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Advanced clinical practice: examining the complex patient > Week 6 > Flashcards

Week 6 Flashcards

1
Q

What are the non-modifiable risk factors of cancer?

A
  • Age
  • Genetics
  • Epigenetics
  • Immunosuppression (relative)
  • Radiation (relative)
  • Sunlight (relative)

Relative meaning that it depends on the person’s lifestyle behaviors

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2
Q

What are the modifiable risk factors of cancer?

A
  • Alcohol
  • Cancer-Causing Substances
  • Chronic Inflammation
  • Diet
  • Hormones
  • Immunosuppression
  • Infectious Agents
  • Obesity
  • Radiation
  • Sunlight
  • Tobacco
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3
Q

A normal cell proliferates and differentiates. What does this include?

A

Proliferation
• Increase in cell number
• Regulated by growth factors
• Cell goes through cell cycle, which is controlled by cell cycle inhibitors, to prevent excessive growth

Differentiation
• Cells becomes “specialized” to carry out particular functions. Tissue is formed that has specific structure and function

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4
Q

What are some of the characteristics of a normal cell?

A

• Limited number of cell divisions
• Contact inhibition: function turning off upon contact with something
• Mutations
- Mutated DNA repaired
- Defective cell may be destroyed by immune system
• Apoptosis

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5
Q

What is cancer normally related to?

A

A genetic/epigenetic alteration. A disease of mutation, that is either within the structure or the function of the cell

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6
Q

What type patients typically have a structure mutation?

A

Childhood and early adult

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7
Q

What type patients typically have an epigenetic/function mutation?

A

In adults

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8
Q

True or False

Only 10% of cancer cases are genetically linked

A

True, Only 10% of cancer cases are genetically linked

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9
Q

What is a tumor?

A

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm

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10
Q

What are the major types of tumors?

A
  • Benign: not cancer
  • In situ: contained
  • Malignant: cancer
  • Unknown origin
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11
Q

What is carcinogenesis?

A

The process by which normal cells are transformed into cancer cells

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12
Q

What are the cellular or tumor characteristics of cancer?

A
  • Abnormality(can also be characteristics of a benign tumor)
  • Uncontrollability(can also be characteristics of a benign tumor)
  • Invasiveness
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13
Q

What are the drivers of carcinogenesis?

A

• Proto-oncogene, a gene involved in normal cell growth. Mutations may cause it to become an oncogene, which
can cause the growth of cancer cells
• Oncogene which is a mutated proto-oncogene
• Tumor suppressor gene, a negative regulator of growth factor stimulation which controls cell growth and division. Suppression or blockage leads to the development of cancer. Normally considered an anti-oncogene, when it has no abnormalities

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14
Q

What is the proposed function of tumor suppressor gene: BRCA1, and if mutated, what does it lead to?

A
  • Proposed function: DNA repair

* Disease if mutated: Breast cancer

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15
Q

What is the proposed function of tumor suppressor gene: p53, and if mutated, what does it lead to?

A

• Proposed function: Transcription/cell cycle
regulation
• Disease if mutated: Sarcoma, carcinoma, leukemia

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16
Q

What is the proposed function of tumor suppressor gene: Rb, and if mutated, what does it lead to?

A
  • Proposed function: Nuclear transcription factor

* Disease if mutated: Retinoblastoma

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17
Q

What is the proposed function of tumor suppressor gene: MEN1, and if mutated, what does it lead to?

A
  • Proposed function: Intrastrand DNA crosslink repair

* Disease if mutated: Parathyroid and pituitary adenomas, islet cell tumors

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18
Q

When is a person considered a cancer survivor?

A

At the time of diagnosis

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19
Q

True or False

Even though black women have a lower incidence rate for breast cancer than white women, black women have a 2-3x higher mortality rate(they die faster)

A

True, Even though black women have a lower incidence rate for breast cancer than white women, black women have a 2-3x higher mortality rate(they die faster)

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20
Q

What population is kidney cancer mostly seen?

A

American indians / alaska natives

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21
Q

What population is liver cancer mostly seen?

A

American indians/ alaska natives, asians, and pacific islanders

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22
Q

What population is prostate cancer mostly seen?

A

African american men

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23
Q

What population is cervical cancer mostly seen?

A

Women in rural areas

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24
Q

What population is multiple myeloma mostly seen?

A

African americans

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25
Q

What are the risk factors associated with cancer disparities?

A
  • Genetic and biological factors
  • Health care access
  • Socioeconomic factors
  • Chemical and physical exposures
  • Diet
  • Physical inactivity
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26
Q

True or False

The prevalence rate of cancer is the US is going down

A

FALSE, The prevalence rate of cancer is the US is going UP. This is a good thing, because mortality rates are decreasing

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27
Q

What does an incidence rate refer to?

A

Frequency of occurrence of new cases of disease or injury in a population over a specified period of time
• Denominator is usually:
- Summed person-years of observation
- Average population(more commonly used)

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28
Q

What does a mortality rate refer to?

A

Frequency of occurrence of death in a defined population during a specified interval
• Variety of measures: Subsets
and Mid-interval
• Denominator is usually avg population

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29
Q

What are the major types of cancer seen in children 0-14 years?

A
  • Acute lymphocytic leukemia (ALL)
  • Brain and other central nervous system (CNS) tumors
  • Neuroblastoma
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30
Q

What is the average age of cancer diagnosis in children?

A

6

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31
Q

What is the population often affected by cancer in children?

A

White and Hispanic children have higher incidence rates than other racial and ethnic groups

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32
Q

What is the prevalence of cancer diagnosis in children?

A

1 in 330 will be diagnosed by age 20

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33
Q

What population is at a high risk for cancer?

A
  • Heavy alcohol use
  • Older adults
  • Frequent exposure to cancer causing substances
  • Obese persons
  • Frequent unprotected exposure to sunlight
  • High inflammatory dietary habits
  • Cancer survivors
  • Treatments including hormones or radiation
  • Persons with immunosuppression
  • Exposure to tobacco or smoke
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34
Q

Why do cancer health disparities exist?

