Objectives Oncology Pathology

Differentiated

changes that a cell takes when forming, based on what system the cell will becomes, Being able to tell a cell apart from other cells, Being able to tell what “normal” for that cell type is

Undifferentiated

when cells change to the point where they are no longer identical to the parent cell, The more undifferentiated the cell is in comparison to the parent cell, the worse the prognosis

Dysplasia

cells may change in size, shape or organization, usually due to chronic irritation

Metaplasia

first level, reversible, benign

Anaplasia

most advanced form (malignant)

Hyperplasia

cells that increase in number resulting in a mass

Neoplastic hyperplasia

malignant tumor

Tumor types

benign, malignant, primary, secondary, in situ, infiltrating/invasive, metastatic

Malignant

cancerous

Primary tumor

tissue of the main cancer

Secondary tumor

tumor in another tissue, but where it originated

In situ

“in its original place”, confined to the primary tissue

Infiltrating/invasive tumor

spread locally beyond the primary tissue, neighboring structures

Metastatic

spread to distant areas of the body

How does metastatic tumors happen

CA cells break away from the primary tumor, travel by blood or lymph system and become trapped in the capillaries of other organs

Five most common sites of metastasis

Lymph nodes, Liver, Lungs (most common), brain, bone

Red Flag of lung cancer

dry, persistent cough is most often the first symptom of pulmonary metastasis

Bone metastasis

Axial skeleton/spine is most commonly involved with spread to the pelvis, ribs, proximal femur, proximal humerus, and skull

Primary symptom of bone metastasis

pain, usually deep and worsened with activity

Breast cancer mets to

bone, liver, lung

Lung mets to

adrenal gland, bone, brain, liver, other lung

Prostate mets to

adrenal gland, bone, liver, lung

TNM Stage

describes the extent of disease, and helps guide treatment/prognosis

T stage is a

primary tumor

Tis is a

tumor in situ, T1 to 4 is assessed as increase of tumor in size and regional involvement

N stage

regional lymph node involvement

N0

no met to local lymph nodes, N1 to 3 is assessed for progressive involvement of local lymph nodes

M and M1

distant metastasis

M0

no distant metastasis

G1

well differentiated tumor

G2

moderately differentiated tumor

G3

poorly differentiated tumor

G4

undifferentiated tumor

Advanced CA

N/V and retching (NVR), anorexia and subsequent weight loss, Fever may be seen in the absence of infection, One of the most common symptoms is pain

Dx of cancer

any scans known to man pretty much, Biopsy is the most definitive, Tumor markers can also be found in the blood serum

Preventative for cancer

diet and lifestyle habits

Curative treatment for cancer

Surgery, chemotherapy, radiation, immunotherapy, biotherapy

Immunotherapy is used to

strengthen immune system to fight it

Biotherapy

bone marrow or stem cell transplant

Brachytherapy

Small radioactive pellets are implanted either permanently or temporarily to cause radioactive decay of tumor tissue

Palliative

not curative, focus on symptom relief and improving QOL

Side effects of surgery systemically

Loss of function, Post op infection, Pain, lymphedema

Side effects of chemotherapy systemically

Myelosuppression, Bone marrow suppression, Neuropathies

Cancer Related Cog. Impairment

“Brain fog”, Changes in memory, attention, processing speed, executive function

Side effects of Radiation Systemically

Radiation illness, Myelosuppression (anemia, etc.), Fibrosis, Malignancy of other tissues, OP

Side effects of Hormonal Therapy Systemically

HTN, Steroid induced DM, Steroid induced myopathy, Hot flashes, OP

What is common with all treatment modalities for cancer

Fatigue

PT Implications of cancer

Address impairments (Weakness, ROM, endurance, Pain), Functional limitations, Teach energy conservation, Safety, aware of PPE

Anemia Guidelines

Interval training (short bouts with rest)

What Modalities increase risk for metastasis

Electric and thermal especially over areas of known or suspected malignancy

Contraindications to Exercise for cancer

Febrile neutropenia, Unstable/acute CVP events, Uncontrolled bleeding/acute hemorrhage, medical instability

Medical instability includes

sepsis, organ failure

RPE Goal is what for patients with cancer

12 to 14 on Borg, Moderate intensity exercise is the goal

Intensity for patients with cancer should start with

40 to 50% HR max and avoid vigorous activity

ABCDE for red flag

asymmetry, border, color, diameter, evolving