9-26a Cancer

Question 1

What is cancer?

Answer 1

Rapid uncontrollable growth of cells

Question 2

Define neoplasm

Answer 2

(tumor) new tissue growth

spectrum of disease characterized by abnormal growth of cells resulting in distorted tissue architecture

Question 3

What is a malignant tumor?

Answer 3

cancerous tumor

capable of invasion and spread (metastasis)

fast growing

invasive
anaplastic, undifferentiated, immature cells

Question 4

What is a benign tumor?

Answer 4

non-cancerous growth

non-invasive, do not spread, slow growing, encapsulated, well-differentiated cells

Question 5

What is the classification system for a tumor?

Answer 5

Malignant or Benign

Tissue of origin and anatomic location

Question 6

Define dysplastic

Answer 6

abnormal cells that are not cancerous – often precursor to cancerous lesions

Question 7

Define in situ

Answer 7

neoplasm that has not invaded adjacent structures

Question 8

How would you classify a benign and malignant tumor of epithelial tissue (skin, glands, GI, reproductive?)

Answer 8

Benign: Adenoma
Malignant: Carcinoma

Question 9

How would you classify a benign and malignant tumor of connective tissue? (bone, fat, muscle, cartilage)

Answer 9

Benign: tissue type + “oma”
Malignant: sarcoma

Question 10

How would you classify a benign and malignant tumor of connective tissue? (bone, fat, muscle, cartilage)

Answer 10

Benign: tissue type + “oma”
Malignant: sarcoma

Question 11

Benign tumor of fat cells

Answer 11

lipoma

Question 12

Malignant Tumor of squamous cells

Answer 12

squamous cell carcinoma

Question 13

Malignant tumor of basal cells

Answer 13

basal cell carcinoma

Question 14

Malignant tumor of breast glandular cells

Answer 14

breast adenocarcinoma

Question 15

Benign tumor of bone

Malignant tumor of bone

Answer 15

osteoma

osteosarcoma

Question 16

What are the most common cancers for men? women?

Answer 16

Males: prostate, lung, colorectal
Females: breast, lung, colorectal

Question 17

what are the necessary components of cell growth?

Answer 17

Recognize DNA damage or errors in replication

Activate checkpoints to stop further/unnecessary replication

Implement corrective measures or induce apoptosis

Question 18

What are the reasons for loss of control of cell growth?

Answer 18

Genetic
Epigenetic
Abnormal signaling

Question 19

What is epigenetic?

Answer 19

Chronic inflammation from environment activating genetic predisposition (obesity, smoking, hormones)

Question 20

What does abnormal signaling consist of in general?

Answer 20

□ Positive and negative feedback for cell growth

Signaling could be from overactivation of ras pathway

Question 21

What is the most common genetic and epigenetic factors that can lead to tumor formation?

Answer 21

inactivation of tumor suppressor genes (most common)

activation of genetic oncogenes

Question 22

What genetic and epigenetic factors can lead to tumor formation?

Answer 22

inactivation of tumor suppressor genes (most common)
activation of genetic oncogenes
role of viruses (HPV)

Question 23

What are abnormal signaling factors that can lead to tumor formation?

Answer 23

hormone effect (hormone replacement therapy)
angiogenesis: process where blood vessels form in the new tumor; involves increased proliferation of VEGF

Question 24

What are the hallmarks of malignant tumors?

Answer 24

Proliferation: grow and divide faster than healthy cells
Invasion: via basement membrane to nearby CT
Metastatic potential: angiogenesis where cells are seeding into the blood stream and travelling and depositing to distant organs

Question 25

In general, what are common sites of metastases?

Answer 25

bone, liver, brain, lung (and adrenal glands)

Question 26

What are cancer risk factors?

Answer 26

``` Weight Genetics Environmental exposures Viruses/prior infections Immunocompromised state Tobacco Nutrition Physical Activity Alcohol Excess sun exposure ```

Question 27

What does a diagnosis of cancer involve?

Answer 27

Screening Genetic testing Diagnostic imaging CT, MRI, whole-body PET-CT, etc. Clinical manifestations/symptoms and systemic effects Ultimately need biopsy for tissue sample to confirm

Question 28

At what age should people get colonoscopies? mammograms? pap smear? lung? prostate

Answer 28

``` 50 40-50 21 55 with greater than 30 pack year removal of recommendation, if needed at 50 ```

Question 29

What are signs and warnings of cancer?

Answer 29

``` Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharged Thickening or lump (in breast or elsewhere) Inability to swallow food easily Obvious change in a wart or mole Nagging cough or hoarseness Unexplained weight loss Loss of appetite Weakness and fatigue Anemia Pain Organ-specific ```

Question 30

What are organ specific warnings of cancer?

Answer 30

``` Liver: jaundice, ascites Lung: dyspnea, cough Bone: fractures, pain Brain: confusion, loss of coordination Breast: nipple discharge, skin changes Colon: constipation ```

Question 31

What is grading of cancer? What are the grades?

Answer 31

how abnormal is the cell? 1: almost normal, well-differentiated 3-5: so undifferentiated and anaplastic, hard to recognize cell of origin

Question 32

What is staging for cancer?

Answer 32

tumor (size and degree of local invasion), nodes (regional lymph nodes affected), and metastases (TNM) system 0-3 roughly

Question 33

What are some cancer treatments?

Answer 33

hormone therapy, surgery, bone marrow transplant, chemotherapy, targeted therapy, radiation therapy, immunotherapy

Question 34

What can we treat for?

Answer 34

curative intent: (5 year disease-free survival) palliative: improve symptom burden and QOL Hospice: expected <6 months PT is an option for all of these phases (gain strength for treatment or home hospice)

Question 35

What are the roles of PT and cancer?

Answer 35

Prevention, Detection, and Treatment

Question 36

How does PT prevent cancer?

Answer 36

Anti-inflammatory benefits of physical activity/exercise | Promotion of healthy lifestyle

Question 37

How does PT detect cancer?

Answer 37

Skin checks | Identification of CAUTION symptoms or concerning pain patterns

Question 38

How does PT treat cancer?

Answer 38

Quality of life and psychosocial effects (Improved compliance with treatment) Functional status/ability to receive treatment (Cardiovascular, metabolic and immune function) patients need an ECOG of 0-2 for chemo Anti-inflammatory benefits (Improved survival in physically active patients)

Question 39

What cancer comorbities can PT help treat?

Answer 39

Post-operative deconditioning and mobility Cancer-related fatigue Chemotherapy-related cognitive impairment Lymphedema Radiation Fibrosis

Question 40

What are some precautions PT should take when working with patients with cancer? When is it emergent? When is it urgent?

Answer 40

Emergent: Sudden onset or worsening shortness of breath Sudden onset of lower extremity/calf swelling or pain Sudden worsening muscle weakness or neurologic deficit Unstable vital signs ``` Urgent: Increase or change in pain New palpable mass Worsening or new lymphedema Worsening mental status Change in continence ```