A
  • Access to and use of health care
  • Genetics
  • Physical and mental health
  • Treatments received
  • Social and economic status
  • Cultural beliefs
  • Exposure to environmental cancer risk factors
  • Clinical trial participation
  • Health literacy
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35
Q

True or False

Everyone has a cancer risk

A

True, everyone has a cancer risk

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36
Q

What is the best approach to use when talking to a patient about cancer?

A

Use a client-oriented approach (tailored approach)
- Individual or lifestyle assessment
- Motivational interviewing
• Identify any targeted evidence or awareness campaign
materials (message targeting)
- Unique characteristics
- Outcomes of interest
• Routine reminders have been shown to increase adherence to current screening and lifestyle modification recommendations

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37
Q

What are the general lifestyle recommendations for lung cancer?

A

Reduce/minimize:
• Single greatest avoidable risk factor (World Health Organization)
• Smoking or oral tobacco cessation or reduce secondhand smoke exposure

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38
Q

What are the general drinking recommendations for patients to reduce their risk for cancer?

A
  • One drink per day for women (4-8 oz)

* Two drinks per day for men (4-8 oz)

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39
Q

What are the types of diets that is recommended to reduce the risk of all cancers?

A
  • Select a diet that reduces inflammation
  • Reduce your diabetes risk
  • Have a lifestyle that encourages physical activity
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40
Q

What can be done to help reduce the risk of breast cancer?

A

Have children or minimize your use of hormone therapy

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41
Q

In order to reduce the risk of cancer, people should maintain a healthy weight. Why is this?

A

Obesity is associated with inflammation, increased estrogen levels, increased insulin and insulin-like growth factors, increased adipokines, and changes in cell growth
regulators

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42
Q

What are the things that we want to do to reduce the risk of getting virus related cancers?

A

Vaccinations (HPV, Hep B, Hep C)

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43
Q

What are the things that we want to do to reduce the risk of getting skin cancers?

A

Protect your skin with sunscreen products, clothing, and hats/visors
• Minimize your time in the sun between 10am-4pm
• Wear dark fabrics
• Check your skin regularly

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44
Q

At what age does any moles developed lead to skin cancer?

A

After the age of 25, 70% of the time

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45
Q

What are the current screening recommendations for skin cancer?

A

Current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults

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46
Q

What are the current screening recommendations for lung cancer?

A

Annual screening for lung cancer with low-dose computed tomography
(LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years

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47
Q

What are the current screening recommendations for breast cancer?

A

Recommends biennial screening mammography for women aged 50 to 74 years

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48
Q

The acronym CAUUTION-P is used to determine when action should be taken for a patient that might indicate when they have cancer. What does it mean?

A
  • Change in bowel and bladder habits for up to 3 days
  • A sore that does not heal for up to 3 days
  • Unusual bleeding or discharge in stool for up to 3 days
  • Unusual bleeding in between periods for up to 3 days
  • Thickening or lump in the breast, testicles, or elsewhere for up to 3 days
  • Indigestion or difficulty swallowing for up to 3 days
  • Obvious change in the size fo a mole or mouth sore for up to 3 days
  • Nagging cough or hoarseness for up to 3 days
  • Pain
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49
Q

What is the action to be taken when a patient complains of a Change in bowel and bladder habits for up to 3 days?

A

Ultrasonography and endoscopy

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50
Q

What is the action to be taken when a patient complains of a A sore that does not heal for up to 3 days?

A

Biopsy and oral and skin exam

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51
Q

What is the action to be taken when a patient complains of Unusual bleeding or discharge in stool for up to 3 days?

A

Rectal exam and colonoscopy

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52
Q

What is the action to be taken when a patient complains of Unusual bleeding in between periods for up to 3 days?

A

Gynecology exam for cervix and biopsy

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53
Q

What is the action to be taken when a patient complains of Thickening or lump in the breast, testicles, or elsewhere for up to 3 days?

A

Ultrasonography and FNAC if abnormal

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54
Q

What is the action to be taken when a patient complains of Indigestion or difficulty swallowing for up to 3 days?

A

Endoscopy

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55
Q

What is the action to be taken when a patient complains of an Obvious change in the size fo a mole or mouth sore for up to 3 days?

A

Biopsy

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56
Q

What is the action to be taken when a patient complains of a Nagging cough or hoarseness for up to 3 days?

A

ENT examination and chest x ray

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57
Q

What are the pain complaints that a patient might have that will require they get a work up to rule out cancer?

A

• Different times
- Acute, chronic/persistent, breakthrough
• Different types
- Nerve, bone, soft tissue, phantom, or referred
• Pain that does not respond to treatment or change in position
• Nocturnal pain
• Headache in the am (first thing in the morning, consistently) but improves throughout the day; may worsen with physical activity or positional changes

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58
Q

What are the theories behind the reason of nocturnal pain in cancer patients?

A
  • Relax muscles and tumor invasion becomes more noticeable
  • Perception of pain influenced by drop in body temperature, increase in carbon dioxide, or decrease in mental distraction
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59
Q

What are the characteristics of a benign tumor?

A 
Typically slow growing
• Localized
• Not invasive (unrelated
tissues/organs)
• Not cancerous
• Recurrence unlikely
• Encapsulated
• End with "oma", regardless of their cell type
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60
Q

What are the characteristics of a malignant tumor?

A 
• Rapid or slow growth
• Invasive
• Encapsulated
• Cancerous
• Possible recurrence
• End in “oma”
  - more description regarding
pathology
• Organ or cell of origin
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61
Q

____ malignant cancer is slow growing

A

Prostate malignant cancer is slow growing

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62
Q

What is the pathology of a carcinoma?

A

Skin or in tissues that line or cover internal organs, various subtypes.

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63
Q

What is the pathology of a sarcoma?

A

Bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue

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64
Q

What is the pathology of leukemia?

A

Blood-forming tissue

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65
Q

What is the pathology of lymphoma and myeloma?

A

Cells of the immune system

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66
Q

What is the pathology of Central nervous system cancers?

A

Brain and spinal cord tissue

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67
Q

What is the name of a benign tumor and malignant tumor of an adult fibrous tissue?

