Cancer Flashcards
(191 cards)
1
Q
How is cancer defined/characterized
A
Abnormal cells that divide without control over division. DNA of cells becoming damaged leading to abnormal gene function
2
Q
What are the differences in structure between a normal cell and a cancer cell?
A
Normal: large cytoplasm, single nucleus with smooth border, single nucleolus, fine chromatin
Cancer: small cytoplasm, multiple nuclei with irregular border, multiple large nucleolus, coarse chromatin
3
Q
True or false hyperplasia of cells is abnormal tissue
A
False. Hyperplasia is still an abnormality in the transition to invasive cancer, but at this point it is still normal tissue, just an increase in the number of normal cells
4
Q
Describe the 5 steps from a normal cell to invasive cancer
A
normal cell –> cell mutation –>hyperplasia (normal tissue) –> dysplasia –> cancer in situ (more abnormal than normal cells) –> invasive cancer
5
Q
Describe dylpasia
A
Abnormal changes in cellular shape, size or organization. There is a replacement of a mature cell type with a less mature cell type.
6
Q
True or false, in situ tumors do not invade the basement membrane
A
true
7
Q
True or false, benign tumors continue to grow in size abnormally
A
true, however they will not invade other unrelated tissues or organs in the body
8
Q
Describe a malignant tumor
A
Cells that invade the basement membrane and invade other parts of the body
9
Q
Name two ways malignancy occurs
A
Direct extension: neighboring organs, tissues
Indirect extension: to distant sites via the vascular, lymphatic system or seeding of CA cells into body cavities
10
Q
Carcinoma arises from what tissue?
A
Skin or tissues that line or cover internal organs
11
Q
How are cancer categorized?
A
The tissue which they arise
12
Q
Sarcoma arises from
A
supportive and CT: bone, cartilage, fat, muscle, blood vessels
13
Q
Which is more malignant carcinoma or sarcoma?
A
Sarcoma
14
Q
Where does leukemia arise from
A
blood forming tissue/bone marrow
15
Q
Where does lymphoma and myeloma arise from
A
cells of the immune system
16
Q
Where does CNS cancer arise from
A
brain and SC
17
Q
Most breast cancers are categorized as what kind?
A
Carcinoma
18
Q
how many CA survivors are there in the US
A
15.5 million
19
Q
Talk about the overall estimated trends in cancer prevalence and survivor rate
A
CA survivors is going to increase, however more people are going to be diagnosed with CA
20
Q
What is the most prevalent CA among men? women?
A
Prostate
Breast
21
Q
What is a major risk factor for CA?
A
AGE: the older you are the more at risk
22
Q
What is the lifetime probability of having cancer in your lifetime for males? females?
A
Males: 1 in 2
Females: 1 in 3
23
Q
Where age is 89% of CA prevalence located?
A
50+
24
Q
True or false, more people are surviving their CA diagnosis as time goes on
A
true
25
What are african american women more likely to be diagnosed with?
triple negative breast cancer, they are not positive on three hormone receptors making it much more difficult to breast
26
True or false, african americans have lower survival rates than whites for most cancer types
true: later stage diagnosis, lower likelihood of receiving quality treatment, triple negative breast cancer
27
What cancer is the leading cause of death in men an women?
lung and bronchus CA
28
What mechanism does radiation work through vs. chemotherapy?
Radiaiton: direct damage to DNA (CA cells are more fragile than healthy ones so they will die more easily)
Chemotherapy: targets an aspect of cell growth cycle
29
Name the phases of the proliferative cycle
GI: postmiotic period - protein synthesis and cell growth
Synthesis: DNA replication
G2: premiotic: cell checks DNA and gets ready to divide
Mitosis: cell division
30
Chemo agents target what?
