System Interactions - NPTE Review

Carcinoma

Malignancy originating from the epithelial cells of organs. 80% of all cancers.

General S/S of Cancer

C - change in b/b routine A- a sore that will not heal U - unusual bleeding/discharge T - thickening/lump develops I - Indigestion or difficulty swallowing O-Obvious change in wart/mole N - Nagging cough/hoarseness

Primary Prevention

Screening, vaccines, elimination of modifiable risk factors

Secondary Prevention

Early detection, preventative pharm agents, multifactorial risk reduction

Tertiary Prevention

Prevent disability, limit complications, manage symptoms

Epithelium

Carcinoma, adenocarcinoma (skin, lining of internal cavities, mucous membrane, lining of bladder)

Pigmented Cells

Malignant melanoma (moles)

Connective Tissues

Sarcomas (striated mm, blood vessels, bone, cartilage, fat, smooth mm)

Nerve Tissues

Astrocytoma, Glioma, Neurilemic Sarcoma, Neuroblastoma, Retinoblastoma (brain, nerves, SC, retina)

Lymphoid Tissues

Lymphoma (Lymph nodes/tissue, spleen)

Hematopoietic Tissues

Leukemia, myelodysplasia, myeloproliferative syndromes, multiple myeloma (bone marrow, plasma cells)

TNM Staging system

T = size and extent of primary tumor N = Lymph node involvement M = presence of metastasis

Stage 0

Early malignancy that is present only in the layer of cells in which it began. For most cancers this is referred to as carcinoma in situ. Not all cancers have a stage 0

Stage I

Malignancy limited to the tissue of origin with no lymph node involvement or metastasis

Stage II

Malignancy spreading into adjacent tissues; lymph nodes may show signs of micrometastases

Stage III

Malignancy that has spread to adjacent tissue showing signs of fixation to deeper structures. The likelihood of metastatic lymph node involvement is high

Stage IV

Malignancy that has metastasized beyond the primary site.

Clinical Staging

Estimated extent of malignancy present based on the findings of a pts physical examination, lab values, imaging tests and biopsy

Pathologic staging

Refers to staging based on the pathology findings of tissue samples obtained during surgery

Lymphedema

Chronic, incurable condition. Primary and secondary.

Complete decongestive therapy (CDT)

combo of manual lymphatic drainage, compression bandaging/garments, education, skin care, and exercise.

CDT Phase 1

Considered the intensive acute tx phase typically provided in outpatient setting by trained clinician 4-5 days/week for 4-6 weeks.

CDT Phase 2

Refers to the long-term management of symptoms utilizing various components of CDT modified for a self-care model

Brain Cancer - Etiology

Most primary cancers outside of the brain metastasize to the brain during progression of the cancer

Brain Cancer - S/S

HA, seizures, inc ICP, cognitive and emotional impairment, and dec motor and sensory function

Breast cancer

Most common female malignancy. Majority of cases are classified as adenocarcinoma and it is the second leading cause of female death from cancer. If cancer recurs, it is usually within two years of the initial diagnosis

Breast Cancer - S/S

The mass is typically firm, irregular, and non-painful. The pt may also present with signs including nipple discharge, erythema or a change in breast shape. Current 5-year survival rate for localized tumors is 92%; this drops substantially if there is nodal involvement

Cervical Cancer

Cells on the surface of the cervix, typically squamous cells. This precancerous condition is called dysplasia and is easily treatable. Annual cervical screening is recommended; diagnosis is made through a Pap test. Prognosis is good with timely intervention

Cervical Cancer - etiology

Human papilloma virus (HPV) is the primary cause of cervical cancer, it is slow growing risk

Cervical Cancer - S/S

Symptoms can include abnormal bleeding, pelvic and low back pain, impairment with b/b function

Colorectal Cancer

15% of cancer deaths annually. Adenocarcinoma and primary lymphoma account for the majority of intestinal cancers

Colorectal cancer - S/S

Does not provide early signs of disease and most prominent symptom is continuous change in bowel habits. Bright red blood from the rectum is another prominent sign of colon cancer. Fatigue, weight loss, anemia and overt rectal bleeding

Lung Cancer

Most frequent cause of death from all cancers

Lung Cancer - tx

Poor prognosis secondary to expedited metastasis (less than 14% for a five year survival rate)

Lymphoma (Hodgkin's dz, non-Hodgkin's z)

lymphomas are categorized as Hodgkin's dz or non-Hodgkin's lymphoma. S/S = painless lump usually first sign

