Week6 6671/6611 Flashcards

1
Q

Modifiable risk factors for cancer

A
Alcohol 
Cancer-causing substances
Chronic inflammation 
Diet
Hormones
Immunosuppression 
Infectious agents 
Obesity 
Radiation 
Sunlight 
Tobacco
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Carcinogenic drivers

A

Proto-oncogene
Gene involved in normal cell growth
Mutations may cause it to become an oncogene- which can cause growth of ca cell

Oncogene
Mutated proto-oncogene

Tumor suppressor gene
Negative regulator of growth factor stimulation
Controls cell growth and division
Suppress or block the development of cancer
Anti-oncogene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cellular or tumor characteristics of cancer

A

Abnormality

Uncontrollability

Invasiveness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Prevalence refers to?
Expressed by?
Pint prevalence?
Period prevalence?

A

Number of cases of disease divided by everyone at risk for the disease

Expressed per 1000 people

Point prevalence- counts only those alive at a particular date in time

Period prevalence- counts all cases, including new cases and all deaths between 2 dates (better measure of disease load)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

When does a person become a cancer survivor?

A

At time of dx

Prevalence = survivorship

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Incidence rates

A

New cases

Frequency of occurrence of new cases of disease or injury in a population over a specified period of time

Denominator(s)…
Summed person-years of observation
Average population (usually what literature uses)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Mortality rate

A

Frequency of death in defined population during a specified interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Childhood cancer

A

Average age at dx : 6 y/o

ALL: Acute lymphocytic leukemia
Brain and other CNS tumors
Neuroblastoma

White and Hispanic children have higher incidence rates

1 in 330 dx by age 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Everyone has a cancer risk, but certain populations are high-risk.
High risk populations?

A
Heavy alcohol use 
Older adults 
Frequent exposure to ca causing substances
Obesity 
Frequent unprotected exposure to sunlight 
High inflammatory dietary habits 
Ca survivors 
Tx including hormones or radiation 
Persons w/ immunosuppression 
Exposure to tobacco or smoke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Median ca age

A

66 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Skin ca lifestyle recommendations

A

Protect w/ sunscreen (products, clothing, hats and visors)

Minimize time in sun between 10am-4pm

Wear dark fabrics

Check skin regularly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lung ca screening recommendations

A

Annual screening with low-dose CT (LDCT) in adults 55-80 who have a 30 pack year smoking history and currently smoke or have quit within past 15 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Breast ca screening recommendations

A

Biennial mammogram aged 50-74

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prostate ca screening recommendations

A

55-69 y/o

Individual decision to do PSA (prostate-specific antigen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Change in bowel or bladder habits

Action to be taken?

A

US and endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A sore that does not heal

Action to be taken?

A

Biopsy and oral and akin examination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

High risk moles - occur after age ?

A

New moles after age 25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Unusual bleeding or discharge in stool

Action to be taken?

A

Rectal exam and colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Unusual bleeding between periods

A

Gyno exam for cervix and biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Thickening or lump in breast or testicles

Action to be taken?

A

US and FNAC if abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Indigestion or difficulty swallowing

Action to be taken?

A

Endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Obvious change in size of mole or mouth sore

Action to be taken?

A

Biopsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Nagging cough or hoarseness

Action to be taken?

A

ENT exam and chest X-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pain warranting more investigation

