Week 6 Flashcards
(262 cards)
1
Q
What are the non-modifiable risk factors of cancer?
A
- Age
- Genetics
- Epigenetics
- Immunosuppression (relative)
- Radiation (relative)
- Sunlight (relative)
Relative meaning that it depends on the person’s lifestyle behaviors
2
Q
What are the modifiable risk factors of cancer?
A
- Alcohol
- Cancer-Causing Substances
- Chronic Inflammation
- Diet
- Hormones
- Immunosuppression
- Infectious Agents
- Obesity
- Radiation
- Sunlight
- Tobacco
3
Q
A normal cell proliferates and differentiates. What does this include?
A
Proliferation
• Increase in cell number
• Regulated by growth factors
• Cell goes through cell cycle, which is controlled by cell cycle inhibitors, to prevent excessive growth
Differentiation
• Cells becomes “specialized” to carry out particular functions. Tissue is formed that has specific structure and function
4
Q
What are some of the characteristics of a normal cell?
A
• Limited number of cell divisions
• Contact inhibition: function turning off upon contact with something
• Mutations
- Mutated DNA repaired
- Defective cell may be destroyed by immune system
• Apoptosis
5
Q
What is cancer normally related to?
A
A genetic/epigenetic alteration. A disease of mutation, that is either within the structure or the function of the cell
6
Q
What type patients typically have a structure mutation?
A
Childhood and early adult
7
Q
What type patients typically have an epigenetic/function mutation?
A
In adults
8
Q
True or False
Only 10% of cancer cases are genetically linked
A
True, Only 10% of cancer cases are genetically linked
9
Q
What is a tumor?
A
An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancer), or malignant (cancer). Also called neoplasm
10
Q
What are the major types of tumors?
A
- Benign: not cancer
- In situ: contained
- Malignant: cancer
- Unknown origin
11
Q
What is carcinogenesis?
A
The process by which normal cells are transformed into cancer cells
12
Q
What are the cellular or tumor characteristics of cancer?
A
- Abnormality(can also be characteristics of a benign tumor)
- Uncontrollability(can also be characteristics of a benign tumor)
- Invasiveness
13
Q
What are the drivers of carcinogenesis?
A
• Proto-oncogene, a gene involved in normal cell growth. Mutations may cause it to become an oncogene, which
can cause the growth of cancer cells
• Oncogene which is a mutated proto-oncogene
• Tumor suppressor gene, a negative regulator of growth factor stimulation which controls cell growth and division. Suppression or blockage leads to the development of cancer. Normally considered an anti-oncogene, when it has no abnormalities
14
Q
What is the proposed function of tumor suppressor gene: BRCA1, and if mutated, what does it lead to?
A
- Proposed function: DNA repair
* Disease if mutated: Breast cancer
15
Q
What is the proposed function of tumor suppressor gene: p53, and if mutated, what does it lead to?
A
• Proposed function: Transcription/cell cycle
regulation
• Disease if mutated: Sarcoma, carcinoma, leukemia
16
Q
What is the proposed function of tumor suppressor gene: Rb, and if mutated, what does it lead to?
A
- Proposed function: Nuclear transcription factor
* Disease if mutated: Retinoblastoma
17
Q
What is the proposed function of tumor suppressor gene: MEN1, and if mutated, what does it lead to?
A
- Proposed function: Intrastrand DNA crosslink repair
* Disease if mutated: Parathyroid and pituitary adenomas, islet cell tumors
18
Q
When is a person considered a cancer survivor?
A
At the time of diagnosis
19
Q
True or False
Even though black women have a lower incidence rate for breast cancer than white women, black women have a 2-3x higher mortality rate(they die faster)
A
True, Even though black women have a lower incidence rate for breast cancer than white women, black women have a 2-3x higher mortality rate(they die faster)
20
Q
What population is kidney cancer mostly seen?
A
American indians / alaska natives
21
Q
What population is liver cancer mostly seen?
A
American indians/ alaska natives, asians, and pacific islanders
22
Q
What population is prostate cancer mostly seen?
A
African american men
23
Q
What population is cervical cancer mostly seen?
A
Women in rural areas
24
Q
What population is multiple myeloma mostly seen?
A
African americans
25
What are the risk factors associated with cancer disparities?
* Genetic and biological factors
* Health care access
* Socioeconomic factors
* Chemical and physical exposures
* Diet
* Physical inactivity
26
True or False
The prevalence rate of cancer is the US is going down
FALSE, The prevalence rate of cancer is the US is going UP. This is a good thing, because mortality rates are decreasing
27
What does an incidence rate refer to?
Frequency of occurrence of new cases of disease or injury in a population over a specified period of time
• Denominator is usually:
- Summed person-years of observation
- Average population(more commonly used)
28
What does a mortality rate refer to?
Frequency of occurrence of death in a defined population during a specified interval
• Variety of measures: Subsets
and Mid-interval
• Denominator is usually avg population
29
What are the major types of cancer seen in children 0-14 years?
* Acute lymphocytic leukemia (ALL)
* Brain and other central nervous system (CNS) tumors
* Neuroblastoma
30
What is the average age of cancer diagnosis in children?
6
31
What is the population often affected by cancer in children?
White and Hispanic children have higher incidence rates than other racial and ethnic groups
32
What is the prevalence of cancer diagnosis in children?
1 in 330 will be diagnosed by age 20
33
What population is at a high risk for cancer?
* Heavy alcohol use
* Older adults
* Frequent exposure to cancer causing substances
* Obese persons
* Frequent unprotected exposure to sunlight
* High inflammatory dietary habits
* Cancer survivors
* Treatments including hormones or radiation
* Persons with immunosuppression
* Exposure to tobacco or smoke
34
Why do cancer health disparities exist?
