Adult Oncology Flashcards
(73 cards)
1
Q
Three most common cancers in children?
A
leukemia, CNS tumors, lymphoma
2
Q
Three most common cancers in adults?
A
Breast, prostate, lung
3
Q
Genetic pathophysiology? (3)
A
Gene mutations
Proto-oncogene vs. Oncogene
Tumor suppressor gene
4
Q
Gene mutations - vast are? Some?
A
Vast majority are acquired
Some inherited
5
Q
What’s an oncogene? What suppresses it? What happens in cancer btwn these two?
A
- gene that causes growth
- tumor suppressors stop it
- Nice balance btwn the two in a healthy individual, in cancer you have that either the tumor suppressing gene isn’t working well enough or oncogene is overactive
6
Q
Modifiable cancer risk factors? (4)
A
Tobacco
Alcohol
Radiation Exposure
Infectious Organisms
7
Q
Non- Modifiable cancer risk factors? (7)
A
Gene mutations Hormones Immune conditions Age Family history Downs Syndrome Chemotherapy and radiation
8
Q
Sequence of errors in cell division that lead to cancer?
A
hyperplasia (bundle of cells) -> dysplasia (bundle of non recognizable cells, atypical and disorganized) -> in situ CA (breaks through the membrane) -> Invasive CA (breaks into circulatory system and can travel anywhere)
9
Q
What is metastases? Travel how? (2) Not the same as? What is it?
A
- Cancer cells travel to a remote area
- Blood vessels
- Lymph vessels
- Not the same thing as a second primary: not a cause and effect, just another primary cancer
10
Q
CA prevention? (5)
A
Tobacco and alcohol use Viruses and infection Sedentary lifestyle 1 UV Exposure Screening
11
Q
What is the difference between benign and malignant?
A
All tumors are considered cancers, but it could be malignant (has ability to mestasize) or benign (position or size could be problematic)
12
Q
CA types and their locations - lymphoma? Sarcoma? Leukemia? Carcinoma?
A
- immune system
- connective tissue and bone
- hematopoietic cells
- soft tissue
13
Q
How do you name the stages?
A
T - 1° tumor size & extent
N - Lymph node involvement
M - Distant metastasis
14
Q
Signs and Symptoms? (6)
A
- Pallor - low CBC, low hemoglobin and platelets
- Easy bruising - low platelet levels, less clotting. Bruising is subcutaneous bleeding
- Pain that wakes from sleeping
- Lymphadenopathy
- Fatigue
- Unintentional weight loss
15
Q
Diagnoses? (3)
A
- imaging
- blood tests
- biopsy
16
Q
What types of imaging are done? (5)
A
CT Scan PET Scan X-Ray Ultrasound MRI
17
Q
What types of blood tests are done?
A
CBC
Peripheral blood smear
18
Q
What types of biopsies are done? (2) Subtypes under each? (2)
A
- Needle FNA Core - Surgical Excisional (take whole thing out) Incisional (take small piece out) - Lymphnodes Sentinel node Dissection
19
Q
Breast cancer concerns? (4)
A
- Metastases to bone and brain: may present like stroke, confusion, personality change
- Axillary lymph node dissection bc breast tissue is really close to lymph nodes
- Flexion restrictions after surgery
- Cording/Axillary Web Syndrome
20
Q
What’s often performed with gynecologic CA?
A
Retroperitoneal Lymph Node Dissection (RPLND) often performed
21
Q
Head and Neck concerns? (2) 3 things pertaining to the second concern?
A
- Restrictions in neck ROM post-op: guardian stitch, head stitched to neck
- Trismus: inability to open mouth due to radiation to side of face
» G-tube
» Radiation fibrosis
» 3 finger rule - able to get them btwn teeth = typical mouth open size
22
Q
Lung CA concerns? (4)
A
- Metastasizes to bone and brain
- Pulmonary health
- Oxygen saturation levels
- Positioning
23
Q
Leukemia & Lymphoma concerns? (5) PT precautions?
A
- Perpetually low blood counts
- Stem cell transplant and prolonged isolation
- Avascular Necrosis
- Tachycardia
- Low platelets - monitor for falls
- No high impact, manual therapy, or resistance
24
Q
Concern in peds? What’s important?
A
- Developmental delay
- Parent education is extremely important
25
Primary Bone Tumors - peak at? Mestasizes to? Two options?
- Peaks at growth spurts
- Metastasizes to: lung
- Limb salvage vs. amputation
26
Brain tumors may be? What changes quickly? Treatments? (3) Any PT restrictions?
- May be inoperable
- Level of function changes very quickly
- Ommaya reservoir: bubble underneath scalp bc blood brain barrier keeps big molecules out. Pour chemo into it. No PT restrictions.
- Steroids and anti-convulsant
27
Prostate CA - most men die how? Colorectal, Pancreatic, and GI CA - what's needed?