Either one phase of cell growth (postmitotic, synthesis, premitotic, mitosis) or all phases
31
Define neoadjuvant chemotherapy
before surgery: shrinks the CA to allow it to be removed
32
Define adjuvant chemotherapy
after surgery: used to kill undetected cells that have traveled from the tumor
33
Metastatic disease
goal is to keep CA at bay
34
Name the neurotoxic chemotherapy agents
- Taxanes: commonly used with breast cancer
- Alkaloids
- Platinum based
- epothilones
- PI
- Thalidomine and lenalidomide
- Eribulin
- Nelarabine
35
Chemotherapy targets what kind of cells
rapidly dividing ones
36
What is alopecia
hair loss
37
What is the premise of targeted therapy
specifically attach to different receptors on CA hormones
38
How do targeted therapies differ from standard chemo?
Targeted act on specific molecular targets where chemo acts on all rapidly dividing cells
Targeted are cytostatic (block proliferation) and chemo is cytotoxic (kill cells)
39
What kind of therapy is SERM and Aromatase inhibitor? and what are they generally used for?
Hormone therapy commonly used for breast cancer
40
What kind of therapy is HER2 and herceptin and what CA is it gernally used for?
Monoclonal antibodies used for breast cancer
41
Autologous, syngeneic, allogenic transplants generally used for what kind of CA?
Blood/liquid
42
Define: autologous, syngeneic, allogenic in terms of transplants
Autologous: your own stem cells have been removed and used
Syngeneic: identical twin
Allogenic: someone who is a relatively close match to you
43
What is BMT and PBSCT?
And why are they used in cancer treatment?
What types of CA are treated with it?
BMT: bone marrow translplant
PBSCT: peripheral blood stem cell transplantation
Used in CA treatment bc with high dose chemo and/or radiation can destroy pts bone marrow. They can no longer make WBC, WBC, platelets. This allows them to
Commonly used in liquid CA's (leukemia, lymphoma, multiple myeloma, neuroblastoma)
44
How are stem cell transplantations received? and how long does an individual stay in the hospital for?
IV then you wait for engraftment (in hospital for 100 days)
45
What is GVHD
graft vs. host disease: long term complication of transplants
46
Name some less common treatments of CS
vaccines, cyrosurgery, hyperthermia, lasers, photodynamic
47
Name the 3 decreasing CA diagnosis
3 increasing?
Decreasing: Colorectal, prostate, lung
Increasing: thyroid, melanoma, liver
48
50% of CA death due to which four diagnoses
Lung, prostate, breast, colorectum
49
BRCA 1 and 2 are what?
tumor suppressor genes, therefore when they have a mutation cells go crazy
50
Change in CA population in head and heck cancers
Then and now
Whats the difference?
Then: 50+ males, alcohol and tobacco use
Now: 30+ females or males, no h/o ATOH or smoking
Difference = HPV!
51
Breast CA screening recommendations
40?
45-54?
>55?
Known BRCA mutation, 1st degree relative, 25% lifetime risk of breast cancer start at when
40: start annual exams if hx of breast CA
45 - 54: annual screens for all
>55: biennial screening and should continue as they have a life expectancy >10 yrs
High risk: Start at 30 yrs
52
What makes you high risk for breast cancer?
- known or likely BRCA mutation and other gentic syndroms
| - treated with chest wall radiation for Hodgkin disease
53
Down the line radiation used to treat Hodgkins lymphoma led to what?
Breast CA
54
When should an individual be referred to a genetic counselor (concerning breast CA)
family hx of multiple relatives w/breast or ovarian CA, or if relative was diagnosed <50 yrs old
55
What are the five red flag signs for CA?