* Access to and use of health care
* Genetics
* Physical and mental health
* Treatments received
* Social and economic status
* Cultural beliefs
* Exposure to environmental cancer risk factors
* Clinical trial participation
* Health literacy
35
True or False
Everyone has a cancer risk
True, everyone has a cancer risk
36
What is the best approach to use when talking to a patient about cancer?
Use a client-oriented approach (tailored approach)
- Individual or lifestyle assessment
- Motivational interviewing
• Identify any targeted evidence or awareness campaign
materials (message targeting)
- Unique characteristics
- Outcomes of interest
• Routine reminders have been shown to increase adherence to current screening and lifestyle modification recommendations
37
What are the general lifestyle recommendations for lung cancer?
Reduce/minimize:
• Single greatest avoidable risk factor (World Health Organization)
• Smoking or oral tobacco cessation or reduce secondhand smoke exposure
38
What are the general drinking recommendations for patients to reduce their risk for cancer?
* One drink per day for women (4-8 oz)
| * Two drinks per day for men (4-8 oz)
39
What are the types of diets that is recommended to reduce the risk of all cancers?
* Select a diet that reduces inflammation
* Reduce your diabetes risk
* Have a lifestyle that encourages physical activity
40
What can be done to help reduce the risk of breast cancer?
Have children or minimize your use of hormone therapy
41
In order to reduce the risk of cancer, people should maintain a healthy weight. Why is this?
Obesity is associated with inflammation, increased estrogen levels, increased insulin and insulin-like growth factors, increased adipokines, and changes in cell growth
regulators
42
What are the things that we want to do to reduce the risk of getting virus related cancers?
Vaccinations (HPV, Hep B, Hep C)
43
What are the things that we want to do to reduce the risk of getting skin cancers?
Protect your skin with sunscreen products, clothing, and hats/visors
• Minimize your time in the sun between 10am-4pm
• Wear dark fabrics
• Check your skin regularly
44
At what age does any moles developed lead to skin cancer?
After the age of 25, 70% of the time
45
What are the current screening recommendations for skin cancer?
Current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adults
46
What are the current screening recommendations for lung cancer?
Annual screening for lung cancer with low-dose computed tomography
(LDCT) in adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years
47
What are the current screening recommendations for breast cancer?
Recommends biennial screening mammography for women aged 50 to 74 years
48
The acronym CAUUTION-P is used to determine when action should be taken for a patient that might indicate when they have cancer. What does it mean?
* Change in bowel and bladder habits for up to 3 days
* A sore that does not heal for up to 3 days
* Unusual bleeding or discharge in stool for up to 3 days
* Unusual bleeding in between periods for up to 3 days
* Thickening or lump in the breast, testicles, or elsewhere for up to 3 days
* Indigestion or difficulty swallowing for up to 3 days
* Obvious change in the size fo a mole or mouth sore for up to 3 days
* Nagging cough or hoarseness for up to 3 days
* Pain
49
What is the action to be taken when a patient complains of a Change in bowel and bladder habits for up to 3 days?
Ultrasonography and endoscopy
50
What is the action to be taken when a patient complains of a A sore that does not heal for up to 3 days?
Biopsy and oral and skin exam
51
What is the action to be taken when a patient complains of Unusual bleeding or discharge in stool for up to 3 days?
Rectal exam and colonoscopy
52
What is the action to be taken when a patient complains of Unusual bleeding in between periods for up to 3 days?
Gynecology exam for cervix and biopsy
53
What is the action to be taken when a patient complains of Thickening or lump in the breast, testicles, or elsewhere for up to 3 days?
Ultrasonography and FNAC if abnormal
54
What is the action to be taken when a patient complains of Indigestion or difficulty swallowing for up to 3 days?
Endoscopy
55
What is the action to be taken when a patient complains of an Obvious change in the size fo a mole or mouth sore for up to 3 days?
Biopsy
56
What is the action to be taken when a patient complains of a Nagging cough or hoarseness for up to 3 days?
ENT examination and chest x ray
57
What are the pain complaints that a patient might have that will require they get a work up to rule out cancer?
• Different times
- Acute, chronic/persistent, breakthrough
• Different types
- Nerve, bone, soft tissue, phantom, or referred
• Pain that does not respond to treatment or change in position
• Nocturnal pain
• Headache in the am (first thing in the morning, consistently) but improves throughout the day; may worsen with physical activity or positional changes
58
What are the theories behind the reason of nocturnal pain in cancer patients?
* Relax muscles and tumor invasion becomes more noticeable
* Perception of pain influenced by drop in body temperature, increase in carbon dioxide, or decrease in mental distraction
59
What are the characteristics of a benign tumor?
```
Typically slow growing
• Localized
• Not invasive (unrelated
tissues/organs)
• Not cancerous
• Recurrence unlikely
• Encapsulated
• End with "oma", regardless of their cell type
```
60
What are the characteristics of a malignant tumor?
```
• Rapid or slow growth
• Invasive
• Encapsulated
• Cancerous
• Possible recurrence
• End in “oma”
- more description regarding
pathology
• Organ or cell of origin
```
61
____ malignant cancer is slow growing
*Prostate* malignant cancer is slow growing
62
What is the pathology of a carcinoma?
Skin or in tissues that line or cover internal organs, various subtypes.
63
What is the pathology of a sarcoma?
Bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue
64
What is the pathology of leukemia?
Blood-forming tissue
65
What is the pathology of lymphoma and myeloma?
Cells of the immune system
66
What is the pathology of Central nervous system cancers?
