PT 611 (Exam 2) - Oncological Health Conditions

Define cancer

A large group of diseases characterized by uncontrolled cell proliferation and spread of abnormal cells

Define differentiation

Process by which normal cells undergo physical and structural changes as they develop to form different tissues of the body

Describe when a cell is well differentiated

• Very little to no mutation

• Specialized cell types for specific function

Describe when a cell is poorly differentiated

• More mutations

• Cells may not resemble same tissue cells

• Less differentiated = faster metastasis = worse prognosis

Describe oncogenesis, what may activate it, and what it may release.

“cancer-causing genes” can transform normal cells into malignant cells

• May be activated by carcinogens

• Release strong growth-stimulating genes and driving cell growth

Describe tumor suppressor genes

When activated, can regulate cell growth and inhibit carcinogenesis

When are tumor cells created?

When oncogene defects occur simultaneously within activation of tumor suppressor cells

Define a tumor/neoplasm

Abnormal new growth of tissue that serves no useful purpose and may harm host by competing for blood and nutrients

Malignant tumor

cancerous mass of abnormal cells, grows uncontrollably

Benign tumor

relatively harmless, does not spread or invade other tissue (can create harm based on size)

Primary tumor

from cells that are normally local to structure

Secondary tumor

from cells that have metastasized from another part of body

Metastasis

spread of cancer cells from primary site to other sites of body

When do metastases typically occur?

Usually occurs within 3-5 years after initial diagnosis and treatment

What are common sites for metastases?

• Lung (most common)

• Liver (primary site for tumors of stomach, colorectum, pancreas)

• Brain (commonly from lung, breast)

• Bone

What are some symptoms of metastases

• Shortness of breath, dry cough, pleural pain (lung)

• Pain

• Headache, change in vision, dizziness, seizures (brain)

• Fracture (bone)

• Jaundice and abdominal swelling (liver)

• Extreme loss of energy or fatigue

• Unintentional weight loss

• New lump

• Abdominal pain/RUQ pain, anorexia (liver)

• Impaired cognition/mentation (brain)

Describe typical staging for cancer.

0: Carcinoma in situ (premalignant)

1: Early stage, usually localized

2: Increased risk of regional spread

3: Local cancer has spread regionally but may not be in distant regions

4: Cancer has spread to distant sites

Describe TNM staging (T portion)

T: Primary tumor

Tx: cannot be assessed

T0: no primary tumor

TIS: carcinoma in situ

T1, T2, T3, T4: progressive increase in tumor size and involvement locally

Describe TNM staging (N portion)

N: Regional lymph nodes

Nx: cannot be assessed

N0: no metastasis to regional lymph nodes

N1, N2, N3: increasing degrees of

involvement in regional lymph nodes

Describe TNM staging (M portion)

M: Distant metastasis

Mx: cannot be assessed

M0: no distant metastasis

M1: distant metastasis

Solid Tumors: Definition

Localized abnormal mass in specific organ or tissue (dx with imaging and biopsy)

Solid Tumors: Type

• Carcinoma-most common, begin in epithelial tissue (breast, lung, prostate, colorectal)

• Sarcoma-originate in connective or supportive tissues; can develop in bones, muscles, fat, blood vessels or deep skin tissue (osteosarcoma, liposarcoma)

Solid Tumors: Treatment

potential surgery, radiation, chemotherapy, immunotherapy

Blood cancer - Definition

• Hematologic malignancy affecting production and function of blood cells (dx with blood tests and bone marrow biopsy)

• Typically start in bone marrow

• Uncontrolled growth of abnormal type blood cell circulating through body-prevents normal function of body (immune response, coagulation)

Blood Cancer - Types

• Leukemia- affects WBCs and bone marrow

• Lymphoma- lymphatic system, affects lymphocytes

• Multiple Myeloma- plasma cells, cause bone damage

Blood Cancer - Treatment

systemic therapies-chemotherapy, stem cell or bone marrow transplant

Where in the list of leading death causes is cancer in the U.S.?

Second

What are the five most commonly diagnosed types of cancer?

• Lung

• Female Breast

• Colorectal

• Prostate

• Skin

Describe cancer survivorship.

• “A person is considered a cancer survivor from the time of diagnosis through the balance of life.”

(National Cancer Institute)

Survivorship - Lung

• Most common cancer in men, 2nd most in women

• Leading cause of cancer morbidity and mortality

• 5 year survivor <20% in most countries

Survivorship - Breast

• Female breast cancer is 2nd most common cancer (1st in women)

• 4th leading cause of cancer mortality

• 5 year survivor: 90.8% (dependent on type and stage)

Survivorship - Colorectal

• 3rd most common cancer, 2nd in cancer mortality

• 5 year survival 63% (colon) and 67% (rectal)

Survivorship - Prostate

• 2nd most frequent cancer in men, 5th in cancer mortality in men

• 5 year survival 98%

Prevention - What are four things that are connected to cancer that can be avoidable?

• 19% associated with cigarette smoking

• 8% associated with excess body weight

• 5% associated with alcohol consumption

• Routine screening can prevent many colorectal and cervical cancers

Prevention - How can physical activity and diet affect cancer?

• Physical activity decreases cancers of colon, breast, endometrium, kidney, bladder, esophagus, and stomach

• “Unhealthy diet (low consumption fruits, vegetables, and dietary fiber and calcium; high consumption red and/or processed meats) is associated with increased risk of cancer in colorectum, oral cavity, esophagus, pharynx and larynx”

• “Alcohol consumption increases risk for cancers of the oral cavity, pharynx, larynx, esophagus, liver, colorectum, and female breast”

What are risk factors of cancer?

