Anglund Bedfast/ Oncology Flashcards
Adult Primary Cancers – Bone Metastases
Breast Thyroid Lung Kidney Prostate
(BLT with kosher pickle)
Adult Primary Cancers - Spinal Cord Metastases
Lung
Breast
Colon
Sarcoma
Adult Primary Bone Cancers
Marrow origin:
- Multiple Myeloma (most common – peaks between age 50-60)
- Lymphoma
- Leukemia
Matrix and fibrous tumors:
- Osteosarcoma (most common – 75% in age 20 or younger)
- Chondrosarcoma (age 40 or older)
- Ewing Sarcoma (80% 20 yrs or younger)
Adult Joint Involvement
Metastatic process Primary tumor Paraneoplastic syndromes (intrathoracic tumors)
Adult Muscle and Skin Involvement
Tumors can metastasize to muscles and cause pain and decreased function due to muscle or nerve compression
These masses may be small and deep-seated
Dermatomyositis and polymyositis have a progressive proximal muscular weakness and is associated with lung and gastric cancer 50% of the time
Acanthosis nigricans is associated with gastric or abdominal malignancies
Pediatric Cancer Incidence
Leukemias (26.5%) Acute lymphoblastic leukemia (19%) CNS tumors (17.7%) Lymphomas (14.6%) Other (10.3%) Thyroid (4%), melanoma (3.4%) Soft tissue sarcoma (7%) Germ cell (6.4%) Bone tumor (5.3%) Neuroblastomas (4.8%) Renal tumor (3.9%)
Pediatric Cancer- MSK
Malignant musculoskeletal tumors account for approximately 12% of malignant neoplasms of childhood
Most common are:
Osteosarcoma – during puberty, around the knee
Ewing’s sarcoma
Rhabdomyosarcoma
** Pain is the most common presenting symptom
Bone Metastases Incidence
Cancer causes less than 1% of back pain in the general population
98% of known cancer patients who present with back pain have underlying metastases
Up to 1/3 of patients with cancer develop metastases to the spine
Bone Metastases- general
Pain is the most common presenting symptom
Localized, constant bone pain is the hallmark
Often begins as dull and intermittent but worsens steadily, often over several days or weeks
Pain at night and at rest is common
Common sites are the vertebral column (esp thorax), skull, humerus, ribs, pelvis, and femur
Red Flags
Unexplained musculoskeletal pain
Pain in spine or proximal extremities (hips, thighs, shoulders) that doesn’t correlate with a known injury
Night or rest pain
Pain referral patterns
High cervical spine mets – posterior headache
C7-T1 – interscapular pain
T12-L1 – flank, iliac crest, or sacroiliac joint
Sacral destruction – saddle distribution
flow chart for MSK pain
pain at rest? no– probably not cancer
yes– x-rays. Suspicious?
no–> whole body bone scan
yes–> metastatic workup, computed tomography of chest, abdomen, and pelvis plus lab eval
Treatment
OMT Pain management (opiates) Assessment for impending fracture or other complication Chemotherapy, radiation, systemic radionucleotides, hormone therapy, bisphosphonate therapy Surgery Emotional/Spiritual support -- Forgiveness Nutritional
OPP principles
The body is a unit; the person is a unit of body, mind, and spirit.
The body is capable of self-regulation, self-healing, and health maintenance.
Structure and function are reciprocally interrelated.
Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.
Why treat a cancer patient with OMT?
Why not?
Optimization of function especially visceral
Pain reduction
Comfort of touch
Mitigate “side effects” of other treatments
Empowers patients to live until they die.
Emotional support – reduces tension and stress