A
  • Benign: fibroma

* Malignant: Fibrosarcoma

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68
Q

What is the name of a benign tumor and malignant tumor of an embryonic(myxmatous) fibrous tissue?

A
  • Benign: myxoma

* Malignant: myxosarcoma

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69
Q

What is the name of a benign tumor and malignant tumor of fat?

A
  • Benign: lipoma

* Malignant: liposarcoma

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70
Q

What is the name of a benign tumor and malignant tumor of cartilage?

A
  • Benign: chondroma

* Malignant: chondrosarcoma

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71
Q

What is the name of a benign tumor and malignant tumor of the bone?

A
  • Benign: osteoma

* Malignant: osteosarcoma

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72
Q

What is the name of a benign tumor and malignant tumor of the notochord?

A
  • Benign: —

* Malignant: chordoma

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73
Q

What is the name of a benign tumor and malignant tumor of the connective tissue, probably fibrous?

A
  • Benign: fibrous histiocytoma

* Malignant: malignant fibrous histiocytoma

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74
Q

What are the characteristics of a malignant tumor cell?

A

• No normal cell organization or differentiation
• Lack control of cell division
• No contact inhibition
• Do not adhere to each other, which allows them to often break loose from mass and invade other tissues and may spread to distant sites
• Do not undergo apoptosis
• Abnormal cell membranes
• Altered surface antigens
• Compress blood vessels which leads to deprivation of normal cells of nutrients
• Necrosis and inflammation around tumor
- Loss of normal cells
- Reduction in organ integrity and function

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75
Q

Malignant tumors secrete cytokines and chemokines that encourage the development of new capillaries. What are the characteristics of this?

A

• Development of new capillaries
– Angiogenic factor secretion
- Including Vascular, Endothelial, Growth Factor (VEGF)
– Secretion of matrix metalloproteinase (MMP), which
breaks down collagen in ECM through collagenase

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76
Q

What are the evasion strategies of a malignant tumor?

A 
Immune escape
• Loss of immunogenicity
   - Lack of loading into class I MHC and lack of presentation to
T cells (tolerance)
• Antigenic modulation
  - Loss of surface antigens, 
    antibodies cannot bind
• Induction of immune suppression
• Prevention of NK and T cell activation
  - Downregulation of MHC, NK cell-activating receptors, and T
cell activation
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77
Q

What is the preferred method to get the definitive diagnosis of cancer?

A

A biopsy

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78
Q

What is a primary cancer?

A

The source of the cancer. The most common sites being, the skin, lung, female breasts, colorectal, corpus uteri, prostate

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79
Q

What is a secondary cancer?

A

The metastasis/spread of a primary cancer to a different location

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80
Q

___ is the technical term for a tumor growth

A

Neoplasm is the technical term for a tumor growth

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81
Q

On __% of cancers are found by a palpable mass or lump

A

On 10% of cancers are found by a palpable mass or lump

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82
Q

What are some other methods of diagnosing cancer?

A 
• Palpable mass or lump
–Detection varies by cancer
type
• Biopsy
–Preferred method
–Definitive diagnosis
• Imaging technologies
• Histology
• Tumor markers
• Grading
• Staging
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83
Q

What is a tumor maker?

A

Basically blood chemistry, and it varies from by cancer type. Ex: gynecological cancer is CA125. It is a screening tool, making it highly sensitive, so they require additional testing

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84
Q

What is grading?

A

A histological and pathological activity, where they look at the abnormalities of the tissues, and with that a pathologist can give a grade.

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85
Q

What is a grade GX on the cancer grading system?

A

Grade cannot be assessed/inconclusive

undetermined grade

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86
Q

What is a grade G1 on the cancer grading system?

A

Well differentiated (low grade)

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87
Q

What is a grade G2 on the cancer grading system?

A 
Moderately differentiated
(intermediate grade)
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88
Q

What is a grade G3 on the cancer grading system?

A

Poorly differentiated (high grade)

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89
Q

What is a grade G4 on the cancer grading system?

A

Undifferentiated (high grade)

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90
Q

What is the difference between grading and staging of cancer?

A

Grading is a pathological exercise, while staging is a clinical exercise and is usually given by a medical/surgical oncologist

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91
Q

What system is usually used for cancer staging?

A

The TNM system

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92
Q

What does the summary system of cancer staging allow us to do?

A

Summary systems allow us to collect large amounts of data about the tumor and the cancer survivor

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93
Q

What is the purpose of cancer staging?

A

Common language, treatment

planning, prognostic, data collection

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94
Q

What are the elements that cancer clinical staging looks at?

A
  • Biopsies
  • Imaging
  • Physical examination
  • Tumor markers
  • Surgical reports
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95
Q

True or False

Only primary tumors are staged and graded

A

True, Only primary tumors are staged and graded

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96
Q

Why aren’t recurrent and metastasis cancer staged and graded?

A

A metastasis is a secondary cancer, meaning that it is part of the primary cancer’s process, and most of the time when a patient has metastasis to another organ, it is considered a grade 4 and the only time it doesn’t occur is with reproductive cancers

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97
Q

On the TMN system, what is a primary tumor stage TX?

A

Primary tumor cannot be

evaluated

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98
Q

On the TMN system, what is a primary tumor stage T0?

A

No evidence of primary tumor

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99
Q

On the TMN system, what is a primary tumor stage Tis?

A

Carcinoma in situ, where the basement membrane has not broken

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100
Q

On the TMN system, what is a primary tumor stage T1, T2, T3, T4?

A

Size and/or extent of the primary tumor

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101
Q

On the TMN system, what is a regional lymph nodes (N)

NX?

A

Regional lymph nodes cannot be evaluated

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102
Q

On the TMN system, what is a regional lymph nodes (N)

N0?

A

No regional lymph node

involvement

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103
Q

On the TMN system, what is a regional lymph nodes (N)

N1, N2, N3?

A

Degree of regional lymph
node involvement (number and
location of lymph nodes)

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104
Q

On the TMN system, what is a Distant Metastasis: MX?

A

Distant metastasis cannot be

evaluated

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105
Q

On the TMN system, what is a Distant Metastasis: M0?