Brain and spinal cord tissue
67
What is the name of a benign tumor and malignant tumor of an adult fibrous tissue?
* Benign: fibroma
| * Malignant: Fibrosarcoma
68
What is the name of a benign tumor and malignant tumor of an embryonic(myxmatous) fibrous tissue?
* Benign: myxoma
| * Malignant: myxosarcoma
69
What is the name of a benign tumor and malignant tumor of fat?
* Benign: lipoma
| * Malignant: liposarcoma
70
What is the name of a benign tumor and malignant tumor of cartilage?
* Benign: chondroma
| * Malignant: chondrosarcoma
71
What is the name of a benign tumor and malignant tumor of the bone?
* Benign: osteoma
| * Malignant: osteosarcoma
72
What is the name of a benign tumor and malignant tumor of the notochord?
* Benign: ---
| * Malignant: chordoma
73
What is the name of a benign tumor and malignant tumor of the connective tissue, probably fibrous?
* Benign: fibrous histiocytoma
| * Malignant: malignant fibrous histiocytoma
74
What are the characteristics of a malignant tumor cell?
• No normal cell organization or differentiation
• Lack control of cell division
• No contact inhibition
• Do not adhere to each other, which allows them to often break loose from mass and invade other tissues and may spread to distant sites
• Do not undergo apoptosis
• Abnormal cell membranes
• Altered surface antigens
• Compress blood vessels which leads to deprivation of normal cells of nutrients
• Necrosis and inflammation around tumor
- Loss of normal cells
- Reduction in organ integrity and function
75
Malignant tumors secrete cytokines and chemokines that encourage the development of new capillaries. What are the characteristics of this?
• Development of new capillaries
– Angiogenic factor secretion
- Including Vascular, Endothelial, Growth Factor (VEGF)
– Secretion of matrix metalloproteinase (MMP), which
breaks down collagen in ECM through collagenase
76
What are the evasion strategies of a malignant tumor?
```
Immune escape
• Loss of immunogenicity
- Lack of loading into class I MHC and lack of presentation to
T cells (tolerance)
• Antigenic modulation
- Loss of surface antigens,
antibodies cannot bind
• Induction of immune suppression
• Prevention of NK and T cell activation
- Downregulation of MHC, NK cell-activating receptors, and T
cell activation
```
77
What is the preferred method to get the definitive diagnosis of cancer?
A biopsy
78
What is a primary cancer?
The source of the cancer. The most common sites being, the skin, lung, female breasts, colorectal, corpus uteri, prostate
79
What is a secondary cancer?
The metastasis/spread of a primary cancer to a different location
80
___ is the technical term for a tumor growth
*Neoplasm* is the technical term for a tumor growth
81
On __% of cancers are found by a palpable mass or lump
On **10%** of cancers are found by a palpable mass or lump
82
What are some other methods of diagnosing cancer?
```
• Palpable mass or lump
–Detection varies by cancer
type
• Biopsy
–Preferred method
–Definitive diagnosis
• Imaging technologies
• Histology
• Tumor markers
• Grading
• Staging
```
83
What is a tumor maker?
Basically blood chemistry, and it varies from by cancer type. Ex: gynecological cancer is CA125. It is a screening tool, making it highly sensitive, so they require additional testing
84
What is grading?
A histological and pathological activity, where they look at the abnormalities of the tissues, and with that a pathologist can give a grade.
85
What is a grade GX on the cancer grading system?
Grade cannot be assessed/inconclusive
| undetermined grade
86
What is a grade G1 on the cancer grading system?
Well differentiated (low grade)
87
What is a grade G2 on the cancer grading system?
```
Moderately differentiated
(intermediate grade)
```
88
What is a grade G3 on the cancer grading system?
Poorly differentiated (high grade)
89
What is a grade G4 on the cancer grading system?
Undifferentiated (high grade)
90
What is the difference between grading and staging of cancer?
Grading is a pathological exercise, while staging is a clinical exercise and is usually given by a medical/surgical oncologist
91
What system is usually used for cancer staging?
The TNM system
92
What does the summary system of cancer staging allow us to do?
Summary systems allow us to collect large amounts of data about the tumor and the cancer survivor
93
What is the purpose of cancer staging?
Common language, treatment
| planning, prognostic, data collection
94
What are the elements that cancer clinical staging looks at?
* Biopsies
* Imaging
* Physical examination
* Tumor markers
* Surgical reports
95
True or False
Only primary tumors are staged and graded
True, Only primary tumors are staged and graded
96
Why aren't recurrent and metastasis cancer staged and graded?
A metastasis is a secondary cancer, meaning that it is part of the primary cancer's process, and most of the time when a patient has metastasis to another organ, it is considered a grade 4 and the only time it doesn't occur is with reproductive cancers
97
On the TMN system, what is a primary tumor stage TX?
Primary tumor cannot be
| evaluated
98
On the TMN system, what is a primary tumor stage T0?
No evidence of primary tumor
99
On the TMN system, what is a primary tumor stage Tis?
Carcinoma in situ, where the basement membrane has not broken
100
On the TMN system, what is a primary tumor stage T1, T2, T3, T4?
Size and/or extent of the primary tumor
101
On the TMN system, what is a regional lymph nodes (N)
| NX?
Regional lymph nodes cannot be evaluated
102
On the TMN system, what is a regional lymph nodes (N)
| N0?
No regional lymph node
| involvement
103
On the TMN system, what is a regional lymph nodes (N)
| N1, N2, N3?
Degree of regional lymph
node involvement (number and
location of lymph nodes)
104
On the TMN system, what is a Distant Metastasis: MX?