Lymphoma Hodgkin's - etiology

Epstein - Barre virus, drug abuse, immunosuppressant use, obesity, chronic or autoimmune dz

Lymphoma Non-Hodgkin's - etiology

Exposure to benzene (cigarette smoke( auto emissions and pollution

Lymphoma Hodgkin's - tx

One of most curable cancers depending on age, disease stage, overall health and responsiveness to tx

Pancreatic Cancer - etiology

Tobacco use, gender, increasing age, and cholecystectomy

Pancreatic Cancer - S/S

Weight loss, jaundice and epigastric pain that can radiate to the thoracic region

Prostrate Cancer

Second highest cause of death from cancer in men. Approximate 10% fatality from this diagnosis

Basal Cell Carcinoma - Skin Cancer

Slow growing form of skin cancer that rarely metastasizes. It originates from the epidermis and is the most common form of skin cancer

Basal Cell Carcinoma - S/S

Open sores that can bleed or crust and remain for three or more weeks, reddish patches of skin, a shiny bump on the skin that is often pink, or scar-like area that has poorly defined borders

Malignant Melanoma

Classified as: Superficial spreading, nodular, lentigo maligna or acral lentiginous melanomas. Peak incidence btw 40-50 y/o. Early diagnosis vital to prognosis, as it can spread and metastasize quickly.

Malignant Melanoma - S/S

Lesions can be elevated on the surface of the skin and appear keratotic or scaly. Asymmetry, irregular borders, varied color, and a diameter of greater than six millimeters.

Malignant Melanoma - Tx

Form of cancer is 100% curable with early diagnosis

Astrocytoma

50% of pediatric brain tumors

Astrocytoma - s/s

Two types - cerebellar, supratentorial. Cerebellar = clumsiness, ataxic gait, HA, change in personality and vomiting. Supratentorial = HA, seizures, change in personality, visual impairments and vomiting.

Astrocytoma - Tx

Surgical resection of cerebellar tumors offers an 80-90% cure rate

Leukemia

Pediatric. Cancer of the blood that occurs when leukocytes change into malignant cells

Leukemia - etiology

Acute lymphoblastic leukemia (ALL) and acute myelogenous leukemia (AML) occurring most frequently in children

Leukemia - S/S

Abrupt onset with high fever, bleeding, enlarged lymph nodes and spleen, progressive weakness, fatigue, and painful joints. Blood work will indicate anemia, a leukocyte count greater than 500,000 mm3 and thrombocytopenia

Leukemia - Tx

Over 90% of pts with ALL achieve complete remission with tx, while 70-80% of pts with AML achieve complete remission with treatment

Neuroblastoma

Pediatric. Sympathetic nervous system, primarily seen in the adrenal glands or paraspinal ganglias. This is the most common malignant tumor seen in children

Neuroblastoma - S/S

Abdominal mass, change in personality, anemia, sweating, pain and diarrhea

Neuroblastoma - Tx

Prognosis is best for children diagnosed in first year of life

Osteogenic Sarcoma

Pediatric. Epiphyses of long bones. Osteogenic sarcoma is the most common form of bone cancer in children with a peak incidence btw the ages of 10 and 20.

Osteogenic Sarcoma - S/S

Presence of a mass, rapid metastases, and associated pain

Osteogenic Sarcoma - tx

Amputation with proximal resection to ensure proper removal of affected tissue or surgical procedures that attempt to resect the tumor and salvage the limb. Radiation not effective

Wilm's Tumor

Pediatric. Found in kidney. Diagnosed btw one and four years of age

Wilm's Tumor - Etiology

Autosomal dominant disease or a non-inherited form

Wilm's Tumor - S/S

Abdominal mass, pain, hematuria, fever, nausea and vomitting

Wilm's Tumor - Tx

Five-year cure rate is approx 75%

Radiation

Teletherapy (external beam), brachytherapy (a sealed and/or implanted source) or system therapy (unsealed source). Radiation destroys the hydrogen bonds between the DNA strands of malignant cells. Most useful with localized malignancy.

Chemotherapy

Nausea, vomiting, electrolyte imbalance, sexual dysfunction, hair loss, pain, and a dec in platelet, red and white blood cell counts

Biotherapy (immunotherapy)

Utilizes various agents and/or techniques to change the relationship btw the malignancy and its host. Fever, chills, nausea, vomiting, anorexia, central nervous system impairment, inflammatory reactions, leukopenia, and fatigue.