1) unexplained weight loos >10 lbs
2) fever, chills, night sweats
3) rest/night pain
4) Fatigue
5) skin changes
56
ABCDE's of melanoma
```
A: assymetry
B: border
C: color
D: dimeter (pencil eraser)
E: enlargement or evolving
```
57
Signs and symptoms of CA
CAUTION
```
C: change in bowel and bladder
A: A sore that is not healing
U: unusal bleeding or discahrge
T: thickening or lump
I: indigestion or trouble swallowing
O: obvious change in wart/mole
N: nagging cough or hoarseness
```
58
CA staged as In situ:
In situ: abnormal cells are present only in the layer of cell in which they developed
59
CA staged as regional
CA has spread beyond primary site to nearby lymph, tissues or organs
60
CA staged as localized
CA is limited to organ which it began without evidence of spread
61
CA staged as unknown
not enough to determine stage
62
CA staged as distant/metistatic
CA has spread to distant tissue, lymph or organs
63
Explain the T of cancer staging
T: size or extent of tumor
```
Tis: in situ
T1: <20mm
T2: 50<20 mm
T3: >50 mm
T4: any size with direct extension to the chest wall and or to the skin
```
64
Explain the N of cancer staging
N: amount spread to lymph nodes
pN0: no regional lymph node metastasis
pN1: 1-3 axillary lymph nodes
pN2: 4-9 nodes
pN3: > or = 10 nodes
65
Explain the M of cancer staging
M: metastasis
0: non
1: metastasis
66
Stage IV CA means what
CA has spread to distant tissue or organs
67
Stage 0 CA means what
In situ: not within the membrane
68
Tests used for stagin
Physical exam, imaging, lab tests, pathology reports, surgical reports
69
What were the most common functional cited problems in CA patients in the cited study
Balance and ambulation
70
True or false oncology clinicians adequately document functional problems in CA patients
False!
71
True or false oncology is a specialization by the ABPTS?
True
72
In what stage (pre-screening, screening, treatment etc) is rehab appropriate?
Most appropriate?
Always appropriate but particularly pre-treatment
73
Does a PT's role in CA care include diagnose?
According to her slide yes
74
What does the following describe?
Brief investigation of:
Anatomical & physiological status of body systems
Communication ability, affect, cognition, learning style
Review of “red flags” and other screening data
A systems review
75
What is an orange flag?
Psychiatric symptoms
76
What is a yellow flag?
Beliefs and judgments
77
Name some causes of concern or red flags that occur with CA rehab?
Compression of neurologic tissue
Cardiac ventricular funciton
Bone health
Anemia, neutropenia, thrombocytopenia
78
Common location of metastasis for breast cancer?
bone, liver, lung, pleura
79
Common location of metastasis for colorectal cancer
Liver, periotoneal cavity
80
Common location of metastasis for small cell lung cancer
Non small
bone, liver, opposite lung, brain, pancreas, adrenal glands
Opposite lung, brain
81
Common location of metastasis for multiple myeloma
Osteolytic bone lesions
82
Common location of metastasis ovarian
peritoneal cavity
83
Common location of metastasis pancreatic cancer
liver, lungs, local tissues
84
Common location of metastasis prostate cancer
Bone
85
Common location of metastasis for sarcoma
Lung
86
The metastatic sites to know
```
Breast
Small lung
Multiple myeloma
Pancreatic
Prostate
```
```
Breast: bone
Small lung: bone
Multiple myeloma: Osteolytic bone lesions
Pancreatic: liver, lung, local tissue
Prostate: bone
```
87
What are the precautions for >50% of cortex involvement?
This is high risk of pathologic fracture
No twisting, or exercises!
Do: Touch down, NWB, use of AD, AROM exercise,
88
What indicates high risk for bony metastasis
cortical lesions >2.5-3 cm
>50% cortical involvement
Painful lesions
Unresponsive to radiation
89
What are the precautions for 25-50% cortex involvement
This is moderate risk
No stretching, lifting, straining
Do: PWB, light aerobic activity
90
What are the precautions for 0-25% cortex involvement
None, full WB
91
When risk of pathologic fracture is high what kind of things do you avoid? focus on?
Avoid: Open chain exercises, ballistic movements, risk of falling
Focus on : WB exercises (except with cortical involvement >50%), general conditioning
92
What level of hematocrit would you not exercise someone
25%
93
What level of hemoglobin would you not exercise someone?