Distant metastasis cannot be
| evaluated
105
On the TMN system, what is a Distant Metastasis: M0?
No distant metastasis
106
On the TMN system, what is a Distant Metastasis: M1?
Distant metastasis is present
107
What is a stage O cancer?
Carcinoma in situ
108
What is a stage I cancer?
Early stage, localized to the primary organ
109
What is a stage II cancer?
Increased risk of regional spread, still localized
110
What is a stage III cancer?
Local cancer has spread regionally
111
What is a stage IV cancer?
Metastasis
112
What are mechanisms in which metastasis occurs?
* Distant lymph node involvement
* Blood borne metastases(using the blood vessels)
* Implantation/seeding metastases. Because of the loose contact between the cancer cells, they can break off and use any fluid in the body to move to other parts of the body
113
What are the characteristics of a tumor spreading through invasion?
* Local spread
* Tumor cells grow into adjacent tissues and destroy them
* Example: Uterine carcinoma invades vagina
114
What are the characteristics of a tumor spreading through metastasis?
Spread to distant sites
• Via blood or lymph
• Example: Carcinoma of the colon spreads to the liver
115
What are the characteristics of a tumor spreading through seeding (Implantation)?
• Another form of metastasis
• Spread to distant sites
• Via other body fluids or along membranes
• Example: Ovarian cancer spreads throughout peritoneal
cavity
116
What are the major sites of tumor metastasis?
Bone(#1 site), liver, brain and lung
117
What are the signs and symptoms of bone cancer?
* Deep aching pain
* Pain that does not go away with position changing
* Pain that does not go away with interventions
118
What does the signs and symptoms of brain cancer depend on?
The lobe the tumor is in
119
What are the signs and symptoms of liver cancer?
Metabolic changes
120
What are the signs and symptoms of lung cancer?
Respiratory changes
121
What is the size threshold for moving a person to another cancer stage or subcategory?
2cm
122
What are the common cancer treatments?
* Watchful waiting used for slow growing tumors, most due to the risk being bigger than the benefit
* Surgery
* Chemotherapy
* Radiation therapy
* Targeted therapy to include immunotherapies
* Supportive care medications
* Hormonal therapy, if the receptor status is positive
123
What is chemotherapy?
Any drug used to treat disease/cancer.
124
What are the different administration methods of chemotherapy?
* Oral
* Intramuscular injection
* Subcutaneous injection
* Intravenous chemotherapy
* Intrathecal chemotherapy
* Multiple methods simultaneously
125
What are the goals of chemotherapy?
* Cure/get patient into remission
* Control
* Palliation and we're just trying to improve QoL
126
What are the timing characteristics of chemotherapy?
• Neoadjuvant: occurs before primary therapy.
• I nduction, or preoperative
– Adjuvant chemotherapy: done after primary intervention, which is usually surgery
– Palliative
127
True or False
Chemotherapy is built to address the cell cycle
True, Chemotherapy is built to address the cell cycle
128
What is a non-cycle specific chemotherapy?
They destroy all or slow down the activities of the cell cycle. Or they can have been formulated and created to work on a specific point within the cell cycle
129
Patients that are taking chemotherapy agents that their cell cycle mechanism has what type of side effects?
The side effects will be worse, because it is impacting all the phases of the cell cycle
130
What is the goal of radiation therapy in the treatment of cancer?
Curative or palliative
131
What is the timing of radiation therapy in the treatment of cancer?
* Neoadjuvant
* Intraoperative (IORT)
* Adjuvant
132
What are the methods of delivery for radiation therapy in the treatment of cancer?
```
• External beam radiation
- Teletherapy
• Internal radiation
- Brachytherapy
• Systemic: radiation pill mostly seen in thyroid cancer
```
133
What are the parameters for the radiation therapy treatments?
* 5-10 minutes
* Daily over 4-6 weeks
* Treatment schedules vary
* Measured in Grays (Gy)
134
As a PT, what are the things to know about a patient receiving radiation therapy?
- Total dosage of radiation
135
What are the methods of external beam radiation?
```
• Linear accelerator (LINAC)
• 3-dimensional conformal radiation
therapy (3D-CRT)
• Intensity-modulated radiation
therapy (IMRT)
• Image-guided radiation therapy (IGRT)
• Tomotherapy
• Stereotactic radiosurgery
• Stereotactic body radiation therapy
• Proton therapy which has the lowest amount of side effects
• Other charged particle beams
```
136
Based on the total dosage of radiation, what is the effects on the body?
* 40 Gy + - skin effects
* Hair loss can occur with >1Gy
* Dryness of glands
* 50 Gy + - bone effects
* 60 Gy + - soft tissue effects
* 70 Gy + - muscle and tendon effects
137
What is the dose of radiation?
The irradiation absorbed by each kilogram of tissue expressed as Grays (Gy) - 1 Gy = 1 J/kg of tissue.
138
What determines the total dose of radiation?
Tumor sensitivity and tissue tolerance
139
What are the characteristics of the internal beam radiation?
* Pellets or seeds, wires, ribbons
* Treated over hours, days, weeks or months
* Low or high dose treatment
* Temporary or permanent placement
* Chemoradiation – combination of chemotherapy and radiation
140
What are some other treatment methods of cancer?
* Immunotherapy
* Antiangiogenic Therapy: typical therapy where they are trying to decrease the neoangiogenesis tumors that can secrete chemokines and cytokines that make the body produce more capillaries
* Hormonal Therapy
* Integrative Medicine
141
What are the cancer treatments that can result in osteoporosis as a side effect?
