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Examine Complex Patient 6671 > Week6 6671/6611 > Flashcards

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
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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

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3
Q

Cellular or tumor characteristics of cancer

A

Abnormality

Uncontrollability

Invasiveness

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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)

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5
Q

When does a person become a cancer survivor?

A

At time of dx

Prevalence = survivorship

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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)

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7
Q

Mortality rate

A

Frequency of death in defined population during a specified interval

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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

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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
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10
Q

Median ca age

A

66 y/o

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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

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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

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13
Q

Breast ca screening recommendations

A

Biennial mammogram aged 50-74

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14
Q

Prostate ca screening recommendations

A

55-69 y/o

Individual decision to do PSA (prostate-specific antigen)

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15
Q

Change in bowel or bladder habits

Action to be taken?

A

US and endoscopy

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16
Q

A sore that does not heal

Action to be taken?

A

Biopsy and oral and akin examination

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17
Q

High risk moles - occur after age ?

A

New moles after age 25

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18
Q

Unusual bleeding or discharge in stool

Action to be taken?

A

Rectal exam and colonoscopy

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19
Q

Unusual bleeding between periods

A

Gyno exam for cervix and biopsy

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20
Q

Thickening or lump in breast or testicles

Action to be taken?

A

US and FNAC if abnormal

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21
Q

Indigestion or difficulty swallowing

Action to be taken?

A

Endoscopy

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22
Q

Obvious change in size of mole or mouth sore

Action to be taken?

A

Biopsy

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23
Q

Nagging cough or hoarseness

Action to be taken?

A

ENT exam and chest X-ray

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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

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25
Q

Benign tumor

7 characteristics

A
  1. Typically slow growing
  2. Localized
  3. Not invasive
  4. Not cancerous
  5. Recurrence unlikely
  6. Encapsulated
  7. End with “oma”
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26
Q

Malignant tumor

11 characteristics

A
  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
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27
Q

Cancer in skin or in tissues that line/cover internal organs

A

Carcinoma

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28
Q

Cancer of bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue

A

Sarcoma

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29
Q

Cancer blood-forming tissue

A

Leukemia

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30
Q

Cancer of immune system cells

A

Lymphoma and myeloma

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31
Q

Cancer of brain and spinal cord tissue

A

CNS cancer

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32
Q

Tumor behaviors- evasion strategies

A 
Immune escape: 
Loss of immunogenicity 
Antigenic modulation 
Induction of immune suppression 
Prevention of NK and T cell activation
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33
Q

Most common primary ca sites

A 
Skin
Lung 
Breast (F)
Colorectal 
Corpus uteri 
Prostate (M)
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34
Q

Grading ca

A

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)

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35
Q

Ca staging - specific vs general

A

Tumor type specific staging takes precedence over general staging guidelines

Primary tumors are staged and graded
Recurrent lesions are NOT restaged

36
Q

TNM system

A

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
Q

Staging ca

A

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
Q

Spread of malignant tumors

Invasion

A

Local spread

Tumor cells grow into adjacent tissues and destroy then

Ex: uterine carcinoma invades vagina

39
Q

Spread of malignant tumors

Metastasis

A

Spread to distant sites
Via blood or lymph

Ex: carcinoma of colon spreads to liver

40
Q

Spread of malignant tumors

Seeding

A

Implantation

Another form of metastasis
Spread to distant sites via body fluids or along membranes