<8g/dL
94
What WBC count would you not exercise someone at
<5.0 10^9 w/ fever
95
What platelet count would you not exercise someone at
<20 k/uL
96
Common CA causing spinal cord compression
Thoracic, breast, lung, lumbar, prostate, melanoma, GI
Most commonly extradural mass from vertebral metastasis: 60% in Tspine
97
Common CA causing malignant pericardial effusion
BREAST, chest wall radiation
98
What diagnosis does SBP fall in and why
malignant pericardial effusion
they have a space occupying fluid in the pleura therefore there is too much pressure against the heart when they inhale
99
Common CA causing superior vena cava syndrome.
MEDIASTINUM LOCATION: lung, lymphoma, breast
100
What is this?
```
Early Recognition CRITICAL
Most commonly extradural mass from vertebral metastasis
Location:
60% in thoracic spine
30% in LS spine
10% cervical spine
```
Acute spinal cord compression
101
Common symptoms of acute SC compression
worsening back pain, NIGHT PAIN, change in neurological status
102
What are these common treatments for?
| high dose steroids, focused radiotherapy to shrink the tumor, surgical resection
Acute SC compression
103
Prognosis for acute SC compresion
3-6 months survival
| 1 yr survival rate 30%
104
Pre-treatment ambulatory status and acute SC compression
if they were not ambulating before it is very unlikely they will resume ambulating after
105
Vena Cava syndrome is loss of what?
drainage to the head, neck, arms and upper thorax
106
Symptoms of Superior vena cava syndrome
Jugular venous distention, facial edema, collateral veins of chest, SOB, arm edema
107
True or false Superior vena cava syndrome is emergently life threatening?
false
108
Name common treatments for superior vena cava syndrome
High dose steroids, intravascular stenting, localized radiotherapy
109
When does tumor lysis occur?
After stem cell therapy, shortly after chmotherapy = when a large number of neoplastic cells are killed rapidly
110
What is very common in hematologic CA issues?
DVT's
111
Who does neutropenic fever occur in?
What does it present like
pts recieving chemo
Neutropenia at onset --> temperature --> septic shock
112
What are the Wells rules used for?
Determine risk of DVT's
113
Tumor lysis syndrome and hypercalcemia are what kind of cancers?
Metabolic
114
What classification of cancer are the following symptoms related to?
- Fatigue, bone pain, polyuria
- GI: Constipation, abdominal pain
- Neurological: muscle weakness, lethargy, confusion, delirium, and coma
- Cardiac: EKG changes, MI
Hypercalcemia - a metabolic cancer
115
Cancers with rapidly proliferating cells
- Acute lymphoblastic leukemia
- High grade lymphomas
Solid tumors that are chemo sensitive
-Neuroblastoma, breast, small-cell lung
Tumor lysis syndrome - a metabolic cancer
116
Score of ______ on Well rules = 75% probability of _____
> or = to 3
DVT
117
Unexplained unilateral limb swelling is a tumor or clot unless what?
PROVEN OTHERWISE
118
What are unusually engorged or numerous veins in atypical local called and what do they indicate
Collateral veins: indicate tumor, clot and is a red flag unless hx offers an explanation
119
Name some common neuromuscular complications in CA pts
nerve palsy (eye movement), plexopathy, dystonia, peripheral neuropathy
120
Explain somatic pain
localized, activation of peripheral nociceptors (no damage to peripheral nerve or CNS); sharp, reproduced by movement
121
Explain visceral pain
diffuse, difficult to localize, referred to superficial structure, activation of nociceptors of thoracic, pelvic, or organs/viscera
122
Explain neuropathic pain
burning, stabbing, shooting, damage to somatosensory NS.
Dysethesias: abnormal sensations
Allodynia: pain from normally non-painful
123
Contraindications to superfiial heat
acute inflammation, over tumor, recently irradiated area, impaired sensation, mental status, DVT, over area of long term steroid use
124
Contrainications to superficial cold
post radiation, impaired sensation, cold hypersensativity or intolerance, Raynaud's
125
When do we commonly see dysvascular tissue?