A

Different tunes- Acute, Chronic/persistent, breakthrough

Different types- nerve, bone, soft tissue, phantom or referred

Nocturnal pain

Doesn’t respond to tx or position change

HA in morning that improves throughout day; may worsen w/ position changes or activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Benign tumor | 7 characteristics
1. Typically slow growing 2. Localized 3. Not invasive 4. Not cancerous 5. Recurrence unlikely 6. Encapsulated 7. End with “oma”
26
Malignant tumor | 11 characteristics
1. Rapid or slow growing 2. Invasive 3. Encapsulated - abnormal cell membranes 4. Cancerous 5. Possible recurrence 6. End in “oma” but has more description regarding pathology (organ or cell of origin) - ex: end in “sarcoma” 7. No normal cell organization/differentiation 8. Lack of control of cell division 9. No contact inhibition 10. Don’t adhere to each other- often break free from mass, invade other tissues 11. Don’t undergo apoptosis
27
Cancer in skin or in tissues that line/cover internal organs
Carcinoma
28
Cancer of bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue
Sarcoma
29
Cancer blood-forming tissue
Leukemia
30
Cancer of immune system cells
Lymphoma and myeloma
31
Cancer of brain and spinal cord tissue
CNS cancer
32
Tumor behaviors- evasion strategies
``` Immune escape: Loss of immunogenicity Antigenic modulation Induction of immune suppression Prevention of NK and T cell activation ```
33
Most common primary ca sites
``` Skin Lung Breast (F) Colorectal Corpus uteri Prostate (M) ```
34
Grading ca
Cell/tissue appearance based on microscopic exam- GX: Grade cannot be assessed G1: well differentiated (low grade) G2: moderately differentiated (intermediate grade) G3: poorly differentiated (High grade) G4: undifferentiated (high grade)
35
Ca staging - specific vs general
Tumor type specific staging takes precedence over general staging guidelines Primary tumors are staged and graded Recurrent lesions are NOT restaged
36
TNM system
T: primary tumor N: regional lymph nodes M: distant metastasis For each: X: cannot be evaluated 0: NO evidence/involvement/metastasis 1-4: size/extent/degree or M1: metastasis
37
Staging ca
0: carcinoma in situ 1: early stage, localized to primary organ 2: increased risk of regional spread 3: local ca spread regionally 4: metastasis
38
Spread of malignant tumors | Invasion
Local spread Tumor cells grow into adjacent tissues and destroy then Ex: uterine carcinoma invades vagina
39
Spread of malignant tumors | Metastasis
Spread to distant sites Via blood or lymph Ex: carcinoma of colon spreads to liver
40
Spread of malignant tumors | Seeding
Implantation Another form of metastasis Spread to distant sites via body fluids or along membranes Ex: ovarian ca spreads through peritoneal cavity
41
Main sites of metastasis | Cancer type: bladder
Bone Liver Lung
42
Main sites of metastasis | Cancer type: breast
Bone Brain Liver Lung
43
Main sites of metastasis | Cancer type: colorectal
Liver Lung Peritoneum
44
Main sites of metastasis | Cancer type: kidney
``` Adrenal gland Bone Brain Liver Lung ```
45
Main sites of metastasis | Cancer type: lung
``` Adrenal gland Bone Brain Liver Other lung ```
46
Main sites of metastasis | Cancer type: melanoma
``` Bone Brain Liver Lung Skin/muscle ```
47
Main sites of metastasis | Cancer type: ovary
Liver Lung Peritoneum
48
Main sites of metastasis | Cancer type: pancreas
Liver Lung Peritoneum
49
Main sites of metastasis | Cancer type: prostate
Adrenal gland Bone Liver Lung
50
Main sites of metastasis | Cancer type: stomach
Liver Lung Peritoneum
51
Main sites of metastasis | Cancer type: thyroid
Bone Liver Lung
52
Main sites of metastasis | Cancer type: uterus
``` Bone Liver Lung Peritoneum Vagina ```
53
#1 site of metastasis
Bone
54
Radiation therapy | Goal, timing and methods
Curative or palliative Timing: Neoadjuvant, intraoperative (IORT), adjuvant External beam, teletherapy Internal radiation, brachytherapy Systemic
55
Radiation planning process | External beam
Simulation: Temp skin marks/tattoos Positioning Tx: 5-10 min Daily 4-6 weeks Measured in Grays (Gy)
56
Radiation therapy | Total dosage effects
40 Gy + Skin effects, hair loss can occur w/ >1 Gy, dryness of glands 50 Gy+ Bone effects 60 Gy+ Soft tissue effects 70 Gy+ Muscle and tendon effects
57
The glycocalyx layer
Semi-permeable membrane which keeps fluid in the interstitial tissues and unable to re-enter the venous system If the glycocalyx is intact, when fluid leaves a vessel it NEVER re-enters it. Venous system is NOT primary mover of interstitial fluid back to the heart
58
Lymphatics return ___% of whatever is leaked into the tissues.
100% Technically all edema in skin is lymphedema
59
The lymph system is a(n) ___ system. Performs ___ not ____.
Open system Performs lymph transport not lymph circulation Flow is created with low pressure dynamics (osmotic/tissue pressures, peristaltic muscle and local physiologic conditions)
60
2 networks of lymph system
Deep and superficial Deep cannot be treated We work with superficial (People don’t live long with deep network problems)
61
Superficial lymph system
Dx and tx performed ONLY in this level Flow of lymph arranges into 6 zones Each have a grouped bed of lymph nodes Each region independent Each region marked by a functional landmark called a WATERSHED All lymph from watershed borders flows towards it’s lymph node bed
62
Lymph node - | Pressures that drive flow
Return to heart: Normal BP Good muscle contraction and tissue pressure Blood protein concentrations (Normal osmotic pressures) Retained in tissue: Gravity Poor tissue pressure
63
Lymphedema often occurs as a result of
Systemic and biomechanical malfunctions
64
Primary lymphedema
Lymphedema from genetic miscoding and anomalies Hyperplasia or Hypoplasia of venous-lymphatic networks Transport of loads become poor as management demands increase Absence of lymphatic structures (aplasia)
65
Primary Lymphedema onset