* Alkylating agents
* Anthracyclines
* Taxanes
* Corticosteroids
* Radiation
* Hormonal therapy
142
What are the impairments of body functions/structure that we see as a result of osteoporosis?
* Increased risk of fracture
* Kyphotic posture
* Pain with movement
143
What are the clinical signs and activity limitations that we see as a result of osteoporosis?
* Pain
| * Decreased mobility
144
What are the cancer treatments that can result in a change in body composition (cachexia or obesity) as a side effect?
* Alkylating agents
* Anthracyclines
* Taxanes
* Corticosteroids
* Hormonal therapy
* Radiation
* Surgery
145
What are the impairments of body functions/structure that we see as a result of a change in body composition (cachexia or obesity)?
* Weight Loss
* Weight Gain
* Increased waist circumference
146
What are the clinical signs and activity limitations that we see as a result of a change in body composition (cachexia or obesity)?
* Decreased mobility
* Decreased functional ability
* Fatigue
147
What are the cancer treatments that can result in arthralgia as a side effect?
* Aromatase Inhibitors
* Radiation
* Surgery
148
What are the impairments of body functions/structure that we see as a result of arthralgia?
Pain with movement
149
What are the clinical signs and activity limitations that we see as a result of arthralgia?
* Pain
* Decreased mobility
* Decreased functional ability
150
What are the cancer treatments that can result in decreased muscle strength as a side effect?
* Alkylating agents
* Anthracyclines
* Taxanes
* Corticosteroids
* Hormonal therapy
* Radiation
* Surgery
151
What are the impairments of body functions/structure that we see as a result of decreased muscle strength?
* Decreased range of motion
* Fatigue
* Pain with movement
* Contractures
152
What are the clinical signs and activity limitations that we see as a result of decreased muscle strength?
* Decreased functional ability
* Pain
* Fatigue
153
What is the screening tools used for osteoporosis?
OPERA
154
What are the screening tools used for change in body composition (cachexia or obesity)?
```
• Height, weight, waist and hip
circumference measurements
• Skin fold measurements
• Bio-electrical impedance
• Weight loss/gain in last 6 month
```
155
What are the interventions used for the treatment of osteoporosis?
• Weight bearing activities
• Postural training – avoid cervical flexion and positions that promote kyphosis
• Kinesiotaping for postural
cues
156
What are the screening tool used for arthralgia?
WOMAC
| DASH
157
What are the interventions used for the treatment of change in body composition (cachexia or obesity)?
* Physical activity
* Nutritional consults
* Resistive exercises
* Aquatic training
158
What are the interventions used for the treatment of arthralgia?
* Weight loss
* Assistive devices
* Thermo/cryo therapy
* Electrotherapy
159
What are the screening tool used for decreased muscle strength?
```
• Manual muscle testing
• Functional testing
• Timed Up and Go
• ADLS
• Short Physical Performance
Battery
```
160
What are the interventions used for the treatment of decreased muscle strength?
* Progressive resistance exercise
* Aquatic training
* Kinesiotaping
161
What is the term for the cognitive changes seen in a person receiving chemotherapy?
Chemotherapy induced cognitive impairments(CICI)
162
What are the cancer medical treatments that can cause a side effect of cognitive changes?
* Chemotherapy
* Corticosteroids
* Radiation
* Surgery
* Hormonal therapy
163
What are the impairments of body functions/structure that we see as a result of cognitive changes?
Changes in mental function
164
What are the clinical signs and activity limitations that we see as a result of cognitive changes?
* Memory deficits
* Word finding problems
* Decreased concentration
* Sleep disturbances
* Fatigue
165
What are the cancer medical treatments that can cause a side effect of Peripheral Neuropathy?
* Taxanes
* Plant alkaloids
* Platinum compounds
166
What are the impairments of body functions/structure that we see as a result of Peripheral Neuropathy?
* Parasthesias
* Pain
* Loss of sensation
* Distal weakness
* Loss of Deep Tendon Reflexes
* Foot drop
* Muscle weakness
167
What are the clinical signs and activity limitations that we see as a result of Peripheral Neuropathy?
* Decreased balance
* Gait Abnormalities
* Mobility limitations
* Falls
* Distal pain and weakness
* Numbness
* Tingling
* Constipation
* Urinary retention
* Fatigue
168
What are the screening tools used for cognitive changes in patient with chemotherapy?
* MiniMental/ MiniMaC
* FACT-COG
* High Sensitivity
* Cognitive Screen
* CogHealth
* Headminder
169
What are the interventions used for the treatment of cognitive changes?
* Meditation
| * Cognitive behavioral training
170
What are the screening tools used for Peripheral Neuropathy in patient with chemotherapy?
```
• Monofilament
• Berg Balance
• Tinetti
• Leeds Assessment of
Neuropathy Symptoms and Signs
• Total Neuropathy Scale
```
171
What are the interventions used for the treatment of Peripheral Neuropathy?
* Acupuncture
* Assistive devices
* Aerobic and resistive exercise
172
What is the main side effect of chemotherapy/hormone therapy on the cardiovascular system?
Left ventricular dysfunction
173
What are the impairments of body functions/structure that we see as a result of Left ventricular dysfunction?
* Decreased ejection fraction
| * Decreased endurance/deconditioning
174
What are the clinical signs and activity limitations that we see as a result of Left ventricular dysfunction?
```
• Decreased ability to perform
activities of daily living
• Decreased ability to ambulate
long distance
• Decreased ability to
ascend/descend a multiple flights of stairs
• Abnormal vital signs
• Clubbing nails
• Flaring of the nostrils
• Accessory breathing
• Fatigue
```
175
What are the screening tools used for left ventricular dysfunction in patient with chemotherapy?