Multiple environmental, genetic, and viral factors disrupting the immune system is likely cause of cancer development:

• Advancing age is one of most significant risk factors

• Previous cancer

• Exposure to viruses

• Exposure to hormones

• Geographic location

• Gender

• Ethnicity

• Occupation

• Stress

• Socioeconomic status

• Lifestyle (Cigarette smoking, Diet/physical activity, Alcohol use, Sexual behaviors, Obesity, Exposure to sunlight)

Management - Conservative

Cancer may not warrant treatment

• Burdens vs benefits of treatment

• Slow growing or minimally invasive cancer

Management - Chemotherapy

• Chemical agents (medications) to destroy cancer cells

• Particularly useful in widespread or metastatic cancer

Management - Radiation Therapy

• Destroys cancer cells while damaging normal cells as little as possible

• More useful for local lesions

• Can be used preoperatively to shrink tumor

Management - Immunotherapy (Biological)

•Biologic response modifiers to change relationship between tumor and host

•Varied availability regionally-still considered experimental

Management - Surgery

•Curative or palliative

•Used in combination with other treatment

Management - Hematopoietic Cell Transplant

•Cancers responsive to high doses chemotherapy or radiation but toxic to bone marrow

Cancer Treatment Side Effects

• Bone marrow suppression (chemotherapy and some radiation)-leads to decreased WBCs, RBCs, platelets

• Leukopenia (neutropenia)-increased risk infection

• Mouth sores

• Nausea/vomiting

• Fluid retention

• Pulmonary edema

• Cough

• Headache

• CNS effects

• Peripheral neuropathies

• Malaise/fatigue

• Dyspnea

• Hair loss

What are some LONG-TERM cancer side effects?

• Cardiovascular- pericarditis, cardiomyopathy, coronary artery disease, congestive heart failure, valvular disease, sinus node dysfunction

• Lymphatic- lymphedema

• Pulmonary- fibrosis

• Neurologic- impaired hearing or vision, vestibular impairment, neuropathy

• MSK- pain, Raynaud’s, avascular necrosis, bone loss/pathologic fracture, altered muscle activity, arthritis

• Integumentary- Radiation recall

• GI- malabsorption, bowel dysfunction, incontinence

• Renal- chronic kidney disease

• Endocrine- thyroid impairment, DM, osteoporosis, adrenal insufficiency

PT Roles - Primary

• Screening and prevention of cancer (assess risk factors)

• Screening and referral for possible undiagnosed cancer

• Awareness of precautions and contraindications for cancer management

• Prevention of complications from cancer and cancer management

• Awareness of red and yellow flags

PT Roles - Secondary

• Rehabilitation after cancer diagnosis and cancer management

• Prevention of complications after cancer diagnosis and management

• Awareness of precautions and contraindications with cancer and cancer management

PT Roles - Tertiary

Specialized care/certifications

• Oncologic Clinical Specialist

• Lymphedema certification

What are some warning signs that a PT should look out for?

• Change in bowel/bladder habits

• Sore that does not heal in 6 weeks

• Unusual bleeding or discharge

• Thickening lump in breast (or elsewhere)

• Difficulty swallowing or indigestion

• Obvious change in mole or wart

• Nagging cough, hoarseness

• Rapid unintentional weight loss (10% body weight in 10-21 days)

• Changes in vital signs

• Frequent infections

• Night pain

• Proximal muscle weakness

• Change in deep tendon reflexes

• Pathologic fracture

• Growing mass/tumor until proven otherwise (Example: hematoma should decrease (not increase) in size)

Describe a history for someone whom you may suspect has cancer?

Screen for potential cancer symptoms based on location and body systems:

•Pulmonary: pleural pain and dyspnea, cough, wheezing

•Skeletal: bone pain, pathologic fracture

•Hepatic: bilateral carpal tunnel syndrome, ab pain/tenderness with malaise

•Neurologic:

• Brain: headache, personality change, seizure

• Spinal cord: pain, sensory symptoms, muscle weakness

Medical Record - What lab values, diagnostic testing =, and cancer management details should you look into?

Lab Values

• Red blood cells (RBC)

• Hemoglobin and Hematocrit (H/H)

• Platelet count (Plt)

• White blood cells (WBC)

• Neutrophil count

Diagnostic Testing

• Imaging

• Biopsy

Cancer Management

• Consider timing and type of management

• May affect lab values or patient activity tolerance

• Consider location and extent of tumor

Describe skin cancer.

Caused by prolonged or intermittent exposure to UV rays from sun (especially when sunburn/blistering occurs) and damages DNA

What are risk factors associated with skin cancer?

age, family or personal history, moles with ABCDE features, light complexion, skin that burns easily, h/o painful/blistering sunburns, use of tanning beds, transplant recipient, short, intense episodes sun exposure

Skin Cancer: Non-melanoma

• Common and slow growing

• Responsive to intervention, rarely metastasize (nearly 100% cure rate)

Skin Cancer: Melanoma

• <1% skin cancer cases but responsible for majority of skin cancer deaths

• 92% 5-year survival rate if localized, 25% 5-year survival rate if invasive or metastasized

• Flat, colored, irregular lesion that an be mottled with brown/black

Skin Cancer: ABCDE Describe melanoma

Asymmetrical, Borders are uneven, multiple Colors, larger than ¼ in. Diameter, and Evolving in size or shape

Describe lymph node palpation

Performed over multiple regions to detect areas of tenderness or enlargement

• Light touch with fingertips

• Slow, circular motion

• Glide along skin (don’t poke)

What are some PT considerations, precautions, and contraindictations?

Be aware of cancer location and cancer management (current or past)

• Infection prevention

• Risk of bleeding

• Risk of fracture

• Exercise prescription

• Manual contact

• Vital signs-appropriateness for therapy