Post-radiation
126
Contraindications to ESTIM
carotid sinus, implanted device, thrombosis
127
TENS can be very helpful for what kind of pain
bone pain
128
When is NMES contraindicated
increased fracture risk
129
When is US contraindicated
thromosis/thrombophlebitis, malignancy, breast implants, internal stimulators, pregnancy, central nervous tissue
130
True or false, US is generally a modality used in the CA population
FALSE! usually contraindicated - increased tumor growth and metastatic spread in mice
131
What is CIPN
Chemotherapy induced peripheral neuropathy
132
Neurotixic chemotherapy agents
```
TAXANES: commonly used in breast CA
PLATINUM BASED
Vinca-alkaloids
Epothilones
PI's
Thalidomide, and lenalidomide
Eribulin
Nalarabine
```
133
Treatment for CIPN
dose reduction
134
Severity of CIPN based on what generally
dose and duration of medication
135
When does CIPN come on and how long does it last
Comes on 24 hrs after chemo infusion
May last for weeks, months or indefinitely
136
CIPN symptoms
Neurogenic issues: burning, allodynia, electric, cold sensitivity, feels like wearing gloves or stockings
Automomic: diarrhea, constipation, irregular heart beat
Motor: less common if present - foot drop
137
PT exam for CIPN
sensory testing, deep tendon reflexes, strength, balance/proprioception, gait
138
CIPN treatment
Neuromuscular electrical STIM, education, falls prevention (balance and gait training, orthotics, AD), exercises, desensitization, compression
139
hallmark of CA fatigue
not proportional to recent activity and interferes with usual functioning
140
when does CRF present
nearly every day or every day
141
What causes CRF in patients lives?
Everything
142
What score on the numeric rating scale for fatigue shows that patients have decreased functioning and should be referred to PT
> or = 7/10
143
What has shown to be the most effective non-pharma intervention for CRF?
Exercise
144
True or false: Exercise reduces CA related fatigue both during and after CA treatment?
True
145
What two CA is the evidence for aerobic exercises strongest?
Breast and prostate
146
3 guidelines for CA exercise
Activity enhancement
Across all stages of survivorship
AVOID INACTIVITY!!!!
147
True or false: exercise is safe during and after most types of CA treatment
Both unsupervised and supervised have shown to be helpful
TRUE!
True!
148
True or false for exercising: Time is more important than distance
True
149
one major consideration for pts exercise prescription
pretreatment aerobic fitness
150
What kind of exercise is good for prostate CA and why
resistance, aerobic: they have lost testosterone with medication
151
Moderate-intensity, resistance exercise (3–6 METs, 60%–80% 1-RM) reduced CRF more so than those engaging in lower intensity resistance or aerobic exercise of any level of physical exertion (Brown et al., 2011)
duration and frequency have been reported to have no effect on magnitude of CRF reduction in studies across mixed cancer types and delivery methods
152
What is the best mode of exercise for CA treatment
aerobic and resistance training = largest treatment effect
153
What is the montra for CA exercise programs
Start low, progress slow
154
Moderate vs. vigorous intensity exercise
Moderate: talk but not sing, 3 on modified borg (12-14), 50-79% maxHR
Vigorous: can only say a few words, 70-85% max, 5 on modified borg (>14)
155
Caution performing exercise with any of the following
boney metastasis
thrombocytopenia (low plateltes)
Anemia
neutropenia
156
General exercise program for someone who can tolerate moderate exercise
30 min of moderate aerobic exercise 5 days a week
resistive exercise 2-3x a week (not to failure)
Flexibility
Balance
157
Radiation fibrosis through what mechanism
cell death via free radial mediated DNA damage: radiations goal is to cause inflammation so cells die, ongoing response in normal tissue = fibrosis
158
phases of fibrosis
prefibrotic = inflammation
organized fibrosis = high myofibroblasts
Fibroatrophic phase: skin tightens
159
Radiation causes what kind of tissue, what does this mean for PT
Avascular
Don't crank on it
160
Global radiation side effect short term and long term
fatigue!!