A

No distant metastasis

106
Q

On the TMN system, what is a Distant Metastasis: M1?

A

Distant metastasis is present

107
Q

What is a stage O cancer?

A

Carcinoma in situ

108
Q

What is a stage I cancer?

A

Early stage, localized to the primary organ

109
Q

What is a stage II cancer?

A

Increased risk of regional spread, still localized

110
Q

What is a stage III cancer?

A

Local cancer has spread regionally

111
Q

What is a stage IV cancer?

A

Metastasis

112
Q

What are mechanisms in which metastasis occurs?

A
  • Distant lymph node involvement
  • Blood borne metastases(using the blood vessels)
  • Implantation/seeding metastases. Because of the loose contact between the cancer cells, they can break off and use any fluid in the body to move to other parts of the body
113
Q

What are the characteristics of a tumor spreading through invasion?

A
  • Local spread
  • Tumor cells grow into adjacent tissues and destroy them
  • Example: Uterine carcinoma invades vagina
114
Q

What are the characteristics of a tumor spreading through metastasis?

A

Spread to distant sites
• Via blood or lymph
• Example: Carcinoma of the colon spreads to the liver

115
Q

What are the characteristics of a tumor spreading through seeding (Implantation)?

A

• Another form of metastasis
• Spread to distant sites
• Via other body fluids or along membranes
• Example: Ovarian cancer spreads throughout peritoneal
cavity

116
Q

What are the major sites of tumor metastasis?

A

Bone(#1 site), liver, brain and lung

117
Q

What are the signs and symptoms of bone cancer?

A
  • Deep aching pain
  • Pain that does not go away with position changing
  • Pain that does not go away with interventions
118
Q

What does the signs and symptoms of brain cancer depend on?

A

The lobe the tumor is in

119
Q

What are the signs and symptoms of liver cancer?

A

Metabolic changes

120
Q

What are the signs and symptoms of lung cancer?

A

Respiratory changes

121
Q

What is the size threshold for moving a person to another cancer stage or subcategory?

A

2cm

122
Q

What are the common cancer treatments?

A
  • Watchful waiting used for slow growing tumors, most due to the risk being bigger than the benefit
  • Surgery
  • Chemotherapy
  • Radiation therapy
  • Targeted therapy to include immunotherapies
  • Supportive care medications
  • Hormonal therapy, if the receptor status is positive
123
Q

What is chemotherapy?

A

Any drug used to treat disease/cancer.

124
Q

What are the different administration methods of chemotherapy?

A
  • Oral
  • Intramuscular injection
  • Subcutaneous injection
  • Intravenous chemotherapy
  • Intrathecal chemotherapy
  • Multiple methods simultaneously
125
Q

What are the goals of chemotherapy?

A
  • Cure/get patient into remission
  • Control
  • Palliation and we’re just trying to improve QoL
126
Q

What are the timing characteristics of chemotherapy?

A

• Neoadjuvant: occurs before primary therapy.
• I nduction, or preoperative
– Adjuvant chemotherapy: done after primary intervention, which is usually surgery
– Palliative

127
Q

True or False

Chemotherapy is built to address the cell cycle

A

True, Chemotherapy is built to address the cell cycle

128
Q

What is a non-cycle specific chemotherapy?

A

They destroy all or slow down the activities of the cell cycle. Or they can have been formulated and created to work on a specific point within the cell cycle

129
Q

Patients that are taking chemotherapy agents that their cell cycle mechanism has what type of side effects?

A

The side effects will be worse, because it is impacting all the phases of the cell cycle

130
Q

What is the goal of radiation therapy in the treatment of cancer?

A

Curative or palliative

131
Q

What is the timing of radiation therapy in the treatment of cancer?

A
  • Neoadjuvant
  • Intraoperative (IORT)
  • Adjuvant
132
Q

What are the methods of delivery for radiation therapy in the treatment of cancer?

A 
• External beam radiation
  - Teletherapy
• Internal radiation
  - Brachytherapy
• Systemic: radiation pill mostly seen in thyroid cancer
133
Q

What are the parameters for the radiation therapy treatments?

A
  • 5-10 minutes
  • Daily over 4-6 weeks
  • Treatment schedules vary
  • Measured in Grays (Gy)
134
Q

As a PT, what are the things to know about a patient receiving radiation therapy?

A
  • Total dosage of radiation
135
Q

What are the methods of external beam radiation?

A 
• Linear accelerator (LINAC)
• 3-dimensional conformal radiation
therapy (3D-CRT)
• Intensity-modulated radiation
therapy (IMRT)
• Image-guided radiation therapy (IGRT)
• Tomotherapy
• Stereotactic radiosurgery
• Stereotactic body radiation therapy
• Proton therapy which has the lowest amount of side effects
• Other charged particle beams
136
Q

Based on the total dosage of radiation, what is the effects on the body?

A
  • 40 Gy + - skin effects
  • Hair loss can occur with >1Gy
  • Dryness of glands
  • 50 Gy + - bone effects
  • 60 Gy + - soft tissue effects
  • 70 Gy + - muscle and tendon effects
137
Q

What is the dose of radiation?

A

The irradiation absorbed by each kilogram of tissue expressed as Grays (Gy) - 1 Gy = 1 J/kg of tissue.

138
Q

What determines the total dose of radiation?

A

Tumor sensitivity and tissue tolerance

139
Q

What are the characteristics of the internal beam radiation?

A
  • Pellets or seeds, wires, ribbons
  • Treated over hours, days, weeks or months
  • Low or high dose treatment
  • Temporary or permanent placement
  • Chemoradiation – combination of chemotherapy and radiation
140
Q

What are some other treatment methods of cancer?

A
  • Immunotherapy
  • Antiangiogenic Therapy: typical therapy where they are trying to decrease the neoangiogenesis tumors that can secrete chemokines and cytokines that make the body produce more capillaries
  • Hormonal Therapy
  • Integrative Medicine
141
Q

What are the cancer treatments that can result in osteoporosis as a side effect?