Ex: ovarian ca spreads through peritoneal cavity

41
Q

Main sites of metastasis

Cancer type: bladder

A

Bone
Liver
Lung

42
Q

Main sites of metastasis

Cancer type: breast

A

Bone
Brain
Liver
Lung

43
Q

Main sites of metastasis

Cancer type: colorectal

A

Liver
Lung
Peritoneum

44
Q

Main sites of metastasis

Cancer type: kidney

A 
Adrenal gland 
Bone 
Brain 
Liver 
Lung
45
Q

Main sites of metastasis

Cancer type: lung

A 
Adrenal gland 
Bone 
Brain 
Liver 
Other lung
46
Q

Main sites of metastasis

Cancer type: melanoma

A 
Bone 
Brain 
Liver 
Lung 
Skin/muscle
47
Q

Main sites of metastasis

Cancer type: ovary

A

Liver
Lung
Peritoneum

48
Q

Main sites of metastasis

Cancer type: pancreas

A

Liver
Lung
Peritoneum

49
Q

Main sites of metastasis

Cancer type: prostate

A

Adrenal gland
Bone
Liver
Lung

50
Q

Main sites of metastasis

Cancer type: stomach

A

Liver
Lung
Peritoneum

51
Q

Main sites of metastasis

Cancer type: thyroid

A

Bone
Liver
Lung

52
Q

Main sites of metastasis

Cancer type: uterus

A 
Bone 
Liver 
Lung
Peritoneum 
Vagina
53
Q

1 site of metastasis

A

Bone

54
Q

Radiation therapy

Goal, timing and methods

A

Curative or palliative

Timing: Neoadjuvant, intraoperative (IORT), adjuvant

External beam, teletherapy
Internal radiation, brachytherapy
Systemic

55
Q

Radiation planning process

External beam

A

Simulation:
Temp skin marks/tattoos
Positioning

Tx:
5-10 min
Daily 4-6 weeks
Measured in Grays (Gy)

56
Q

Radiation therapy

Total dosage effects

A

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
Q

The glycocalyx layer

A

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
Q

Lymphatics return ___% of whatever is leaked into the tissues.

A

100%

Technically all edema in skin is lymphedema

59
Q

The lymph system is a(n) ___ system. Performs ___ not ____.

A

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
Q

2 networks of lymph system

A

Deep and superficial

Deep cannot be treated
We work with superficial

(People don’t live long with deep network problems)

61
Q

Superficial lymph system

A

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
Q

Lymph node -

Pressures that drive flow

A

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
Q

Lymphedema often occurs as a result of

A

Systemic and biomechanical malfunctions

64
Q

Primary lymphedema

A

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
Q

Primary Lymphedema onset

A

0-2 years old : congenital lymphedema

2-35 years old: lymphedema praecox

> 35 years old: lymphedema tarda

66
Q

Well known genetic syndromes (primary lymphedema)

A 
Milroy syndrome 
Klinefelter syndrome 
Turner syndrome
Meige’s syndrome 
Lymphedema-distichiasis syndrome
67
Q

Secondary causes of lymphatic disease

A 
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
Q

Phlebo-lymphedema

A

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
Q

Differentiate between types of lymphedema

Venous

A 
Darkened skin- hemosiderin staining 
Hx of major organ failure 
Improves w/ rest or sleep 
Low protein edema 
Wounds 
Thin shiny skin
70
Q

Differentiate between types of lymphedema

Lymphatic

A 
Milky white skin tone 
Hx of lymph nodes removed 
Minimally reduces w/ sleep 
High protein edema 
Wounds or hyperkeratosis
71
Q

Differentiate between types of lymphedema

Systemic failure/Generalized edema

A

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
Q

Lymphedema that may indicate 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, HA, bloating, etc

73
Q

Stemmers sign

A

Pinch between two fingers
Base of 2nd finger/toe (dorsum)

W/ true lymphedema can’t pinch bc too thick

74
Q

PT without certification

Lymphedema can treat

A

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
Q

Non-complex edema

General outpatient or subacute facility- certification is not needed

A

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
Q

Complex edema

Outpatient, Acute care or Skilled facility- CERTIFIED lymphedema therapists

A

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
Q

Edema- any symptoms found that may be correlated to infection, cellulitis, DVT, or cancer metastasis/recurrence- patients must be?

A

Sent back to physician ASAP

If provider can’t see pt right away emergency dept may be needed

78
Q

Non complex edema mgmt goals

A

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
Q

Non complex edema -tx options

A

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
Q

Be sure compression is ___.

____ is always less than ___.

A

Gradient

Proximal is always less than distal

81
Q

Non complex edema -tx options

AVOID vs use

A

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
Q

Complex edema and lymphedema- to refer to lymphedema therapist
Presentation

A

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
Q

Complete decongestive therapy

Certified lymphedema therapists

A

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
Q

Manual lymph drainage
(Certified lymphedema therapist)
Phase 1: reduction
(complete decongestive therapy)

A

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
Q

Multi-layered compression bandaging
(Certified lymphedema therapist)
Phase 1: reduction
(complete decongestive therapy)

A

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
Q

Manual lymph drainage
(Certified lymphedema therapist)
Phase 2: containment, independent maintenance, self care, and compression garments
(complete decongestive therapy)

A

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

Examine Complex Patient 6671 (8 decks)

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