161
Result of radiation on soft tissue (3)
decreased vascular perfussion
Decreased ability to heal
Decreased ability to disperse heat
However it is relatively tolerant of radiation and able to heal post expsure, the issues are due to the vascular changes
162
What is cervical dystonia
SCM so tight = torticollis
Radiation symptom
163
What is Trismus
masseter msucle becomes tighter so they cannot open their mouth
Radiation symptom
164
What is L'Hermitte's sign
flex their head they get shooting sensation in lower half of body
Radiation symptom
165
Tissue fiborsis and scaring interventions
myofascial techniques, compression, kinesio tape for mobilization of scar tissue when patient moves
Flexibility exercises LONG TERM for shoulder and trunk AROM (if supraclavicular add C-spine)
166
When shoud you not mobilize a scar
while they're in chemo or radiation because this will create even more rapidly dividing cells
167
Where is the breast implant placed
beneath pec major
168
TRAM, DIEP and SIEA are what kind of procedures
autologous breast reconstruction surgery
169
Explain a TRAM
transverse rectus abdominis myocutaneous flap
Release rectus abdominus, free all the tissue on the abdomen wall and fold it over to make a breast
170
Sentinel node
- lymph node to which cancer cells are most likely to spread from a primary tumor.
171
What is the following procedure?
A surgeon injects a radioactive substance, a blue dye, or both near the tumor to locate the position of the sentinel lymph node. The surgeon then uses a device that detects radioactivity to find the sentinel node or looks for lymph nodes that are stained with the blue dye. Once the sentinel lymph node is located, the surgeon makes a small incsion (about 1/2 inch) in the overlying skin and removes the node.
Sentinel Lymph Node Biopsy
172
Axillary Lymph Node Dissection requires what
retracting pec major and minor
173
Any kind of breast surgery is trauma to the chest wall. They have a very short pec major and minor creating a kyphosis, then they get radiation and again shorten the tissue and put it at risk for fibrosis
Women have altered resting scapular alignment due to protective posturing (fear pain)
Reduced tissue flexibility --> altered alignment
174
What is the one movement we talked about at the shoulder that decreases tension on the pec major?
Flexion to 90 degrees
175
Pec minor dysfunciton leads to what
Reduced scapular posterior tilt therefore elevation is compromised
More internal rotation during elevation
176
What is the cause of axillary cording?
Portions of the neurovascular bundle getting inflammed and stuck after surgery
177
What do you do for axillary cording?
Nerve glides (mediaN) and ROM exercises
178
What does the Spinal accessory nerve innervate
SCM and trap
179
TORS surgery
Trans oral robotic surgery
180
TLM used for what
transoral laser micosurgery: access to tumors the robot can't reach (oropharyngeal and laryngeal)
181
Radial, modified or selective neck dissection
Removal of cervical level I-V lymph nodes, spinal accessory nerve (SAN), internal jugular vein (IJV), and sternocleidomastoid (SCM)
Radical
182
Radical, modified or selective neck dissection:
Removal of cervical level I-V lymph nodes, but preserves at least 1 of the following structures: SAN, IJV, and SCM
Modified radical neck dissection
183
Radial, modified or selective neck dissection
One or more cervical lymph node levels removed during radical neck dissection are preserved
selective neck dissection
184
True or false: Above the clavicle there are 50 lymph nodes?
False: 200
185
Explain the level of nodes
the higher the number of level, the more nodes that are dissected traveling down the head and neck area
186
I II III IV V level of nodes
```
I: submental
II: upper jugular
III: middle jugular
IV: lower jugular
V: posterior triangle - generally the spinal acessory nerve with get damaged with surgery here
```
187
Scapular flip sign is to show what?
if pt has spinal accessory nerve palsy
188
Plus test
looking at serratus function: arm is in flexion with thumb up and you apply pressure
189
If someones spinal acessory nerve is weak so their scap is flying all over the place, but they need to strengthen their serratus, how can you accomplish this?
Supine! their body weight will stabilize the table
190
GVHD is a risk for what kind of tranplant
allogeneic
191
What is key to working with GVHD patients
Joint contractures: ROM and soft tissue work, thermal modalities
Steroid myopathy: exercises for proximal muscles, transfer and balance training
surgical release is NOT effective