* Electrocardiogram
* Echocardiogram
* 6 Minute Walk Test
176
What is the intervention used for the treatment of left ventricular dysfunction?
Cardiac rehabilitation
177
What are the medical treatments that are used for the cancer that causes a side effect of alopecia?
* Chemotherapy
| * Radiation
178
What are the impairments of body functions/structure that we see as a result of alopecia?
Hair Loss
179
What are the clinical signs and activity limitations that we see as a result of alopecia?
Grooming issues
180
What are the current screening recommendations for prostate cancer?
For men aged 55 to 69 years, the decision to undergo periodic prostatespecific antigen (PSA)–based screening for prostate cancer should be an individual one
181
What is lymphedema?
Swelling caused by the inability of the lymph system to perform it’s basic function of removal of water and protein waste from it’s designated lymphatic region of the body. With the inability to help the body defend against organism
182
What is the most world wide cause of lymphedema?
Filariasis (mosquito born parasite)
183
What are the cancers most associated with lymphedema?
Breast, head, and neck cancer
184
What are the lymphatics?
Blind open ended vessels that have larger opening for reabsorption. They take in fluids and large protein waste into their vessels them become part of the lymphatic flow and become lymphatic fluid
185
What creates the flow in and out of vessels, out of the arteriole towards the tissues, from the tissues into the venule, and from the tissues into the lymphatic capillaries?
Created by multiple elements such as: osmotic pressures, mechanical pressures. They are dynamic and varying at all times
186
What does the presence of a glycocalyx layer do in the starlings system?
The presence of a Glycocalyx layer is now understood to be semi-permeable membrane which keeps fluid in the interstitial tissues and unable to re-enter the venous system. This causes the venous system to not the primary mover of interstitial fluid back to the heart
187
___ is the only structure fluid that is able to return fluid to the heart
*Lymphatics* is the only structure fluid that is able to return fluid to the heart
188
Any edema seen in the skin is ___
Any edema seen in the skin is *Lymphedema*, whether the lymph system is intact or not
189
Where are the general regions of lymph node beds in the body?
2 inguinal
2 subaxillary
2 cervical
190
Once fluids reach the lymph nodes, what happens?
The lymph nodes process the fluid, breakdown and kill any organisms that are infectious , breakdown the proteins, until the fluid is purified. All of the fluid then makes its way up towards the heart in the lymph system, and once it is above the heart, through the long thoracic duct which will then merge back into the venous system just below the clavicle above the heart at the angles. This is how lymph fluid eventually returns back into circulation
191
What creates flow in the lymphatic system?
Low pressure dynamics, mostly osmotic and tissue pressures
192
What are the networks of the lymph system?
Deep(cannot be treated and end up in death when there is a dysfunction present) and Superficial(only we can affect it)
193
What makes up the structures in the lymph system?
Structures are made of endothelium, peristaltic smooth muscle, and valves.
194
True or False
Each lymph region is independent from other lymph
regions
True, Each lymph region is independent from other lymph
| regions
195
Each region of the lymph node is marked by functional landmark called a ____
Each region of the lymph node is marked by functional landmark called a *watershed*
196
All lymph from the watershed
| borders flows towards it’s ___
All lymph from the watershed
| borders flows towards it’s **lymph node bed**
197
What are the pressures that may impair the flow of lymph fluid back to the heart?
* Low/poor tissue pressure
| * Constant effect of gravity moving fluid in the wrong direction
198
What are the pressures that will help drive the flow of lymph fluid back to the heart?
* Good BP
* Good muscle contraction
* Good tissue pressure
* Normal blood protein concentration
199
What are the things that directly impact lymph movement?
Systemic and mechanical functions directly impact
| Lymph Movement
200
What direct fluid flow in the lymphatic system?
Fluid flow is directed by gradients that move
them from higher to lower pressure states. These gradients are created by several systemic and mechanical factors which add
together to create the needed re-absorption by lymphatics or they will produce unwanted
swelling
201
What is a primary lymphedema?
Lymphedema from genetic miscoding and anomalies
202
All Lymphedema arising from GENETIC mutations are
| considered PRIMARY Lymphedema and present as what?
• Over or undergrowth (hyper/hypoplasia)
of the venous-lymphatic networks
• Absence of lymphatic structures (aplasia)
203
What happens in the case of an over or undergrowth (hyper/hypoplasia) of the venous-lymphatic networks?
Depending on how serious or involved the mutation is, over time there is going to be an inability to transport the lymph and venous nodes, because the structures are poorly formed and as lymph fluid production increases or demand increases, there will be increasing failure
204
What happens in the absence of lymphatic structures (aplasia)?
Presentation is usually at birth, and the absence of lymphatic is very obvious
205
___ is the most likely side effect of chemotherapy
*Peripheral neuropathy* is the most likely side effect of chemotherapy
206
__ is the most likely side effect of radiation
*Integumentary fibrosis* is the most likely side effect of radiation
207
Why do cancer patients have night pain?
- Either because of increased body temp
| - Or from a cognitive point where is because everything else is turned off
208
Why do cancer patients have night pain?
- Either because of increased body temp
| - Or from a cognitive point where is because everything else is turned off
209
What is the onset of congenital lymphedema?
0-2 years old
210
What is the onset of lymphedema praecox?
2-35 years old
211
What is the onset of lymphedema tarda?
35 years old or greater
212
What gene has a mutation in Lymphedema-Distichiasis Syndrome?
FOXC2 also associated with primary valve failure in veins
213
What is the physical presentation of Lymphedema-Distichiasis Syndrome?
