin and ___ could result in skin damage or even tearing.
edema
Chemotherapy can cause alterations to blood. What are they and why are they considerations?
leukopenia and thrombocytopenia. Reduced WBC and platelets. Reduced immune system function and impaired healing.
Chemotherapy can be delivered via ___. These should be considered when selecting exercises for the client.
port
Chemotherapy can result in being susceptible to ____ of the skin. Mindful programming will avoid too much pressure being placed on the skin.
bruising.
All cancer patients have special considerations regardless of the type of treatment. What are these?
Careful wording to not trigger a bad emotion and sensitivity to difficult situations
What are the most common symptoms for cx pts? (there are 6)
lymphedema, pain, body image changes, muscle weakness, depression/anxiety and fatigue
What percentage of cx pts experience fatigue?
72-95%
How does CRF differentiate from normal fatigue?
CRF is different in that it occurs without exertion.
What is a concise definition of fatigue?
Energy expenditure outstrips the restorative process
Describe CRF
severe, chronic, spread widely, unrelieved by rest, impairs ADL and unrelated to activity
How long can CRF persist?
months or years following treatment
How could CRF effect a patient?
physically, psychosocially and economically
What are two fatigue theories?
Depletion of energy yielding substances (depletion to maintain blood glucose) and Accumulation of metabolites
What is the Otto Warburg Effect?
Cancer cells have an unusually high rate of glycolysis, even under aerobic conditions. Leads to accumulation of metabolites
What is PFK? How does it fit in glycolysis?
PFK is phosphofructokinase. It is an enzyme which is the rate limiting step in glycolysis.
Trace the accumulation of metabolites from start to resulting CRF
Lactic acid dissociates hydrogren ions
This inhibits PFK, can displace Ca from troponin, stimulate pain receptors, inhibit binding of o2 and hemoglobin, inhibit fatty acid release
How does displacement of Ca from Troponin result in CRF?
Reduce muscle contraction resulting in weakness and increased fatigue.
How may dissociation of hydrogen ions effect blood pH?
reduced pH, leading to acidosis
Normal cell metabolism utilizes the mitochondria when oxygen is present to oxidize glucose. How about when oxygen is not present?
in the absence of oxygen, glucose is converted into lactate
Increased lactate accumulation is a result of ___.
Increased use of glucose in the presences of oxygen.
What is the term to describe use of glucose in the presence of oxygen?
aerobic glycolysis
What alterations can take place in terms of cardiotoxicity?
increased time to peak filling of the LV Decreased RV/LV ejection fractions Abnormal LV contractility Reduced cardiac output =lower o2 saturation and nutrient delivery
What alterations can take place in terms of pulmonary toxicity?
SOB
Reduced total lung capacity
Reduced vital capacity
Reduced inspiratory capacity
Reduced intake of O2, decreased removal of CO2
Decreased submaximal/maximal exercise O2 consumption
What alterations can take place in terms of muscle degeneration?
Cx cachexia can result from decreased protein synthesis and increased atrophy
Destruction of skeletal and adipose tissues
Increased muscular weakness(lower strength/lower time to fatigue)
Myelosuppression is a result of ____. What results can be expected?
Inhibition of bone marrow function. Decreased O2 carrying capacity, decreased RBC(anemia) and increased workload placed on the heart
GI toxicity can result in what physiologic alterations?
Altered metabolism and decreased nutrient, electrolyte and fluid uptake
Hepatotoxicity and nephrotoxicity can result in what physiologic alterations?
Damage to liver and kidneys
Interfere w/ metabolic functions(liver)
Interference in energy production, hydration and waste removal(kidney)
Blood glucose maintenance(liver)
What psychological factors can become present in cx patients?
Decreased attention/cognition Chemo-related cognitive impairment (chemobrain) Depression and anxiety Change in social patterns Change in body image
