Adult Oncology Flashcards
(85 cards)
1
Q
Most common forms of cancer
A
Prostate
Breast
Lung/bronchus
2
Q
Oncogene
A
Genes that cause growth
3
Q
Tumor suppressor gene
A
Genes that stop growth
Example: BRCA gene in breast cancer
4
Q
Modifiable Risk Factors
A
Tobacco
Alcohol
Radiation Exposure
Infectious Organisms
5
Q
Non-Modifiable Risk Factors
A
Gene mutations Hormones Immune conditions Age Family history Downs Syndrome Chemotherapy and radiation
6
Q
In situ cancer
A
Starting to break through the basal membrane and gets its own circulatory system
7
Q
Metastases
A
Cancer cells travel to a remote area
Via blood vessels, lymph vessels
NOT the same thing as secondary primary cancer
Distal representation of original cancer cell
8
Q
Sedentary lifestyle risk factors
A
Much higher incidence of certain types of cancer (colorectal)
9
Q
Screening
A
Colonoscopy
Mammogram
Pap smears
Stage I or II can have up to 85% EFS
10
Q
Difference between benign and malignant
A
Basal membrane break through
Whether or not it’s encapsulated
11
Q
Lymphoma
A
Immune system
12
Q
Sarcoma
A
Connective tissue and bone
13
Q
Leukemia
A
Hematopoietic cells
14
Q
Carcinoma
A
Soft tissue
15
Q
TMN Staging
A
Tumor size and extent
Lymph node involvement
Distant metastasis
16
Q
Cancer signs and symptoms
A
Pallor Easy bruising Pain that wakes from sleeping Lymphadenopathy Fatigue Unintentional weight loss
17
Q
Why pallor?
A
Poor circulation
RBC levels
Low Hb
18
Q
Why easy bruising?
A
Low platelets
19
Q
Imaging
A
CT scan PET scan Xray US MRI
20
Q
Needle biopsy
A
FNA - fluid
Core - punch out a core
21
Q
Surgical biopsy
A
Excisional - they take the whole thing out and then test for cancer
Incisional - they’re not taking out the whole thing
22
Q
Lymph node biopsy
A
Sentinel node
Dissection
23
Q
Cancers that have highest risk for lymphedema
A
Breast cancer
Gynecologic cancer
- Uterine
- Ovarian
- Cervical
24
Q
Breast cancer
A
Metastases to bone and brain
Axillary lymph node dissection
Flexion restrictions
Cording/axillary web syndrome
25
Cording/Axillary Web Syndrome
Cording from axilla all the way to the medial elbow
26
Gynecologic Cancers
Retroperitoneal Lymph Node Dissection (RPLND) often performed
27
Head and Neck Cancers
Restrictions in neck ROM post-op
Trismus
28
Trismus
Inability to open your mouth
G-tube
Radiation fibrosis
3-finger rule - if they can fit three fingers between top teeth and bottom teeth
29
Lung Cancer
Metastasizes to bone and brain
Pulmonary health
Oxygen saturation levels
Positioning - chest PT!
"Bone METS? Have they seen ortho or physiatry? In WB, they are at an extremely high risk of pathological fracture"
30
Leukemia and Lymphoma
Perpetually low blood counts...
No resistive exercise
No manual therapy
No high impact
ONLY functional mobility
Stem cell transplant and prolonged isolation
Avascular necrosis
31
Low Hb
Dizziness
Confusion
Pallor
Tachy
32
Low Platelets
Monitor for safety
33
Pediatric Cancer
Developmental delay
| Parent education is extremely important
34
Primary bone tumors
Peaks at growth spurts
Metastasizes to lung
Limb salvage vs amputation
35
Brain tumors
May be inoperable (brainstem)
Level of function changes very quickly
Ommaya reservoir
Steroids and anti-convulsants
36
Ommaya reservoir
Tiny hole drilled into the skull
Balloon subcutaneously in scalp
They can do whatever except for WB on the Ommaya reservoir (headstand)
37
Prostate
Most men die WITH prostate cancer, not FROM it
38
Colorectal, Pancreatic, GI Cancer
Large scale surgeries needed
Early mobilization is KEY
Pancreatic cancer the most aggressive
39
The "Big 3"
Chemotherapy
Surgery
Radiation
40
Additional cancer treatments
Stem cell transplant
Steroids
Clinical trials
41
Mediports
Subcutaneous venous access, typical subclavian
Restrictions...
Placement - none
Removal - avoid excessive stretch and WB for 2 weeks
If your patient is ACTIVELY getting chemotherapy, DON'T SEE THE PATIENT
42
Chemotherapy
Targets rapidly dividing cells
General SE...