- Hemosiderin staining
- Dark fibrosis of the skin
- Two rowed eyelashes on the upper and lower lid
214
What are the clinical presentations of primary lymphedema?
- Fibrosis
- Hardening of the skin, where it almost looks like calcium/salt deposits (hyperkeratosis)
- Deep creases and small lobes
- Bulbous extremities
215
What are the causes of secondary lymphedema?
- Venous Insufficiency
- Cancer and related medical treatment
- Trauma and Injury
- Diseases of other systems : Renal, Cardiovascular, Hepatic
- Filariasis (parasite) - mostly predominant in warmer climates
216
Lymphedema due to ____ is the most common presentation of swelling
Lymphedema due to **venous congestion** is the most common presentation of swelling
217
What is phlebo-lymphedema?
Lymphatic failure due to chronic venous congestion.
218
What are the clinical presentations of phlebo-lymphedema?
- Darkened legs caused by hemosiderin staining
| - Scaly weeping and leakage of fluid from the legs in prolonged cases
219
In order to determine which system is causing lymphedema and in order to determine if a patient belongs in your clinic, what information is it important that we have?
* Detailed Medical History & Medication
* Pain and response of swelling to activity
* Careful questioning to see if other disease processes are involved.
220
What are the subjective questions that we ask our patients with swelling/lymphedema regardless of whether or not it is based upon cancer presentation?
• How did the swelling begin? Is it tied to an event?
Quick onset or slowly over time?
• Does removing gravity (elevation) produce a rapid improvement (30 min or less) normalizing the area?
• Does the patient wake up 100% normal in the morning and only swell when up against gravity?
221
What questions can be asked to determine the severity of a patient with swelling/lymphedema from the subjective interview?
* Does the skin pit? How hard is the pitting?
* Has the color of the area changed? (darker or milky white- can be used to know the system involved too)
* Does the area seep or weep, even intermittently?
222
What questions can be asked to determine the functional capacity of a patient with swelling/lymphedema from the subjective interview?
* Has the swelling or tightness of the tissues decreased mobility or life activities? (legs might feel heavy and tight)
* Does the swelling worsen with therapy or activity?
223
What questions can be asked to determine whether other systems (asides from the primary one) are involved in a patient with swelling/lymphedema from the subjective interview?
* Are they having trouble breathing? (will tell about fluid accumulation around the lungs)
* Abdomen feel full?
* Chest tightness or pressure around the trunk
224
What is the role of standardized questionnaires in the subjective interview of a patient with swelling/lymphedema?
Used generally to determine function, the type of impact the swelling is having on the pts QoL. Questionnaires include:
• Lower Extremity functional scale(LEFS)
• Upper Extremity functional scale (UEFS)
• Lymphedema life impact scale(LLIS)
225
When you know for a fact that a pt's swelling is due to lymphedema based on their history of cancer, what are some additional information to get during the subjective interview?
* Get a functional and QoL questionnaire
* When did they have cancer?
* Which type of chemotherapy or radiation they had and how many courses?
* Did they have any surgeries with lymph nodes removed?
* Is the cancer active or in remission?
226
What are the functional and QoL questionnaire that are specific for pts with lymphedema?
* Lymphedema Life Impact Score - LLIS
| * Lymphoedema Functioning, Disability and Health Questionnaire Lymph- ICF
227
Why is it important to ask a cancer survivor pt to describe how their swelling began?
In order to differentiate from possible cancer reoccurence, and remission or non-recurrence?
228
What are the symptoms of cancer recurrence?
* Sudden, noticeable increase in volume in an area or region
* Discomfort or pain in the region or noticeable change in color
* Area seems or feels “different” (heavy, achy, tight)
* May have other “new” symptoms: bone/joint pain, headache, bloating, etc.
229
What can the observation of a pt with swelling/lymphedema help the PT do?
* Differentiate the systems which may be involved
| * Determine the severity of the swelling
230
How do we differentiate between the systems involved to result in swelling/lymphedema in a pt during the observation component of the objective exam?
• Is it venous based? ( the limb affected will be darker or colored in a reddish-purplish hue)
• Is it lymphatic based? (pale or milky white will indicate lymph fluid accumulation)
3. Combined insufficiency(venous and lymphatic), which will appear with patchy areas of both colors
231
What are the observations seen in the objective exam of a pt with recurrent cancer?
• Combined insufficiency(venous and lymphatic), which will appear with patchy areas of both colors
232
What are the observations seen in the objective exam of a pt with recurrent cancer in the skin?
The skin will be dark and have an almost venous type presentation, although it will be purely lymphatic
233
How do we determine the severity of the swelling/lymphedema in a pt during the observation component of the objective exam?
```
Changes that will show that the swelling has been there for a long time:
• Fibrosis
• Seeping
• Generalized fluid retention
• Wounds
• Darker color of affected area
• Abnormal or unidentifiable growths
• Presence of mycotic (fungal) nails
• Hyperkeratosis(thickening of the skins outer layer)
```
**fewer findings indicate a fairly new swelling**
234
To complete the objective exam of a pt with swelling, what are the other assessments that must be done?
• Baseline girth measurements
• Pitting Edema (0-3+ scale) and Stemmer’s Sign
• Effect of lymphedema on mobility, endurance and recreation
• Lymphatic congestion in other areas of a the affected lymph
region.
235
During the objective exam, what should a PT do if they suspect that the cause of a pt's swelling is truly lymphedema to see how progressed/significant the pt's case might be?
Look in the remaining region of the area with lymphedema. EX: if lymphedema is in the foot and lower leg edema, check the groin, abdomen, hips and upper thighs, to see if the entire region might be experiencing congestion
236
If a pt comes to the clinic with a swelling exacerbation and has history of swelling, and prior treatment, what are the things you should ask the pt to do?