A
  • Alkylating agents
  • Anthracyclines
  • Taxanes
  • Corticosteroids
  • Radiation
  • Hormonal therapy
142
Q

What are the impairments of body functions/structure that we see as a result of osteoporosis?

A
  • Increased risk of fracture
  • Kyphotic posture
  • Pain with movement
143
Q

What are the clinical signs and activity limitations that we see as a result of osteoporosis?

A
  • Pain

* Decreased mobility

144
Q

What are the cancer treatments that can result in a change in body composition (cachexia or obesity) as a side effect?

A
  • Alkylating agents
  • Anthracyclines
  • Taxanes
  • Corticosteroids
  • Hormonal therapy
  • Radiation
  • Surgery
145
Q

What are the impairments of body functions/structure that we see as a result of a change in body composition (cachexia or obesity)?

A
  • Weight Loss
  • Weight Gain
  • Increased waist circumference
146
Q

What are the clinical signs and activity limitations that we see as a result of a change in body composition (cachexia or obesity)?

A
  • Decreased mobility
  • Decreased functional ability
  • Fatigue
147
Q

What are the cancer treatments that can result in arthralgia as a side effect?

A
  • Aromatase Inhibitors
  • Radiation
  • Surgery
148
Q

What are the impairments of body functions/structure that we see as a result of arthralgia?

A

Pain with movement

149
Q

What are the clinical signs and activity limitations that we see as a result of arthralgia?

A
  • Pain
  • Decreased mobility
  • Decreased functional ability
150
Q

What are the cancer treatments that can result in decreased muscle strength as a side effect?

A
  • Alkylating agents
  • Anthracyclines
  • Taxanes
  • Corticosteroids
  • Hormonal therapy
  • Radiation
  • Surgery
151
Q

What are the impairments of body functions/structure that we see as a result of decreased muscle strength?

A
  • Decreased range of motion
  • Fatigue
  • Pain with movement
  • Contractures
152
Q

What are the clinical signs and activity limitations that we see as a result of decreased muscle strength?

A
  • Decreased functional ability
  • Pain
  • Fatigue
153
Q

What is the screening tools used for osteoporosis?

A

OPERA

154
Q

What are the screening tools used for change in body composition (cachexia or obesity)?

A 
• Height, weight, waist and hip
circumference measurements
• Skin fold measurements
• Bio-electrical impedance
• Weight loss/gain in last 6 month
155
Q

What are the interventions used for the treatment of osteoporosis?

A

• Weight bearing activities
• Postural training – avoid cervical flexion and positions that promote kyphosis
• Kinesiotaping for postural
cues

156
Q

What are the screening tool used for arthralgia?

A

WOMAC

DASH

157
Q

What are the interventions used for the treatment of change in body composition (cachexia or obesity)?

A
  • Physical activity
  • Nutritional consults
  • Resistive exercises
  • Aquatic training
158
Q

What are the interventions used for the treatment of arthralgia?

A
  • Weight loss
  • Assistive devices
  • Thermo/cryo therapy
  • Electrotherapy
159
Q

What are the screening tool used for decreased muscle strength?

A 
• Manual muscle testing
• Functional testing
• Timed Up and Go
• ADLS
• Short Physical Performance
Battery
160
Q

What are the interventions used for the treatment of decreased muscle strength?

A
  • Progressive resistance exercise
  • Aquatic training
  • Kinesiotaping
161
Q

What is the term for the cognitive changes seen in a person receiving chemotherapy?

A

Chemotherapy induced cognitive impairments(CICI)

162
Q

What are the cancer medical treatments that can cause a side effect of cognitive changes?

A
  • Chemotherapy
  • Corticosteroids
  • Radiation
  • Surgery
  • Hormonal therapy
163
Q

What are the impairments of body functions/structure that we see as a result of cognitive changes?

A

Changes in mental function

164
Q

What are the clinical signs and activity limitations that we see as a result of cognitive changes?

A
  • Memory deficits
  • Word finding problems
  • Decreased concentration
  • Sleep disturbances
  • Fatigue
165
Q

What are the cancer medical treatments that can cause a side effect of Peripheral Neuropathy?

A
  • Taxanes
  • Plant alkaloids
  • Platinum compounds
166
Q

What are the impairments of body functions/structure that we see as a result of Peripheral Neuropathy?

A
  • Parasthesias
  • Pain
  • Loss of sensation
  • Distal weakness
  • Loss of Deep Tendon Reflexes
  • Foot drop
  • Muscle weakness
167
Q

What are the clinical signs and activity limitations that we see as a result of Peripheral Neuropathy?

A
  • Decreased balance
  • Gait Abnormalities
  • Mobility limitations
  • Falls
  • Distal pain and weakness
  • Numbness
  • Tingling
  • Constipation
  • Urinary retention
  • Fatigue
168
Q

What are the screening tools used for cognitive changes in patient with chemotherapy?

A
  • MiniMental/ MiniMaC
  • FACT-COG
  • High Sensitivity
  • Cognitive Screen
  • CogHealth
  • Headminder
169
Q

What are the interventions used for the treatment of cognitive changes?

A
  • Meditation

* Cognitive behavioral training

170
Q

What are the screening tools used for Peripheral Neuropathy in patient with chemotherapy?

A 
• Monofilament 
• Berg Balance
• Tinetti
• Leeds Assessment of
Neuropathy Symptoms and Signs 
• Total Neuropathy Scale
171
Q

What are the interventions used for the treatment of Peripheral Neuropathy?

A
  • Acupuncture
  • Assistive devices
  • Aerobic and resistive exercise
172
Q

What is the main side effect of chemotherapy/hormone therapy on the cardiovascular system?

A

Left ventricular dysfunction

173
Q

What are the impairments of body functions/structure that we see as a result of Left ventricular dysfunction?

A
  • Decreased ejection fraction

* Decreased endurance/deconditioning

174
Q

What are the clinical signs and activity limitations that we see as a result of Left ventricular dysfunction?

A 
• Decreased ability to perform
activities of daily living
• Decreased ability to ambulate
long distance
• Decreased ability to
ascend/descend a multiple flights of stairs
• Abnormal vital signs
• Clubbing nails
• Flaring of the nostrils
• Accessory breathing
• Fatigue
175
Q

What are the screening tools used for left ventricular dysfunction in patient with chemotherapy?

