Rehab II - Oncology

imported from quizlet sonniersm

Cancer

Characterized by uncontrollable growth and spread of abnormal cells due to damage to the cell's DNA

1. DNA damage

2. Immune system failure

3. Ignoring suppressor signals

4. Self-stimulating growth

5. Lack of programmed death

6. Loss of contact inhibition

What causes cancer to develop (6 key factors)?

Mutations

__________ in DNA cause cells to grow abnormally and avoid normal cell death

Tumors

Cancer cells ignore space limitations and continue dividing, forming _______.

Tobacco, diet, activity, alcohol, stress, environmental (radiation), viral exposures (HPV, Hep B&C, HIV)

MODIFIABLE risk factors of cancer

Increasing age, gender, ethnic background, inherited genetic mutations (breast, ovarian), hormonal factors, immune and autoimmune conditions

NON-MODIFIABLE risk factors of cancer

Benign tumors

• Non-cancerous, slow-growing.

• NO metastasis but may cause symptoms.

• Encapsulated with clean edges → Easier to remove

Malignant tumors

• Cancerous, rapid-growing

• Metastasizes via blood or lymphatics

• Angiogenesis

• Not encapsulated → Difficult to remove, high recurrence risk.

Carcinomas

Epithelial tissue — most common; spreads via lymphatic & blood systems

Carcinomas

Common sites are — skin, lung, colon, pancreas, stomach, prostate, uterus, bladder, breast

Sarcomas

Connective tissue; spreads via bloodstream and often metastasizes to the LUNGS

Sarcomas

Common sites are — bone, blood vessels, muscle

Lymphomas

Lymphoid tissue, includes hodgkin & non-hodgkin lymphoma

Lymphomas

Common sites are — lymph nodes, spleen, CNS, skin, bones, stomach

Blood/bone marrow

Hematopoietic tissue;

• Leukemia (affects WBCs)

• Myelodysplasia

• Multiple myeloma (plasma cell cancer)

Nervous system tumors

Nerve tissue; Common sites are — brain, SC, retina, and nerves

Nervous system tumors

Examples: glioma, neuroblastoma, retinoblastoma, and astrocytoma

Unexplained weight loss, anemia (fatigue), weakness, pain (diffuse, nondescript)

S/S of cancer; general red flags

Change in bowel/bladder habits

A sore that won't heal

Unusual discharge or bleeding

Thickening or lump (i.e. breast, testicle)

Indigestion or difficulty swallowing

Obvious changes in a wart or mole

Nagging cough or hoarseness

American Cancer Society's 7 Warning Signs (CAUTION)

Asymmetry

Border irregularity

Color changes

Diameter (> 6mm)

Evolution

Skin Cancer: ABCDE Rule

Clinically visible

100 million cells or 1 gram in weight

Symptoms begin

what happens with 100 billion cancer cells

Clinical remission

Fewer than 100 million cells are detected

"Cured"

No detection for 5 years

Tumor, Lymph Nodes, Metastases

Cancer staging; TNM system

0

Carcinoma in situ (pre-cancer, abnormal cells present).

I

Confined to the tissue of origin, NO lymph node spread or metastasis

II

stage_____: Local spread to adjacent tissues; possible lymph node involvement.

III

Spread to adjacent tissues with signs of deeper invasion, likely lymph node involvement.

IV

Metastasizes to distant organs

Primary, secondary, tertiary

Medical prevention strategy categories:

Primary

Prevent cancer from developing (screening, vaccines, modification of risk factors through education, lifestyle changes)

Secondary

____________ Prevention: Early detection & intervention (removal of precancerous cells)

Tertiary

Managing existing cancer, reducing & limiting complications (prevent disability due to cancer and treatment)

Type and location of tumor, extent and spread of disease (staging)

Medical treatment is determined by:

Goals of cancer treatment

• Eradicate tumor (cure) or achieve remission

• Prevent recurrence or metastasis

• Control tumor size and progression

• Palliation of symptoms

Surgery, chemotherapy, radiation therapy, targeted therapies

4 main types of medical management for cancer:

Surgery

Primary treatment method with goals including diagnosis (biopsy), tumor debulking, resection, palliation, cure, and managing life-threatening conditions

Primary tumor, surrounding healthy tissue, and lymph nodes

Surgery often involves-

Local

Surgery follows a (Local/Systemic) and selective approach based on the tumor type

Radiation therapy

A localized but non-selective treatment that destroys cancer cells by damaging DNA and impairing replication

Radiation therapy

Affects both cancerous and healthy cells; MOST useful with localized malignancies

Neoadjunctive, adjunctive

Radiation therapy is most effective for localized malignancies and can be used BEFORE SURGERY (__________) to shrink tumors or AFTER SURGERY (___________) to eradicate the tumor bed

radiation to Shrink tumor

Neoadjunctive does________

radiation post surgery _________: Eradicate the tumor bed

Adjunctive

External beam, internal beam (prostate seed implants)

Two main types of radiation therapy:

Chemotherapy

A SYSTEMIC, NON-selective treatment that targets rapidly dividing cells, making it ideal for widespread or metastatic cancer