Ask them/have them show how able they are able to don and doff prescribed compression garments.
237
What does it mean(pathophysiology) when a pt has a soft pitting edema?
It means that there is not much protein accumulation and that it is mostly fluid
238
What is a 3+ pitting edema?
Edema that remains persistent after 3 secs
239
What is a 2/3 pitting edema?
Edema that resolves within 2 sec or less
240
What is a 0 pitting edema?
No pitting present with depression
241
Hyperkeratosis is the hardening/thickening of the skin, what is the physical presentation of this?
Calcium/salt deposits on the skin that make hard and rough patches that can break off or crack, and is made of keratin.
242
What does the presence of hyperkeratosis mean for a pt?
Lymphedema has been present for a long time
243
What are the components of girth measurements of lymphedema?
For the arm, zero starts at the small of wrist, then go up every 10 cm to denote the location of the swelling, then measure the girth.
Mid palm is a separate measurement
244
Why is it important to not use physical landmarks when measuring the girth of lymphedema?
As swelling changes and goes down, landmarks shift
245
What is a Stemmer’s Sign?
A test done on the dorsum of the foot/hand, behind the 2nd toe/digit. We try to pinch the skin at this spot. There will be difficulty getting a skin pinch with true lymphedema.
246
What are the ways to determine generalized edema?
The trunk will be significantly large, but the arms are not
247
What are the conditions that we must monitor at all times that might indicate the need of immediate treatment?
* Cellulitis in the presence of lymphedema exacerbation(redness and blushed skin)
* Deep Vein Thrombosis
* Cancer Recurrence
248
What is the presentation of venous based lymphedema?
* Darkened skin- hemosiderin staining
* Hx of major organ failure(renal insufficiency, CHF, liver disease, or a type of hepatitis)
* Improves with rest or sleep, d/t elevation
* Low protein edema(soft or easy to leave a pit, on fibrosis will make it harden)
* Wounds or thin, shiny skin
249
What is the presentation of lymphatic based lymphedema?
* Milky white skin tone in the areas of swelling
* Hx of lymph node removal/treatment such as radiation or surgery
* Minimally reduces with sleep/elevation
* High protein edema (firmness)
* Wounds or hyperkeratosis(suggest great severity/long time)
250
What is the presentation of systemic failure(generalized edema) lymphedema?
* Recent weight gain
* Enlarged abdomen with fullness in face, arms and neck OR normal face arms and neck with an enlarged abdomen
* Recent increase in trouble breathing
* Reports "feeling bad"
* Energy level is less functional that previous week
251
What are the symptoms of a DVT?
* Upper or lower extremity can be affected
* Sudden onset of swelling
* Can be present at any level of the extremity
* Often a change of color to red-purple hue or darkening
* May be warmer than unaffected areas
* Painful to touch or with loading the extremity
252
What are the symptoms of cellulitis?
* Can occur in any area of the skin
* Warmer or “hot” to the touch
* Skin appears “inflamed”, red or irritated
* Skin may be seeping fluid from active metabolism of bacteria present
* Pain with touch or pressure is a key indicator
* Patient may complain of feeling badly or unwell (sign of spreading cellulitis that might lead to sepsis)
253
What are the symptoms of cancer recurrence?
* Sudden, noticeable increase in volume in an area or region
* Discomfort or pain in the region or noticeable change in color
* Area seems or feels “different” (heavy, achy, tight)
* May have other “new” symptoms: bone/joint pain, headache, trouble with speech, dizziness, or difficulty with coordinated movement(all indicates brain involvement), bloating(indicates a metastasis to the GI or liver), etc.
254
___ is a condition that has all the signs of cellulitis, but is not a skin infection
*Stasis dermatitis* is a condition has all the signs of cellulitis, but is not a skin infection
255
What are the components of stage 0(latent) lymphedema?
Swelling is not evident despite impaired lymph transport and may exist for months or year before edema becames evident
256
What are the components of stage 1(reversible) lymphedema?
Early onset of the condition. Accumulation of tissue fluid that subsides with limb elevation. Edema may be pitting at this stage (no fibrosis)
257
What are the components of stage 2(irreversible) lymphedema?
Limb elevation alone rarely reduces swelling, and pitting is manifest with protein rich edema fluid.
- Late stage2: there may or may not be pitting as tissue fibrosis is more evident
258
What are the components of stage 3(lymphostatis elephantiasis) lymphedema?
Accumulation of protein rich edema fluid. Tissue is hard(fibrotic) and pitting is absent. Skin changes such as thickening, hyperpigmentation, increased skin folds, fat deposits, and warty overgrowths develop
259
What determines who and in what setting should treatment of a pt with lymphedema be done?
Type and severity of swelling
260
What type of lymphedema can a PT with no lymphedema certification in a general outpatient setting treat?
* Venous Insufficiency Based Lymphedema
* MILD presentation, systemic issues are not present or are controlled
* No cancer history, No acute signs of symptoms,
* Onset of swelling correlates to injury or surgery
* Area of swelling is in one body region of the extremities
* Swelling present less than 1 month
261
What type of lymphedema can a certified lymphedema PT in an outpatient, acute care or skilled facility treat?
* Venous, Lymphedema or Combined/ systemic failure
* Moderate-severe presentation
* Onset of swelling from any cause
* Lymphedema is in more than one region or body part
262
What should be done if there are any symptoms found which may be correlated to Infection, cellulitis, DVT or cancer metastasis/recurrence?
Patient must be sent back to physician ASAP! If the provider cannot see the patient right away, Emergency Department should be recommended.