Nausea
Mucositis (mouth sores)
Low blood counts
Neutropenia
43
Chemo and target
This makes it very difficult for the patient to make any strength gains
mm mass growth = rapidly dividing cells
44
Chemo agents
Vinca-Alkaloyds
Antrhacycline antibiotics
Alkylating Agent
Platinum Based
45
Vinca-Alkaloyds
Vins
Peripheral neuropathy a dosage limiting factor
```
Long finger flexors and dorsiflexors
Diminished reflexes
Mm cramping
Pain/hypersensitivity
Paralysis
```
***Your patients won't report this because they think their chemo is getting cut back
46
Antrhacycline Antibiotics
Rubicins
Cardiotoxicity...
Cardiomyopathy and CHF
Monitor HR closely, asymptomatic
47
Alkylating Agent
Busulfan
Pulmonary fibrosis...
Low O2 sat
DO NOT USE SUPPLEMENTAL O2
***Their new normal is the lower O2 sat; it will make the PF worse
48
Platinum Based
Platins
High frequency hearing loss
Questionable Vestibular involvement
--Might destroy hair cells that sense motion of the endolymph
49
Peripheral neuropathy
Develops at any phase of treatment
Cast as soon as you see these impairments
Total Contact Custom Molded Foam Lined Solid Ankle AFOs
--No hinge bc they'll just collapse at their forefoot
```
Loss of Achilles tendon reflex
Sensory impairments (N+P)
Weakness/mm atrophy
--Lose of fine motor skills
--Gait disturbance with tripping and falls
```
50
Progression of Peripheral Neuropathy
```
Cramping
Pain
Weakness
Numbness
Paralysis
```
51
"Chemo Brain"
Mental cloudiness
Typically rapid onset
Can be ST or LT
Exact cause is unknown
52
"Chemo Brain" possible causes
```
Disease
Treatment
Low blood counts
Sleep problems
Tiredness
Hormone changes
Nutritional deficiencies
Depression, stress, anxiety, worry, or other emotional pressure
```
53
Incidence of Cancer in Adults
1 in 2 men
1 in 3 women
54
Typical Cycle of Chemo
Chemo week
Neutropenic week
Counts return/week of rest
55
Chemo week
Anti-emetics given
| Typically feel reasonably well
56
Neutropenic week
Chemo is taking effect
Mouth sores, nausea, low counts/energy
Will be admitted if febrile
Not the most productive time to use PT services
57
Counts return/week of rest
Energy returns
58
Radiation types
Intensity Modulated
External Beam
Intra-operative
Brachytherapy
59
Intensity Modulated Radiation (IMRT)
Only modulates if it becomes intense enough to have an effect on the tissues
60
External beam (XRT)
Typical large swath of radiation
61
Intra-operative (IORT)
Radiation therapy in the OR
62
Brachytherapy
Common in prostate cancer
63
Patient energy after radiation
Exhausted
64
Radiation effects
Up to 10 years after treatment
Fibrosis
Skin - lack of glands and follicles; altered sensation; pliability decreased
Organs
65
Bone Marrow Transplant
Subset of stem cell transplant
Diseased cells are killed off with chemotherapy and radiation
Hematopoietic stem cells are replaced with new ones from a donor - peripheral blood, umbilical blood
66
Stem Cell Transplant Types
Autogenic
Allogenic
Syngenic
67
Stem Cell Transplant Sources
Peripheral blood
Cord blood
Bone marrow
68
Matching for SCT
HLA typing
69
Stages of HSCT
```
Admission
Cytoreduction
Day of Rest
Transplant
Engraftment
D/C
```
70
Engraftment
Dangerous part where they are stuck in a room and cannot leave
71
Graft v Host Disease
Graft - transplanted immune system
Host - pt
Systems affected - skin, liver, gout
Acute? Goes away within first 100 days of transplant
Chronic? Does not go away
72
Steroids
Prevents increased ICP
Myopathy
Cushingoid symptoms
73
Blood Counts
G-CSF
Hb
Platelets
Transfusions
ACSM guidelines often do not apply here
74
G-CSF
Counting a protein that stimulates bone marrow to produce granulocytes and stem cells
75
Bone Pain
Platelets and HgB produced in bone marrow
Activity has no effect
No risk of fracture damage
76
Osteoporosis causes
```
Chemo
Radiation
Inactivity
Steroids
Hormone therapy
```
77
Higher risk for osteoporosis
Breast cancer
Prostate cancer
Multiple myeloma
78
Pathological fractures
EMERGENCY
Ortho or physiatry consult if metastatic disease is present
79
Tumor Lysis Syndrome
Fracture through tumor
EMERGENCY
80
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
81
Reasons for referral to PT
```
Diagnosis
Active treatment
Survivorship
Palliative care
Pulmonary
Integumentary
Neurological
Cardiovascular
Muscuoloskeletal
```
82
When to proceed
LE DVT c IVC filter
Platelets > 20, HgB >8
Bone pain from increasing counts
Hydration prior to or following chemotherapy
83
When to modify
Platelets 10-20, HgB 7-8 with special orders
Symptomatic
External VP shunt
84
When to delay
Active chemotherapy infusion
Active blood or platelet transfusion
A-Line
85
When to hold
Following radiation
Following dialysis
DVT
PEG-asparaginase (when monitored every 15 minutes)