Chemotherapy

Destroys circulating cancer cells while MINIMIZING harm to healthy tissue

Chemotherapy

Like radiation, higher rate of death for rapidly dividing cells (cancerous > healthy)

Nadir, 7-10

Chemotherapy is typically given in cycles to allow for healthy cell recovery, with the ____ occurring _______ days post-treatment, marking the LOWEST CBC

Neoadjunctive, adjunctive

Chemotherapy can ALSO be used BEFORE SURGERY (__________) to shrink tumors or AFTER SURGERY (_________) to eradicate the tumor bed

Chemotherapy

Cognitive changes, decreased appetite, nausea, vomiting, and diarrhea are some of the SIDE EFFECTS of-

Cardiac toxicities (chemotherapy)

L ventricular failure, decreased EF

Neurological toxicities (chemotherapy)

chemo induced peripheral neuropathy (CIPN), numbness/tingling, proprioceptive deficits, ADL issues, gait dysfunction, LE weakness, falls

Targeted therapies

A type of cancer treatment that offers specialized treatment approaches (i.e. immunotherapy, hormonal therapy)

Immunotherapy

Enhances the immune system's response using agents like IFNs and IL-2 or through stem cell and bone marrow transplants for cancers like Leukemia, Lymphoma, and Myeloma.

Hormonal therapy

Modifies hormone production or action to slow hormone-dependent cancers, such as BREAST and PROSTATE cancer

Antiangiogenic therapy

BLOCKS of new blood vessels that feed tumors, with drugs like Thalidomide playing a role in cutting off the tumor’s blood supply

Targeted therapies to slow growth → neoadjunctive chemo/radiation → surgery → adjunctive chemo/radiation

Common treatment Pathway 1

Surgery → adjunctive chemo/radiation → targeted therapies

Common treatment pathway 2

Localized, selective

Surgery is _______ and _______

Localized, non-selective

Radiation therapy is-

Cancerous and healthy tissue

Radiation therapy harms

Systemic, non-selective

Chemotherapy is-

Cancerous tissue, healthy tissue

Chemotherapy harms ___________ while sparing ______________

Pain

Affects 50-70% of patients and is difficult to manage, limits function

VAS >4/10

With CRF self-report screening, which VAS rating is considered clinically significant?

Chemo cycles, comorbidities, lifestyle

Risk factors of CRF

Deconditioning, decreased QoL, lean muscle loss

cancer related fatigue (CRF) causes-

Thrombocytopenia

Low platelets

~290K

Normal platelet count

< 150K

Thrombocytopenia (increased bleeding risk) platelet count

Thrombocytopenia

GREATEST RISK with exercise

Decreased, increased bleeding risk

Lower platelets = (increased/decreased) clotting → ??

Anemia

Low hemoglobin (HgB) is called

Less, fatigue and lower exercise tolerance

Low HgB = (more/less) oxygen delivery → ??

Women < 12; men < 14

Normal HgB count for women and men

< 11, < 8

With HgB, a cause for concern is if _______, significant concern is if ________

True

T/F? With LOW Hgb monitor fatigue, encourage energy conservation

Neutropenia

Low neutrophils

< 1.5

ANC < _____ = HIGH Infection risk

ANC < 1.5

Thrombocytopenia 50-150K

CBC & exercise: Symptom-based approach; light RESISTIVE or AEROBIC exercise if tolerated.

ANC 0.5-1.0

Thrombocytopenia 20-50K

Monitor for bleeding, fall risk, and safety. Do movement-based exercise WITHOUT resistance (i.e. WALKING, BIKING)

ANC <0.5

Thrombocytopenia < 20K

High risk! Focus on FALL prevention. Only ADLs & ambulation (NO structured exercise).

Thrombocytopenia < 10K

NO EXERCISE. Restricted mobility. Only essential ADLs with close monitoring.

True

T/F? Neutropenic precautions include strict hygiene to avoid exposure risk to infections

Leukopenia

Low WBCs is called:

4,500 - 11,000

Normal WBC

< 3,000

If leukocytes _______, use precautions w/ AEROBIC EXERCISE

< 1,000-1,500

If WBCs _______, infection precautions REQUIRED

Lymphedema

Lymph node involvement and/or removal

Lymphedema

PT management in ________ involves manual lymph drainage (MLD) and/or compression garments

Breast, prostate, lung, and colorectal

4 most common cancers in the US

Lumpectomy

Breast conservation; excision of tumor and SMALL amounts of surrounding tissue

Simple, skin-sparing/nipple-sparing, MRM

What are the 3 different types of mastectomies:

Simple

Removal of entire breast, skin, nipple

MRM (modified radical mastectomy)

Removes the breast, skin, nipple, and sometimes pectoral muscles, along with lymph node dissection or biopsy

DIEP, TRAM

For breast reconstruction, options include-

DIEP

Uses skin & fat from lower abdomen to create a new breast (WITHOUT removing abdominal muscle)

TRAM

Uses skin, fat, AND part of rectus abdominis muscle from abdomen (weakens core and may incr risk of hernias)