A
  • Electrocardiogram
  • Echocardiogram
  • 6 Minute Walk Test
176
Q

What is the intervention used for the treatment of left ventricular dysfunction?

A

Cardiac rehabilitation

177
Q

What are the medical treatments that are used for the cancer that causes a side effect of alopecia?

A
  • Chemotherapy

* Radiation

178
Q

What are the impairments of body functions/structure that we see as a result of alopecia?

A

Hair Loss

179
Q

What are the clinical signs and activity limitations that we see as a result of alopecia?

A

Grooming issues

180
Q

What are the current screening recommendations for prostate cancer?

A

For men aged 55 to 69 years, the decision to undergo periodic prostatespecific antigen (PSA)–based screening for prostate cancer should be an individual one

181
Q

What is lymphedema?

A

Swelling caused by the inability of the lymph system to perform it’s basic function of removal of water and protein waste from it’s designated lymphatic region of the body. With the inability to help the body defend against organism

182
Q

What is the most world wide cause of lymphedema?

A

Filariasis (mosquito born parasite)

183
Q

What are the cancers most associated with lymphedema?

A

Breast, head, and neck cancer

184
Q

What are the lymphatics?

A

Blind open ended vessels that have larger opening for reabsorption. They take in fluids and large protein waste into their vessels them become part of the lymphatic flow and become lymphatic fluid

185
Q

What creates the flow in and out of vessels, out of the arteriole towards the tissues, from the tissues into the venule, and from the tissues into the lymphatic capillaries?

A

Created by multiple elements such as: osmotic pressures, mechanical pressures. They are dynamic and varying at all times

186
Q

What does the presence of a glycocalyx layer do in the starlings system?

A

The presence of a Glycocalyx layer is now understood to be semi-permeable membrane which keeps fluid in the interstitial tissues and unable to re-enter the venous system. This causes the venous system to not the primary mover of interstitial fluid back to the heart

187
Q

___ is the only structure fluid that is able to return fluid to the heart

A

Lymphatics is the only structure fluid that is able to return fluid to the heart

188
Q

Any edema seen in the skin is ___

A

Any edema seen in the skin is Lymphedema, whether the lymph system is intact or not

189
Q

Where are the general regions of lymph node beds in the body?

A

2 inguinal
2 subaxillary
2 cervical

190
Q

Once fluids reach the lymph nodes, what happens?

A

The lymph nodes process the fluid, breakdown and kill any organisms that are infectious , breakdown the proteins, until the fluid is purified. All of the fluid then makes its way up towards the heart in the lymph system, and once it is above the heart, through the long thoracic duct which will then merge back into the venous system just below the clavicle above the heart at the angles. This is how lymph fluid eventually returns back into circulation

191
Q

What creates flow in the lymphatic system?

A

Low pressure dynamics, mostly osmotic and tissue pressures

192
Q

What are the networks of the lymph system?

A

Deep(cannot be treated and end up in death when there is a dysfunction present) and Superficial(only we can affect it)

193
Q

What makes up the structures in the lymph system?

A

Structures are made of endothelium, peristaltic smooth muscle, and valves.

194
Q

True or False

Each lymph region is independent from other lymph
regions

A

True, Each lymph region is independent from other lymph

regions

195
Q

Each region of the lymph node is marked by functional landmark called a ____

A

Each region of the lymph node is marked by functional landmark called a watershed

196
Q

All lymph from the watershed

borders flows towards it’s ___

A

All lymph from the watershed

borders flows towards it’s lymph node bed

197
Q

What are the pressures that may impair the flow of lymph fluid back to the heart?

A
  • Low/poor tissue pressure

* Constant effect of gravity moving fluid in the wrong direction

198
Q

What are the pressures that will help drive the flow of lymph fluid back to the heart?

A
  • Good BP
  • Good muscle contraction
  • Good tissue pressure
  • Normal blood protein concentration
199
Q

What are the things that directly impact lymph movement?

A

Systemic and mechanical functions directly impact

Lymph Movement

200
Q

What direct fluid flow in the lymphatic system?

A

Fluid flow is directed by gradients that move
them from higher to lower pressure states. These gradients are created by several systemic and mechanical factors which add
together to create the needed re-absorption by lymphatics or they will produce unwanted
swelling

201
Q

What is a primary lymphedema?

A

Lymphedema from genetic miscoding and anomalies

202
Q

All Lymphedema arising from GENETIC mutations are

considered PRIMARY Lymphedema and present as what?

A

• Over or undergrowth (hyper/hypoplasia)
of the venous-lymphatic networks
• Absence of lymphatic structures (aplasia)

203
Q

What happens in the case of an over or undergrowth (hyper/hypoplasia) of the venous-lymphatic networks?

A

Depending on how serious or involved the mutation is, over time there is going to be an inability to transport the lymph and venous nodes, because the structures are poorly formed and as lymph fluid production increases or demand increases, there will be increasing failure

204
Q

What happens in the absence of lymphatic structures (aplasia)?

A

Presentation is usually at birth, and the absence of lymphatic is very obvious

205
Q

___ is the most likely side effect of chemotherapy

A

Peripheral neuropathy is the most likely side effect of chemotherapy

206
Q

__ is the most likely side effect of radiation

A

Integumentary fibrosis is the most likely side effect of radiation

207
Q

Why do cancer patients have night pain?

A
  • Either because of increased body temp

- Or from a cognitive point where is because everything else is turned off

208
Q

Why do cancer patients have night pain?

A
  • Either because of increased body temp

- Or from a cognitive point where is because everything else is turned off

209
Q

What is the onset of congenital lymphedema?

A

0-2 years old

210
Q

What is the onset of lymphedema praecox?

A

2-35 years old

211
Q

What is the onset of lymphedema tarda?

A

35 years old or greater

212
Q

What gene has a mutation in Lymphedema-Distichiasis Syndrome?

A

FOXC2 also associated with primary valve failure in veins

213
Q

What is the physical presentation of Lymphedema-Distichiasis Syndrome?