- Most men die with prostate cancer, not from it
- Large scale surgeries needed, early mobilization is key
>> Zero survival rate
28
What are the big 3 in terms of types of tx? Additional tx? (3)
Chemotherapy
Surgery
Radiation
Stem cell transplant
Steroids
Clinical trials
29
What are mediports? Restrictions? Removal?
- Subcutaneous venous access
Restrictions
- Placement: None
- Removal: avoid excessive stretch and weight bearing for 2 weeks
30
Chemo targets? SE? (4)
Targets rapidly dividing cells
Nausea
Mucositis (“mouth sores”)
Low blood counts
Neutropenia
31
Vinca-alkaloyd types? (3) Causes? (6) What is CIPN? Pts often?
Vincristine
Vinblastine
Vinorelibine
- Peripheral Neuropathy
- Long finger flexors and dorsiflexors
- Diminished reflexes
- Muscle cramping
- Pain/hypersensitivity
- Paralysis
- CIPN: chemo-induced peripheral neuropathy: pts will under report bc it's a dosage limiter
32
Antrhacycline Antibiotics types? (4) Can cause? (3) Dangerous why? Responds well to?
Doxorubicin
Danorubicin
Epirubicin
Idarubicin
- Cardiotoxicity
- Cardiomyopathy and CHF
- Monitor HR closely, asymptomatic
- Responds well to training
33
Alkylating Agent? Causes? (3) What should you avoid giving them?
- Busulfan
- Pulmonary Fibrosis
- Low O2 Sat
- Do not use supplemental oxygen
34
Platinum Based agents? (3) Cause? (2)
Cisplatin
Carboplatin
Nedaplatin
Hearing Loss, Vestibular Involvement
35
Peripheral Neuropathy - develops when? Causes? (7)
- Develops at any phase of treatment
- Loss of Achilles tendon reflex
- Sensory impairments
- Numbness
- Parasthesia
- Weakness/muscle atrophy
- Loss of fine motor skills
- Gait disturbance with tripping and falls
36
What should you do immediately upon first signs of symptoms? Prognosis?
- cast it immediately to create custom molded, foam-lined SFOs to avoid skin breakdown
- resolves over time
37
Progression of Peripheral Neuropathy? (5)
cramping -> pain -> weakness -> numbness -> paralysis
38
What is chemo brain? Symptoms? (5) What kind of onset? How long does it last?
- Mental “cloudiness”
- Lapses in memory
- “spacing out” and difficulty concentrating
- Multitasking becomes difficult
- Increased processing time
- Word recall
- Typically rapid onset
- Can be short term or long term
39
Chemo brain etiology? (9)
- Exact cause is unknown
- Disease
- Treatment
- Low blood counts
- Sleep problems
- Tiredness (fatigue)
- Hormone changes or hormone treatments
- Nutritional deficiencies
- Depression, stress, anxiety, worry, or other emotional pressure
40
Typical “Cycle”? (3)
chemo week
neutropenic week
counts return/week of rest
41
What happens during chemo week? (2) Neutropenic week? (3) Counts return week? (1)
```
- Chemo week
>> Anti-emetics given
>> Typically feel reasonably well
- Neutropenic week
>> Chemo is taking effect
>> Mouth sores, nausea, low counts/energy bc rapidly dividing cells aren't dividing and low immune system
- Will be admitted if febrile (feverish)
- Counts return/week of rest
Energy returns
```
42
Might not be worth seeing patients during what week?
Neutropenic
43
Radiation types? Describe each
- Intensity Modulated (IMRT): radiation comes from all different angles, only overlaps and becomes intense enough where the tumor is
- External Beam (XRT): typical large swatch of radiation, whole body
- Intra-operative (IORT): radiation in Or (open and exposed)
- Brachytherapy- radiative pieces of metal
44
How long does radiation stay in our system? Causes? Of? What does it do to the first? (3)
- Up to 10 years after treatment
- Fibrosis
>> Skin
Lack of glands and follicles
Altered sensation
Pliability
>> Organs
45
What is a “bone marrow transplant?” (2) BMT is a subset of? Donors can come from? (2) Pts are? Why?
- Diseased cells are killed off with chemotherapy, radiation
- Hematopoietic stem cells are replaced with new ones from a donor
- BMT is a subset of stem cell transplant
- They can come from peripheral blood, umbilical cord
- Pts are sequestered bc you're killing their immune system
46
Stem Cell Transplant types? (3) Source? (3) Matching?
```
- Types
Autogenic
Allogenic
Syngenic
- Source
Peripheral Blood
Cord Blood
Bone Marrow
- Matching
HLA Typing
```
47
Stages of HSCT (hematopoetic stem cell transplant)? (6)
admission -> cytoreduction (kill off immune system) -> day of rest -> transplant -> engraftment (stuck in room and can't leave) -> d/c
48
What is graft vs host disease? Systems affected? (3)
- host attacking immune system; rejecting graft
- Skin
Liver
Gut
49
Steroids prevent? Causes? (2)
- Prevents increased ICP
- Myopathy
- cushingoid symptoms
50
When should you be on bed rest?
