MS1 - Cancer Medical Mng

Cancer is characterizied by

uncontrolled cell proliferation and spread of abnormal cells

cancer is aka

malignant neoplasm, tumor, malignancy, carcinoma

Cancer is usually d/t

damaged genes controlling cell growth

cancer is ___ genetics: ___ other factors (modifiable)

5%; 95%

Tumors =

abnormal growths of new tissue that serve no useful purpose and may cause harm by competing for blood supply and nutrients

Tumors can either be ___ and ____

benign;

malignant (invasive/metastatic)

Hyperplasia =

increase in cell numbers

Hyperplasia may be

normal (physio)

Which of the following is an example of normal hyperplasia?

breast hyperplasia during pregnancy

What is abnormal hyperplasia?

Neoplastic hyperplasia

Differentiation =

Normal tissue contains cells of uniform size, shape, maturity and nuclear structure.

Differentiated cells specialize in

physiologic function

When a tumor has completely lost identity with the parent tissue, it is considered to be

undifferentiate or anaplastic

Dysplasia is a gernal terms that indicates a(n)

disorganization of cells (size, shape or organization)

What may cause dysplasia?

chronic irritation or infection

Dysplasia may

reverse or progress to cancer

Carcinogen =

cancer causing agent(s)

Viruses are associated with

15% of all human cancers

What are examples of viruses?

herpes simplex viruses types I and II; EpsteinBarr virus; papillomavirus; cytomegalovirus

HIV suppressed immune system involves

Individuals HIV+ or with AIDS = increased incidence of cancer

Chemicals in tobacco smoke are responsible for

~30% of all cancers

Chemicals associated with workplace involves

abestos / benzene

Exposure to large amounts of x-rays =

leukemia

UV light from the sun =

skin cancer

Which of the follwing are X cancer risk factors?

virus(es), geographic/enviromental, occupation

What lifestyle risk factor mostly contributes to cancer?

tabacco

TX , T0 , Tis, T1 , T2 , T3 , T4

Primary Tumor Size

NX , N0 , N1 , N2 , N

Regional Nodal Involvement

MX , M0 , M1

Distant Metastasis

Staging may be differentiated with

C= clincial / P = pathological

Stage 0 =

carcinoma in situ

Stage 1 =

early, local

Stage 2 =

LG size, more likely has spread

Stage 3 =

local spread, but not to distant regions

Stage 4=

define spread to distant sites

Ann Arbor Stage I

Local cancer in one area and local surrounding area; usually no other systemic or clinical symptoms

Ann Arbor Stage II

Located in 2 separate regions on one side of the diaphragm; lymph node(s) and/or lymph organ

Ann Arbor Stage III

Cancer has spread to both sides of the diaphragm; includes one lymph organ or area near the lymph nodes or the spleen

Ann Arbor Stage IV

Diffuse spread to one or more extralymphatic organ or area near the lymph nodes or the spleen; liver, bone marrow, or lung involvement possible

Ann Arbor Staging A =

absence of constitutional symptoms

Ann Arbor Staging B=

presence of constitutional symptoms

Ann Arbor Staging E

extranodal

Ann Arbor Staging X

describes a mass larger than 10cm or mediastinum wider than 1/3 of the chest on a chest x-ray

Construitional Symptoms include

 Nausea  Vomiting  Diarrhea  Malaise  Discomfort or “uneasiness”  Fatigue  Fever  Night sweats  Pallor  Diaphoresis  Dizziness

Common Metastatic sites

 Invasion by lymphatics, venules, capillaries  Lung (1)  Liver (2)  Bone/Bone Marrow (3)  Brain and Meninges

Diagnostic Testing

 X-ray  CT  Bone Scan  MRI  Angiogram  Biopsy  Others

Malignant ALL must be destroyed because

one could reproduce

Immune system can eliminate

only a small number of cancer cells

Medical model

 Surgery  Chemotherapy  Radiation Therapy (RT or XRT)  Biotherapy (aka immunotherapy)  Antiangiogenic Therapy  Hormonal Therapy  Alternative Treatments

What is sucessful treatment?

preventino is primary or Id and treat tumors at an early stage

What is used in successful treatment?

multiple drugs (chemotherapy) / several methods (e.g., surgery + chemo)

What is the objective of srugery?

spare as much “normal” tissue as possible while removing the cancer

Surgery is only effective when cancer is

localized

Even if not localized, surgery may be performed to

release pressure on nerves, airways or other vital tissues

What are the types of surgeries used?

