4.1 Oncology Rehab

define cancer

a general term for abnormal, uncontrolled cell growth that will lead to tissue failure unless the abnormal cells are removed/destroyed

What is metastisis

cells detach from the tumor and enter into the circulatory/lymphatic system, and a secondary tumor grows in anatomically distant tissue

What are carcinomas

originate in epithelial cells which make up the lining of tissues

What percentage of cancers are carcinomas

85-90%

what are melanomas

cancerous growth of melanocytes/pigment producing cells

Where are melanocytes located

the bottom layer of the epidermis and the middle layer of the eye

Where are melanomas most commonly found

on the skin

What are sarcomas

originate in connective tissues, bones, muscle, cartilage

What is typically the most aggressive cancer

sarcomas

What percentage of cancers are sarcomas

2% (very rare)

What is leukemia

abnormal production of WBC in bone marrow

What are the 2 types of leukemia

acute and chronic

describe acute leukemia

immature cells interfere with the production of normal mature cells

describe chronic leukemia

mature cells that appear normal, but do not function normally and cannot fight infections

What are lymphomas

cancer of the lymphocytes (B and T cells)

what are the types of lymphoma

Non-Hodgkin’s

Hodgkin’s

describe Non-Hodgkin’s lymphoma

widespread and effects T and B cells

describe Hodgkin’s lymphoma

spreads from group to group (B cells)

What are T, N, and M used for

staging cancer

What does T indicate

tumor size

What does N indicate

lymph node involvement

What does M indicate

presence or absence of metastatic disease

What is the typical staging range

I-IV

Stage 0:

Early malignancy is present only in the layer of cells that it began

for most cancers, what is stage 0 considered

“carcinoma in situ”

do all cancers have a stage 0

no

Stage 1:

malignancy limited to the tissue of origin with no lymph nodes involvement or metastisis

Stage 2:

malignancy spreading into adjacent tissue lymph nodes that may show signs of micrometastases

Stage 3:

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

Stage 4:

malignancy that has metastasized beyond the primary site

What does DCIS stand for

stays within the duct

What is the scale for grading

I-IV

What grade indicates closer to normal cells

grade 1

What grade is harder to tell origin of tissue

grade 4

describe grade 1

slow growing and less agressive

describe grade 4

fast growing, aggressive, poorly differentiated

what is staging 

progression or spread in the body

What is grading

cell differentiation and rate of growth

How is the grade determined

pathologist will examine a slide of a biopsy

What are the different treatment options for cancer

hormone therapy

surgery

bone marrow transplantation

chemotherapy

targeted therapy

radiation therapy

immunotherapy

What are the therapy options for breast cancer

surgery, chemo, radiation, hormone therapy

is everyone eligible for hormone therapy

no, must be hormone positive

side effect of breast cancer treatments 

pain

posture

ROM

cording

lymphedema

weakness

fatigue

neuropathy

treatments for Head/neck cancer

surgery, chemo and radiation, trach, feeding tube, speech therapy

Why might a head/neck pt show up to PT after radiation/chemo

can cause nerve damage resulting in shoulder/neck pain

side effects of treatments for head/neck cancer

pain

ROM cervical/shoulder

lymphedema

weakness

fatigue

neuropathy

TMD

treatments for lung cancer

surgery, chemo, radiation

side effects for lung cancer treatment

fatigue, weakness, decreased function of UE

treatments for female cancers

surgery, chemo, radiation, hormonal therapy

side effects from female cancer treatments

lymphedema, fatigue, peripheral neuropathy, pelvic floor/core weakness

treatments for brain cancer

gait, balance, pelvic health

treatments for prostate cancer

overall function, pelvic health

treatments for GI cancers

surgery, colostomy, gait, balance strength nutrition

What are the side effects of surgery

scar tissue

limited ROM

muscle weakness

increased energy needs for healing

skin grafts

nutrition

describe radiation

targets cellular DNA in a local area

common side effects of radiation

scar tissue, fibrosis

limited ROM

fatigue

site specific complications

decrease in immune system

describe chemo

systematically targets rapidly producing cells

side effects of chemo

N/V

fatigue

chemo induced neuropathy

gait and balance concerns

chemo brain

low blood counts

describe immunotherapy

uses parts of a persons immune system to fight cancer by stimulating own system or gaining man-made immune proteins

common side effects of immunotherapy

fatigue

diarrhea

fatigue

fever

SOB

rash

N/V

ithching

What does an immunotherapy rash look like

rash/blisters covering less than 10% of the body

What happens if the pt is having sever side effects to immunotherapy

oncologist can hold treatment for a couple weeks before continuing

describe hormonal therapy

blocks a cells ability to receive hormones or limit the body’s ability to produce hormones

side effects of hormonal therapy

joint pain

osteoporosis

weakness

weight gain

What are the benefits of cancer rehab

1. improved physical function

2. pain mgmt

3. enhanced QoL

4. increased energy and stamina

5. emotional and psychological support

6. improved body image and self-esteem

7. enhanced survivorship

8. supportive community

What are the Prehab options

prospective model of surveillance 8

SOZO

What is the purpose of prospective surveillance model

enable early detection of and intervention for physical impairments known to be associated with cancer

What is SOZO

a non-invasive, digital health platformthat tests pts at risk for lymphedema by measuring their bioimedance

What is the goal of SOZO

to test, trigger, and treat before lymphedema becomes chronic

When is a SOZO taken

pre/post checks every 3 months for the first 3 months

how accurate is the L-Dex score

can detect changes in fluid as small as 2.4 tablespoon

What is lymphedema

when the lymph system becomes insufficient and is unable to perform its normal functions → abnormal accumulation of water/protiens in the subcutaneous tissue

Why is cording problematic

limits ROM

How can gait be beneficial

improving endurance while working on increasing speed and improving balance

Why are pts at a higher risk for falling following chemo

chemo induced neuropathy

What is chemotherapy induced neuropathy

damage to the peripheral nervous system incurred by a pt who has received a chemo agent that is neurotoxic

How does the Taxone class of chemo present

mild to mod N/T

burning/stabbing pain in hands and feet

reduced or absent achilles tendon reflex

How does the vinca alkaloid class of chemo present

mild to moderate N/T

burning/stabbing pain in hands and feet

reduced or absent achilles tendon reflex

drop foot

How does the platinum compounds of chemo present

mild to mod N/T of hands and feet can occur after prolonged therapy (4-6 months)

when do symptoms associated with platinum compounds develop

3-8 weeks after last dose

treatments for neuropathy

compression

manual therapy

lymphatic pumps

exercises

gait

supplements

possible supplements to treat neuropathy

Vitamin E

Ca

Mg

anti-seizure drugs

antidepressants

glutathione

alpha lipoic acid

topical treatments for neuropathy

cocoa butter

menthol-based creams

What percentage of cancer pts experience fatigue

72-96%

What health-related outcomes of cancer have strong evidence treatment

cancer-related fatigue

health related quality of life

physical function

anxiety

depression

lymphedema

What health-related outcomes of cancer have moderate evidence treatment

bone health

sleep

typical aerobic exercise Rx

3x/week 30-60 mins

typical resistance exercise Rx

2x/week

2 sets/8-15 reps

typical combo of aerobic and resistance exercise Rx

aerobic: 2-3x/week 20-40 mins

resistance: 2x/week 2 sets 8-15 reps