Platelets below 20 and Hgb below 8
51
Bone pain can be caused by? (2) Restrictions? (2)
- Platelets and HgB are produced in the bone marrow
- Small medullary canal, large bone thikness - pain 2/2 counts coming back
- Activity has no effect
- No risk of fracture or damage
52
Osteoporosis can be caused by? (5) Who's at a higher risk? (3)
```
Causes
Chemo
Radiation
Inactivity
Steroids
Hormone Therapy
```
Higher risk
Breast cancer
Prostate cancer
Multiple myeloma
53
Pathological fx is a? What's needed?
EMERGENCY
| Ortho or Physiatry consult if metastatic disease is present
54
What is Cancer Related Fatigue (CRF)?
Distressing persistent, subjective sense of physical, emotional and/or cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity and interferes with usual functioning.
55
CRF contributing factors? (4)
Environment
Personal/behavioral
Cultural/family
Tx
56
How does environment contribute to CRF? (4)
- Return or stay in treatment area
- Long waits
- Altered schedule and routine
- High cognitive demand situations
57
How does personal/behavior contribute to CRF? (2)
- Negative belief in ability to perform activity
| - Altered sleep patterns
58
How does cultural/family contribute to CRF? (3)
- Adversely affected by others emotions, moods, concerns
- Restricted activity when not indicated
- Others push to perform too much activity
59
How does treatment contribute to CRF? (6)
- Exams
- Not enough recovery time between treatments
- Metabolic changes
- Poor nutrition
- Adverse effects to treatment
- Stage of treatment
60
How does environment alleviate CRF? (4)
- Rest, sleep patterns
- Schedule awake and sleep times
- Shorten clinic visit
- Decrease stimulation around child
61
How does personal/behavior alleviate CRF? (5)
- Focus on child’s ability
- Encourage child to voice concerns
- Allow choices
- Encourage exercise
- Allow choices
62
How does cultural/family alleviate CRF? (4)
- Modify family schedule for when child has more energy
- Quiet and rest periods
- Create realistic expectations
- Avoid limiting activities unnecessarily
63
How does treatment alleviate CRF? (3)
- Monitor nutrition and hematologic status
- Evaluation of interventions
- Blood products as needed
64
Cancer Treatment Stages and Physical Therapy - pretreatment phase - evaluation? Intervention? (2)
- Baseline
- Strengthening and conditioning
- Education on potential treatment related activity and participation limitations
65
Cancer Treatment Stages and Physical Therapy - active care - evaluation? Intervention? (2)
- Address specific impairments, - episodes of care inpatient and outpatient
66
Cancer Treatment Stages and Physical Therapy - Post care/
| Maintenence - evaluation? Intervention? (2)
- tx effects
- Address specific impairments and conditioning.
- Return to activity and participation based on patient’s goals.
67
Cancer Treatment Stages and Physical Therapy - palliation - evaluation? Intervention? (4)
- Driven by patient’s goals
- Focus on patient/family goals. - Improve quality of life.
- Maximize functional skills.
- Durable medical equipment needs
68
Reasons for Referral - diagnosis? Active tx? (5)
- Patient and family education
- Post-surgical rehabilitation
- Peripheral neuropathy
- Deconditioning
- Neurological deficits
- Steroid myopathy
69
Reasons for Referral - survivorship? Palliative care? (2)
- Long term effects of treatment
- Quality of life
- Comfort
70
Reasons for Referral - pulmonary? (4) Integumentary? (2) Neurological? (7)
Post-op
Pulmonary metastases
Infection
Pulmonary fibrosis
Radiation fibrosis
Axillary web syndrome
```
Primary tumor
>> Brain tumor
>> Nerve sheath tumors
>> Cord compression
Peripheral neuropathy
Encephalopathy
Sensory processing
```
71
Reasons for Referral - cardiovascular? (6) Musculoskeletal? (6)
```
Decreased Endurance
Prolonged isolation
Post-op activity limitations
Chemo Induced
Cardiomyopathy
CHF
```
```
Decreased strength
Postural deviation
Altered weight bearing
Post-op Rehabilitation
Steroid myopathy
Avascular necrosis
```
72
Scheduling Treatment Sessions - when to proceed? (4) When to modify? (3)
- Lower extremity DVT with IVC filter
- Platelets > 20, HgB > 8
- Bone pain from increasing counts
- Hydration prior to or following chemotherapy
- Platelets 10-20, HgB 7-8 with special orders
- Symptomatic
- External VP shunt
73
Scheduling Treatment Sessions - when to delay? (3) When to hold? (4)
Active chemotherapy infusion
Active blood or platelet transfusion
A-Line
Following radiation
Following dialysis
DVT UE or no filter
PEG-asparaginase