A
  • Hemosiderin staining
  • Dark fibrosis of the skin
  • Two rowed eyelashes on the upper and lower lid
214
Q

What are the clinical presentations of primary lymphedema?

A
  • Fibrosis
  • Hardening of the skin, where it almost looks like calcium/salt deposits (hyperkeratosis)
  • Deep creases and small lobes
  • Bulbous extremities
215
Q

What are the causes of secondary lymphedema?

A
  • Venous Insufficiency
  • Cancer and related medical treatment
  • Trauma and Injury
  • Diseases of other systems : Renal, Cardiovascular, Hepatic
  • Filariasis (parasite) - mostly predominant in warmer climates
216
Q

Lymphedema due to ____ is the most common presentation of swelling

A

Lymphedema due to venous congestion is the most common presentation of swelling

217
Q

What is phlebo-lymphedema?

A

Lymphatic failure due to chronic venous congestion.

218
Q

What are the clinical presentations of phlebo-lymphedema?

A
  • Darkened legs caused by hemosiderin staining

- Scaly weeping and leakage of fluid from the legs in prolonged cases

219
Q

In order to determine which system is causing lymphedema and in order to determine if a patient belongs in your clinic, what information is it important that we have?

A
  • Detailed Medical History & Medication
  • Pain and response of swelling to activity
  • Careful questioning to see if other disease processes are involved.
220
Q

What are the subjective questions that we ask our patients with swelling/lymphedema regardless of whether or not it is based upon cancer presentation?

A

• How did the swelling begin? Is it tied to an event?
Quick onset or slowly over time?
• Does removing gravity (elevation) produce a rapid improvement (30 min or less) normalizing the area?
• Does the patient wake up 100% normal in the morning and only swell when up against gravity?

221
Q

What questions can be asked to determine the severity of a patient with swelling/lymphedema from the subjective interview?

A
  • Does the skin pit? How hard is the pitting?
  • Has the color of the area changed? (darker or milky white- can be used to know the system involved too)
  • Does the area seep or weep, even intermittently?
222
Q

What questions can be asked to determine the functional capacity of a patient with swelling/lymphedema from the subjective interview?

A
  • Has the swelling or tightness of the tissues decreased mobility or life activities? (legs might feel heavy and tight)
  • Does the swelling worsen with therapy or activity?
223
Q

What questions can be asked to determine whether other systems (asides from the primary one) are involved in a patient with swelling/lymphedema from the subjective interview?

A
  • Are they having trouble breathing? (will tell about fluid accumulation around the lungs)
  • Abdomen feel full?
  • Chest tightness or pressure around the trunk
224
Q

What is the role of standardized questionnaires in the subjective interview of a patient with swelling/lymphedema?

A

Used generally to determine function, the type of impact the swelling is having on the pts QoL. Questionnaires include:
• Lower Extremity functional scale(LEFS)
• Upper Extremity functional scale (UEFS)
• Lymphedema life impact scale(LLIS)

225
Q

When you know for a fact that a pt’s swelling is due to lymphedema based on their history of cancer, what are some additional information to get during the subjective interview?

A
  • Get a functional and QoL questionnaire
  • When did they have cancer?
  • Which type of chemotherapy or radiation they had and how many courses?
  • Did they have any surgeries with lymph nodes removed?
  • Is the cancer active or in remission?
226
Q

What are the functional and QoL questionnaire that are specific for pts with lymphedema?

A
  • Lymphedema Life Impact Score - LLIS

* Lymphoedema Functioning, Disability and Health Questionnaire Lymph- ICF

227
Q

Why is it important to ask a cancer survivor pt to describe how their swelling began?

A

In order to differentiate from possible cancer reoccurence, and remission or non-recurrence?

228
Q

What are the symptoms of cancer recurrence?

A
  • Sudden, noticeable increase in volume in an area or region
  • Discomfort or pain in the region or noticeable change in color
  • Area seems or feels “different” (heavy, achy, tight)
  • May have other “new” symptoms: bone/joint pain, headache, bloating, etc.
229
Q

What can the observation of a pt with swelling/lymphedema help the PT do?

A
  • Differentiate the systems which may be involved

* Determine the severity of the swelling

230
Q

How do we differentiate between the systems involved to result in swelling/lymphedema in a pt during the observation component of the objective exam?

A

• Is it venous based? ( the limb affected will be darker or colored in a reddish-purplish hue)
• Is it lymphatic based? (pale or milky white will indicate lymph fluid accumulation)
3. Combined insufficiency(venous and lymphatic), which will appear with patchy areas of both colors

231
Q

What are the observations seen in the objective exam of a pt with recurrent cancer?

A

• Combined insufficiency(venous and lymphatic), which will appear with patchy areas of both colors

232
Q

What are the observations seen in the objective exam of a pt with recurrent cancer in the skin?

A

The skin will be dark and have an almost venous type presentation, although it will be purely lymphatic

233
Q

How do we determine the severity of the swelling/lymphedema in a pt during the observation component of the objective exam?

A 
Changes that will show that the swelling has been there for a long time:
• Fibrosis
• Seeping
• Generalized fluid retention 
• Wounds
• Darker color of affected area 
• Abnormal or unidentifiable growths
• Presence of mycotic (fungal) nails
• Hyperkeratosis(thickening of the skins outer layer)

fewer findings indicate a fairly new swelling

234
Q

To complete the objective exam of a pt with swelling, what are the other assessments that must be done?

A

• Baseline girth measurements
• Pitting Edema (0-3+ scale) and Stemmer’s Sign
• Effect of lymphedema on mobility, endurance and recreation
• Lymphatic congestion in other areas of a the affected lymph
region.

235
Q

During the objective exam, what should a PT do if they suspect that the cause of a pt’s swelling is truly lymphedema to see how progressed/significant the pt’s case might be?

A

Look in the remaining region of the area with lymphedema. EX: if lymphedema is in the foot and lower leg edema, check the groin, abdomen, hips and upper thighs, to see if the entire region might be experiencing congestion

236
Q

If a pt comes to the clinic with a swelling exacerbation and has history of swelling, and prior treatment, what are the things you should ask the pt to do?

