Cancer

What are the methods for staging cancer?

size, location, degree of spread

What is the most commonly used stage system for cancer and what does each component represent?

TNM

T- tumor

N- node

M- metastisis

Do all cancers use the TNM, system? If not, what do they use?

no

Brain and spinal cord are staged according to cell type and grade

Bone, blood, lymphomas use Ann Arbor Classification System

Seperate system for cervix, vaginal, ovary, vulva

What does summary stage "in situ" mean?

abnormal cells are present only in the layer of cells in which they developed

What does the summary stage "localized" mean?

cancer is limited to the organ in which it began, no spread

What does the summary stage "regional" mean?

cancer spread to nearby

What does the summary stage "distant" mean?

cancer spread to distant tissues or lymph nodes

What does the summary stage "unknown" mean?

not enough information to determine the stage

What are the intrinsic risk factors for cancer?

Age

Heredity

Hormones

Immune system competence

Metabolic abnormalities

What are the extrinsic risk factors for cancer?

Environment

Lifestyle

Occupation

Approximately how many cancers are preventable?

1/3

What are the 7 warning signs of cancer?

-Changes in bowel or bladder

-Obvious changes in wart or mole

-Unusual bleeding or discharge

-Persistent cough or hoarseness

-Difficulty swallowing or indigestion

-Thickening or lump in tissue

-Persistent sore throat

What are the different kinds of breast cancer?

ductal carcinoma in situ

lobular carcinoma in situ

invasive ductal carcinoma

invasive lobular carcinoma

inflammatory breast cancer

Describe some precautions for those who have undergone breast cancer surgery and reconstruction

-flex forward 45* to protect surgical site

-log roll bed

-limit ab movement

-avoid scapular retraction

-avoid bilateral UE movement

-limit to <10lb lifting

-avoid push/pull affected side

-limit shoulder ROM

What is the leading cause of cancer deaths in the US?

lung cancer

What are common symptoms of lung cancer?

cough, dyspnea, recurrent pneuomia/bronchitis. Chest paint, hemoptysis, fever, weight loss

What are the extrinsic risk factors for lung cancer?

smoking/tobacco use, toxic heavy metal exposure, asbestos, radon, radiation, certain organic chemicals, arsenic, air pollution, hx TB

What is the typical treatment for lung cancer?

bronchial stenting, radiation therapy, chemo, lobectomy, wedge resection, segmentectomy, pneumonectomy

Is there a known cure for lung cancer?

no

Describe OT's role in lung cancer:

energy conservation, lifestyle management, activity analysis, anxiety/stress management, home assessments, assistive devies and adaptive equipment breathlessness management, sleep hygiene treatment of related cognitive deficits

*Know common cancer treatment side effects

ex) chemo-brain, CIPN, CRF

memory changes

sensory changes

skin changes

GI changes

fluid retention changes

What is palliative care?

optimize QoL, treating suffering: pain control, sx management, emotional support

What is hospice care?

< 6 mo. who forgo aggressive cure-focused care

What are the 7 dimensions of wellness?

occupational

emotional

spiritual

environmental

physical

social

intellectual

Identify and describe the two types of lung cancer

Small-cell: grows rapidly, poor prognosis

Non-small cell: 85% of lung cancers

= squamous cell carcinoma

= adenocarcinoma

=large-cell undifferentiated carcinoma

What is CIPN? What are the symptoms?

Chemo-induced peripheral neuropathy

Pain, burning, tingling, decreased sensation, decreased coordination, hypersensitivity to temp/touch/pressure

Describe OT's role in addressing CIPN

-Prevent functional decline by modifying activity demands or contexts and environments

-Provide intervention to improve performance skills and client factors

-Establish performance patterns that focus on improving engagement in occupation

-Ensure safety, educate and train, graded exposure to textures

What are some precautions to take into account when treating someone undergoing chemotherapy?

remain clear of saliva and sweat - toxic 48 hr after treatment

What are some precautions to take into account when treating someone undergoing radiation?

Maintain away from at least a few days after (all fluids, secretions, and discharges are radiated)

Common side effect: Skin Changes, Interventions =

keep skin clean and dry, avoid alcohol-based products/perfume, use intense creams, shower warm not hot, pat don't rub dry, loose-fit clothes, sunscreen, nails clean and short, wear gloves as needed, avoid heating pads/ice packs over areas that received radiation, keep eyes moist with glasses/drops

Common side effect: Memory changes, interventions =

plan ahead, be organized, write things down, adequate rest, involve all stakeholders, ask for help

Common side effects: Fluid retention, Intervention =

avoid high salt content, elevate feet when sitting, avoid constricting clothing, regularly weigh yourself, avoid long periods of standing, wear compression stockings if warranted

Common side effect: GI problems, Interventions =

avoid greasy/spicy foods, avoid strong odors, small sips and stay hydrated, smaller/more frequent meals, eat/drink slowly, adapted utensils. Antiemetics, anorexia = try new foods/eat with others, BRAT diet for diarrhea (banana, rice, applesauce, toast), constipation eat fruit/veg fresh, grains/nuts/seeds

Common side effect: Sensory Changes, Intervention =

increase safety awareness during routine activities, incorporate home and bathroom safety, employ fall prevention strategies, compensatory strategies for impaired sensation, medication for nerve pain

Common side effect: Fatigue, Interventions

Energy conservation strategies (prioritize activities, rest breaks, "listen to body", adaptive equipment/modify environment, delegate), modify/grade activities

Other common side effects of cancer treatment include:

sore mouth/throat, alopecia, increased risk of infection, bleeding problems, anemia, sexual dysfunction and fertility changes, changes in urination, psychological issues, disfigurement/scar tissue/deformities, steroid-induced myopathy