Complex -Oncology

carcinomas

cancer of organ/tissue lining

sarcomas

cancers of supporting tissues

leaukemias

cancer in blood

lymphomas

cancer of lymph nodes

most common types of cancer in US

melanoma, lung, prostate, breast ...

T =

tumor size

T stages

X, 1-4

N =

lymph nodes

N stages

X, 1-3

M =

metastasis

M stages

0-1

stage 0=

in situ

stage 1=

local

stage 2=

regional

stage 3=

regional into lymph

stage 4=

distant metastasis

high output failure lymphedma

transport capacity < lymphatic load (TOO MUCH FLUID)

low output failure lymphedema

transport capacity < lumphatic load (COMPROMISED SYSTEM)

combination lymphedema

transport capacity < lymphatic load (Compromised system, too much fluid)

secondary lymphedema

caused by insufficiency of the lymph system due to secondary factors

advanced clinical presentation of lymphedema

fibrosis, paillomas, hyperkeratosis, ulcerations, pitting edema

stage 0 lymphedema

Sub-clinical: lymph transport impaired, no obvious signs/symptoms, can last for years

stage 1 lymphedema

Reversible, limb is soft and pitting, swelling may increase overnight

stage 2 lymphedema

spontaneously irreversible lymphedema; swelling with increase in fibrotic tissue; risk for infection

severe lymphedema

>5 cm difference between affected and unaffected limbs

what percent of pt with CA get cancer rehab?

2%

cachexia

a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

Dietz model

preventative, restorative, supportive, palliative

adjuvant

preventing recurrence, after main event

neoadjuvant

given prior to main event

induction

to induce remission

consolidation

to maintain remission

palliative

care to optimize quality of life

terminal

will result in death, uncurable

ER=

estrogen

PR=

progesterone

HER2

growth factor gene highly activated in cells of certain types of breast cancer

triple negative

ER/PR/HER2, most advance, can't use hormone drugs

global outcome measures (patient-reported)

PROMIS, WAI, CARG, FACT, brief-fatigue inventory, FACT-GOGNTX, mTNS

impairment specific outcome measures

DASH, NDI, ABC, SPADI

clinician based outcomes

vitals, ROM, strength, posture, circumferential, palpation

performance based outcomes

TUG, hand grip strength, 6MWT, 5TSTS, short performance physical battery

Hand grip strength predicts what?

physical decline, decreased QoL

TUG is a marker for

increased fall risk, fatigue, and pain

sentinel lymph node biopsy (SLNB)

removal of less than 5 nodes to check for spread

Axillary Lymph Node Dissection (ALND)

wedge resection of lymph nodes based on spread

lumpectomy

minimal breast tissue + tumor

partial mastectomy

more breast tissue + tumor

total mastectomy

breast gland, nipple, skin, fascia

skin sparing mastectomy

breast gland and nipple removed

radical mastectomy

breast gland, nipple, skin, fascia, pec major, minor

TRAM flap

post-surgical complications

infection, rippling, drain disruption, close/dirty margins, leak of implant capsular contraction, expander dysfunction

post-surgical side effects

lymphedema, scar adhesion, pain, swelling, neuromas, axillary web syndrome, decreased ROM, postural/breathing dysfunction

axillary web syndrome

after node removal, scarring of lymphatic system, pain, tightness

when does axillary web syndrome occur

within first 2-8 weeks, or months later

what type of surgery is more likely to have cording?

ALND > SLNB

where can lymphedema develop?

hand, arm, breast, chest, and/or trunk

when does lymphedema occur?

6 months to 3 years later

s/s of lymphedema

achiness/discomofrt, heaviness, N/T, loss of ROM, tightness, skin texture changes

risk factors of lymphedema

more nodes removed, multiple surgeries, radiation to axilla, taxane chemo, overweight, infection, rural setting

exercises

wall angels, nerve glides, supine cane flexion, wave bye bye, cane extension, pulley, cane ER, active cord release

manual therapy

skin rolling, lymphatic draining, IASTM, segmental, passive ROM, joint mobs, soft tissue massage, scar management

education topics

lymphedema triggers, cording care, expander precautions, compression garments, KT tape, precautions, infection control, importance of exercise

is chemo local or systemic?

systemic

is radiation local or systemic?

local

is targeted care local or systemic?

systemic

ACT

adriamycin, cytoxan, taxol

TC

taxotere, cytoxan

what does chemo do?

use drugs to target and kill rapidly dividing cells

other cells that are killed with chemo:

hair, stomach, blood

the four big C's

1. cancer related fatigue

2. cancer related cog decline

3. cardiotoxicity

4. chemo induced peripheral neuropathy

chemo side effects

hair loss, N/V, GI issues, insomnia, ototoxicity, mouth/throat sores, blood disorders, sarcopenia, osteopenia, allergy, falls, pain, appetite loss, sex dysfunction

what is the number 1 complaint among cancer pt?

FATIGUE

treatable causes of fatigue:

pain, anemia, emotional distress, inactivity

what is the only intervention found to reduce CRF?

exercise

highest connection between cancer related cognitive decline (chemo brain) and what dx?

breast cancer and lymphoma

cardiotoxicty

weakening and damage to heart mm

cardiotoxicity: strong link to chemo drug class called ____________________

anrhacyclines (adriamycin)

adriamycin=

red devil

sx of cardiotox:

dyspnea, edema, cough

chest pressure, increase SOB/HR, radiating pain =

NOTIFY ONCOLOGIST

drug categories that cause chemo induced peripheral neuropathies

platinum, vinca alkaloids, taxanes, immune checkpoint inhibitors

ways to assess peripheral neuropathy:

increased pain scale, decreased myotomes, decreased DTRs, increased vibration, decreased light touch, decreased sharp/dull, poor balance assessment, 9 hole peg, poor capillary refill, stocking glove

why does vibration increase?

because it is deeper pressure

treatment for chemo induced peripheral neuropathy:

foot massage

radiation: use to

control tumor growth, kills dividing cells by damaging DNA

radiation can be used ____________________ or __________________

curatively or palliatively

effects of radiation can take up to _____ weeks

2

conventional radiation

broken into fractions delivered 5 days a week for 2-8 weeks

hypofractionated radiation

single fraction, large doses, fewer sessions

bracytherapy radiation

inside out, implanted radioactive seed

acute side effects of radiation

radiation burns, redness, peeling skin, decreased swelling, follicultis, pleuritic pain, muscular pain, N/V

subacute side effects of radiation

radiation pneumonitis, cough, fever, chest pain, hypo/hyperpigmentation

late side effects of radiation

fibrosis, fat necrosis, rib fracture, graft fracture, pulmonary malignancy, lymphedema, brachial plexopathy, cardiac issues, phlebitis/thrombosis

s/s of radiation fibrosis

tight tissue, axillary webbing, altered sensation, OP, mucositis, diarrhea, frequency, urgency, urinary stenosis, fertility issues

when does radiation fibrosis start?

3 months after finishing radiation

avoid what during/after radiation:

sun exposure, excessive antioxidant use, sedentary lifestyle

how to care for skin

use bland moisturizer, cortisone cream, good deodorant, watch for broken skin, use sunscreen

for ____ weeks post-radiation, DO NOT DO STM

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