A

Ask them/have them show how able they are able to don and doff prescribed compression garments.

237
Q

What does it mean(pathophysiology) when a pt has a soft pitting edema?

A

It means that there is not much protein accumulation and that it is mostly fluid

238
Q

What is a 3+ pitting edema?

A

Edema that remains persistent after 3 secs

239
Q

What is a 2/3 pitting edema?

A

Edema that resolves within 2 sec or less

240
Q

What is a 0 pitting edema?

A

No pitting present with depression

241
Q

Hyperkeratosis is the hardening/thickening of the skin, what is the physical presentation of this?

A

Calcium/salt deposits on the skin that make hard and rough patches that can break off or crack, and is made of keratin.

242
Q

What does the presence of hyperkeratosis mean for a pt?

A

Lymphedema has been present for a long time

243
Q

What are the components of girth measurements of lymphedema?

A

For the arm, zero starts at the small of wrist, then go up every 10 cm to denote the location of the swelling, then measure the girth.
Mid palm is a separate measurement

244
Q

Why is it important to not use physical landmarks when measuring the girth of lymphedema?

A

As swelling changes and goes down, landmarks shift

245
Q

What is a Stemmer’s Sign?

A

A test done on the dorsum of the foot/hand, behind the 2nd toe/digit. We try to pinch the skin at this spot. There will be difficulty getting a skin pinch with true lymphedema.

246
Q

What are the ways to determine generalized edema?

A

The trunk will be significantly large, but the arms are not

247
Q

What are the conditions that we must monitor at all times that might indicate the need of immediate treatment?

A
  • Cellulitis in the presence of lymphedema exacerbation(redness and blushed skin)
  • Deep Vein Thrombosis
  • Cancer Recurrence
248
Q

What is the presentation of venous based lymphedema?

A
  • Darkened skin- hemosiderin staining
  • Hx of major organ failure(renal insufficiency, CHF, liver disease, or a type of hepatitis)
  • Improves with rest or sleep, d/t elevation
  • Low protein edema(soft or easy to leave a pit, on fibrosis will make it harden)
  • Wounds or thin, shiny skin
249
Q

What is the presentation of lymphatic based lymphedema?

A
  • Milky white skin tone in the areas of swelling
  • Hx of lymph node removal/treatment such as radiation or surgery
  • Minimally reduces with sleep/elevation
  • High protein edema (firmness)
  • Wounds or hyperkeratosis(suggest great severity/long time)
250
Q

What is the presentation of systemic failure(generalized edema) lymphedema?

A
  • Recent weight gain
  • Enlarged abdomen with fullness in face, arms and neck OR normal face arms and neck with an enlarged abdomen
  • Recent increase in trouble breathing
  • Reports “feeling bad”
  • Energy level is less functional that previous week
251
Q

What are the symptoms of a DVT?

A
  • Upper or lower extremity can be affected
  • Sudden onset of swelling
  • Can be present at any level of the extremity
  • Often a change of color to red-purple hue or darkening
  • May be warmer than unaffected areas
  • Painful to touch or with loading the extremity
252
Q

What are the symptoms of cellulitis?

A
  • Can occur in any area of the skin
  • Warmer or “hot” to the touch
  • Skin appears “inflamed”, red or irritated
  • Skin may be seeping fluid from active metabolism of bacteria present
  • Pain with touch or pressure is a key indicator
  • Patient may complain of feeling badly or unwell (sign of spreading cellulitis that might lead to sepsis)
253
Q

What are the symptoms of cancer recurrence?

A
  • Sudden, noticeable increase in volume in an area or region
  • Discomfort or pain in the region or noticeable change in color
  • Area seems or feels “different” (heavy, achy, tight)
  • May have other “new” symptoms: bone/joint pain, headache, trouble with speech, dizziness, or difficulty with coordinated movement(all indicates brain involvement), bloating(indicates a metastasis to the GI or liver), etc.
254
Q

___ is a condition that has all the signs of cellulitis, but is not a skin infection

A

Stasis dermatitis is a condition has all the signs of cellulitis, but is not a skin infection

255
Q

What are the components of stage 0(latent) lymphedema?

A

Swelling is not evident despite impaired lymph transport and may exist for months or year before edema becames evident

256
Q

What are the components of stage 1(reversible) lymphedema?

A

Early onset of the condition. Accumulation of tissue fluid that subsides with limb elevation. Edema may be pitting at this stage (no fibrosis)

257
Q

What are the components of stage 2(irreversible) lymphedema?

A

Limb elevation alone rarely reduces swelling, and pitting is manifest with protein rich edema fluid.
- Late stage2: there may or may not be pitting as tissue fibrosis is more evident

258
Q

What are the components of stage 3(lymphostatis elephantiasis) lymphedema?

A

Accumulation of protein rich edema fluid. Tissue is hard(fibrotic) and pitting is absent. Skin changes such as thickening, hyperpigmentation, increased skin folds, fat deposits, and warty overgrowths develop

259
Q

What determines who and in what setting should treatment of a pt with lymphedema be done?

A

Type and severity of swelling

260
Q

What type of lymphedema can a PT with no lymphedema certification in a general outpatient setting treat?

A
  • Venous Insufficiency Based Lymphedema
  • MILD presentation, systemic issues are not present or are controlled
  • No cancer history, No acute signs of symptoms,
  • Onset of swelling correlates to injury or surgery
  • Area of swelling is in one body region of the extremities
  • Swelling present less than 1 month
261
Q

What type of lymphedema can a certified lymphedema PT in an outpatient, acute care or skilled facility treat?

A
  • Venous, Lymphedema or Combined/ systemic failure
  • Moderate-severe presentation
  • Onset of swelling from any cause
  • Lymphedema is in more than one region or body part
262
Q

What should be done if there are any symptoms found which may be correlated to Infection, cellulitis, DVT or cancer metastasis/recurrence?

A

Patient must be sent back to physician ASAP! If the provider cannot see the patient right away, Emergency Department should be recommended.

Advanced clinical practice: examining the complex patient (7 decks)

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