Antiangiogenic Therapy

Focuses on the use of thalidomide and its suppression of blood supply formation. Success with multiple myeloma. Research supports that it blocks the process of growth

Modalities consideration for cancer pts

Use of heat and electrical modalities are typically contraindicated for direct use over malignancies due to the potential for facilitating growth of a malignant mass or hematogenous spread.

Rehab Considerations for pts undergoing chemotherapy and radiation

Massage and heat are contraindicated over irradiated areas for a minimum of 12 mos. Pt vomiting during therapy should be reported to the nurse/physician, especially if the pt is taking antiemetic meds to control nausea and vomiting.

Exercise guidelines for pts undergoing cancer treatment

Common side effects include pain, fatigue, depression, anxiety, altered body image, sleep disturbances, lymphedema and GI distress. Exercise should be conducted at a range of 40-65% of the peak HR, HRR and VO2 max or below anaerobic threshold. RPE should not exceed a 12.

Alkylating Agents - action

Bind the DNA strands together to prevent replication

Alkylating Agents - Ex

Mustargen (mechlorethamine), Busulfex (busulfan), Leukeran (chlorambucil)

Antimetabolite Agents - action

Impair biosynthesis of genetic material and interrupt the cellular pathways that synthesize DNA and RNA.

Antimetabolite Agents - indications

Various malignancies particularly rapidly dividing neoplastic cells

Antimetabolite Agents - Ex

Leustatin (cladribine), adrucil (fluorouracil), Fludara (fludarabine), Trexall (methotrexate)

Antibiotic Agents - action

High toxicity and ability to interfere with DNA and RNA synthesis and subsequent cell division

Antibiotic Agents - side effects

Along with normal risks - SOB, dysrhythmias, blood disorders, myelosuppression, pedal edema

Antibiotic Agents - Ex

Adriamycin (doxorubicin), Mithracin (plicamycin), cosmegen (datinomycin)

Plant Alkaloid Agents (Mitotic inhibitors) - action

Directly target the replication process prior to and during mitosis to inhibit cell division. This limits cell division and cancer growth in various types of malignancy

Plant Alkaloid Agents - ex

Oncovin (vincristine sulfate), taxotere (docetaxel), taxol (paclitaxel)

Hormones - action

Typically used as adjunct therapy along with other forms of treatment specific to the malignancy

Hormones - indications

Hormone sensitive neoplasms

Hormones - side effects

Masculinization in women, hot flashes, general catabolic effects

Hormones - Ex

Nolvadex (tamoxifen citrate), Lupron (leuprolide acetate), Casodex (bicalutamide)

Biologic Response Modifier Agents - action

Responsible for enhancing the body's own ability to respond to neoplastic growth. These agents are not cytotoxic, but facilitate the pts immune response to destroy malignant tissues

Biologic Response Modifier Agents - indications

Leukemias, lymphomas, Kaposi sarcoma, organ and tissue malignancies

Biologic Response Modifier Agents - ex

Proleukin (aldesleukin), Avastin (bevacizumab), Intron - A (interfereon alfa-2b)

Heavy Metal Compounds - action

Used as antineoplastic agents are also known as platinum coordination complexes. They act as alkylating agents that inhibit DNA translation and replication

Heavy Metal Compounds - ex

Platinol (cisplatin), paraplatin (carboplatin), eloxatin (oxaliplatin)

Adjuvant

Treatment provided, in addition to other focused interventions, with the intention of preventing cancer recurrence

Benign Neoplasm

An abnormal cell growth that is usually slow growing and harmless, closely resembling the composition of adjacent tissues

Differentiated Cells

Cells that have matured from a less specific to a more specific cell type

Dysplasia

An abnormal development of cells or tissue that is often an early sign of neoplasia

Hyperplasia

An increase in cell number that may be normal or abnormal depending on early sign of neoplasia

Malignant neoplasm

An abnormal uncontrolled cell growth that invades and destroys adjacent tissues and may metastasize to other sites and systems of the body

Metaplasia

A change in a cell from one type to another that may be normal or abnormal

Neoadjuvant

Chemotherapy or radiation given prior to surgical oncology intervention

Undifferentiated cells

Cells which have not differentiated into a specific type (primitive, embryonic) or have no special structure or function

Affective disorders

Depression, mania, bipolar

Bipolar disorder

Females are at a greater risk, typically begins in a pts 20's