0-2 years old : congenital lymphedema 2-35 years old: lymphedema praecox > 35 years old: lymphedema tarda
66
Well known genetic syndromes (primary lymphedema)
``` Milroy syndrome Klinefelter syndrome Turner syndrome Meige’s syndrome Lymphedema-distichiasis syndrome ```
67
Secondary causes of lymphatic disease
``` Venous insufficiency Cancer (and related tx) Trauma and injury Obesity Diseases of other systems: renal, CV, hepatic ``` Non-western countries (warmer climates): Filariasis (parasite)
68
Phlebo-lymphedema
Combined insufficiency Most common encounter Lymphatic failure due to chronic venous congestion Common following orthopedic injury or surgery Chronic or morbid overload of lymphatics from severe venous congestion Darkened color
69
Differentiate between types of lymphedema | Venous
``` Darkened skin- hemosiderin staining Hx of major organ failure Improves w/ rest or sleep Low protein edema Wounds Thin shiny skin ```
70
Differentiate between types of lymphedema | Lymphatic
``` Milky white skin tone Hx of lymph nodes removed Minimally reduces w/ sleep High protein edema Wounds or hyperkeratosis ```
71
Differentiate between types of lymphedema | Systemic failure/Generalized edema
Recent weight gain Enlarged abdomen, fullness in face, arms and neck Recent increase in trouble breathing Reports “feels bad” Energy level is less functional than previous week
72
Lymphedema that may indicate recurrence
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, HA, bloating, etc
73
Stemmers sign
Pinch between two fingers Base of 2nd finger/toe (dorsum) W/ true lymphedema can’t pinch bc too thick
74
PT without certification | Lymphedema can treat
General outpatient: Venous insufficiency based lymphedema MILD presentation, systemic issues are not present or are controlled No cancer hx, no acute signs of symptoms Onset correlates to injury or surgery Area of swelling is in one body region of the extremities Swelling < 1 month (Cannot treat any in acute or skilled inpatient without being a Certified lymphedema therapist)
75
Non-complex edema | General outpatient or subacute facility- certification is not needed
Newly presenting, venous insufficiency based edema MILD presentation, systemic issues are NOT present or are controlled No cancer hx, no acute s/s Onset correlates to recent injury or surgery Area of swelling is in ONE area of extremities Swelling present <1 month
76
Complex edema | Outpatient, Acute care or Skilled facility- CERTIFIED lymphedema therapists
Venous, lymphedema or combined/systemic failure Moderate-Severe presentation Onset from any cause Lymphedema in more than 1 region or body part Pt has active cancer or in remission
77
Edema- any symptoms found that may be correlated to infection, cellulitis, DVT, or cancer metastasis/recurrence- patients must be?
Sent back to physician ASAP If provider can’t see pt right away emergency dept may be needed
78
Non complex edema mgmt goals
Reduce edema w/o further damage to the skin from excessively tight compression, blood flow reduction or pain Restore tissue laxity enabling greater ROM, ease of movement, less discomfort/pain Improve functional movement due to decrease pain, tightness/stiffness and improved proprioceptive input Facilitate healing and recovery time due to decreased accumulation of cellular waste, increased perfusion and improved therapy performance Independent self mgmt of variations in swelling Teach pt symptoms of complex edema and where to get help
79
Non complex edema -tx options
Elevation is ok for a reasonable period of rest but is not functional for any therapy progress Simple massage (Lower leg) simple compression bandaging Compressive wear: should be worn when up against gravity Velcro on garments, sports compression wear Less than 20 mmHg
80
Be sure compression is ___. ____ is always less than ___.
Gradient | Proximal is always less than distal
81
Non complex edema -tx options | AVOID vs use
Avoid heat- Use cooling agents (But avoid cooling to the point is producing hyperemic effects) Avoid wrapping with bandages that have “low working pressure” - NO ACE, NO TED HOSE
82
Complex edema and lymphedema- to refer to lymphedema therapist Presentation
2 pitting or more Does not return to 100% normal even on waking or with prolonged elevation Persistent color changes More than 1 body area involved (ex: lower AND upper leg) Oncology based patients (active or remission) If non-pitting, the area is more than 3-4 cm larger than unaffected side Even if think is going to pass...Once persists longer than 3-4 weeks it can damage structures and become chronic
83
Complete decongestive therapy | Certified lymphedema therapists
Manual lymph drainage Multi-layer compression bandaging w/ low elastic properties Daily use of compression garments Exercises for improved lymphatic return Excellent skin care and hygiene
84
Manual lymph drainage (Certified lymphedema therapist) Phase 1: reduction (complete decongestive therapy)
Stimulates lymphatic vessels to uptake proteins and transport them to regional lymph nodes Empties lymph nodes and increases their lymph processing Re-routes lymph flow across watersheds when a lymph region is damaged and cannot receive lymph
85
Multi-layered compression bandaging (Certified lymphedema therapist) Phase 1: reduction (complete decongestive therapy)
Creates palpable compression gradient from distal to proximal end of affected body area, promoting fluid and proteins transport towards receiving lymph node beds When done well, bandaging creates functional, effective, comfortable and durable compression environment
86
Manual lymph drainage (Certified lymphedema therapist) Phase 2: containment, independent maintenance, self care, and compression garments (complete decongestive therapy)
Successful containment of lymph and venous return requires high quality, gradient compression garments that can can comfortably worn throughout the day and often at night Daily self lymph clearing Low impact exercise Stress reduction Flexitouch- pneumatic compression