Needle Biopsy  Excision  Reconstruction

Surgery advantages

 No biological resistance  No carcinogenic effects  Cure large portion of undisseminated CA  Assists in quantifying extent/histology of tumor

Surgery disadvantages

 Resection has no specificity for malignant disease  Immediate threat to life  Deformity or loss of function  Not effective in regional sites

Surgical resection alone fails to cure

70% of cancers due to regional and distal metastasis

Common PT issues involving surgeries

 Pain  Musculoskeletal Changes  Lymphedema  Infection

Chemotherpary is

Drug therapy for Cancer Treatment

What is the obejctive for chemotherpy?

 Cure or control cancer by destroying cells  Prophylaxis - cancer prevention

Chemo can be adminstered

 Intravenous  Intra-arterial  Subcutaneous  Intrathecal  Intramuscular  Intracavitary  Oral

Chemotherapy agents

 New agents continually coming on market  Be sure to investigate the individual sideeffects  Specific to the type of cancer  Some cancers can become resistant to chemo drugs over time

Common side effects of chemotherapy

 Bone Marrow Suppression  Immunosuppression  Cardiac Damage  Renal Toxicity  Alopecia  Nausea/Vomiting  Diarrhea  Loss of Fertility  Sexual dysfunction  Weight loss or gain  Hepatic Toxicity  Neurologic Damage  Hemorrhage  Mucositis, stomatitis  Phlebitis  Fatigue  Pain  Anemia  Muscle weakness

Different antineoplastic classes affect

various stages of the cancer’s life cycle

Antineoplastic classes allows lower dosages of each agent

 Hopefully reducing toxicity  Slowing the development of resistance

Dosing cycle _____ effectiveness

ince

Specific dosing schedules

 Single or multiple doses over several days  Gives normal cells a chance to recover  Cancer cells may be more sensitive during the time of the next treatment

Serious toxicity is

Pushed to maximum possible doses

 Greatest number of tumor cells killed  Always results in adverse effects

What is the objective of radiation therapy?

 Cure or control the cancer via destruction of the DNA  May reduce tumor size to decrease pressure on other structures  Reduce pain/symptoms  Reduce bleeding from a tumor

How is radiation therapy administered?

 External beam  Interstitial  Into target tissue/organ  Intracavitary  Into target oriface  Usual schedule: 5X/week X 6-7 weeks

Common side effects is dependent on stages

 Acute 1-6 months  Subacute 6-12 months  Chronic 1-5 years

Common side effects of radition therapy

 Radiation sickness  Immunosuppression  Fatigue  Fibrosis  esp. lung tissue  Burns  Mucositis  Diarrhe  Edema  Hair loss  Delayed wound healing  CNS/PNS effects  Malignancy

What are common PT issues during radiation?

 Aprons/Shields  Film badges

What are common PT issues post radation

Infection Protection of Patient  Skin Care Precautions (avoid application of any non-approved substance)  Adhesions/Fibrosis

What are other PT issues with radiation therapy?

 Decreased ROM  Edema, including lymphedema  Atrophy of soft tissue  Compromised circulation (modalities)

What is the objective of bio(immuno) therapy?

 direct or indirectly kill tumor cells through bolstering the immune system ▪ Limit the severe immunosuppressive effects of other antineoplastic drug

Hormonal therpay for Prostate CA

Leuprolide

Hormaonal therapy for Breast CA

Tamoxifen (Nolvadex)

Leuprolide inhibits

testosterone release

Tamoxifen (Nolvadex) inhibits

estrogen relaease

Cure =

Disease is gone withno sign of reappearing

There must be a ___________ before “ cure ” may be applied  Recurrence is still possible

≥ 5 years remission

Complete Remission =

All signs of disease have disappeared after treatment

NED =

“no evidence of disease”

Partial Remission =

Primary tumor reduced to ½ of its original size after treatment

Improvement =

Primary tumor has been reduced but remains > ½ of its original size

Advanced Disease

Disease has spread to more than 1 location

Stable Disease

No change with treatment (▪ Size ▪ Extent ▪ Severity ▪ Symptoms)

Refractory

Disease resistant to treatment & continues to progress