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39 Cards in this Set
- Front
- Back
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prevalence & incidence of cancer |
2nd leading cause of death in US 2014 new cases: 460.4/100,000 2014 deaths: 173.8/100,000 40% will be dx c cancer at some point 66.1% survive 5 years survival time incr, death rate falling
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common types of cancer |
by % Note that 2 highest are hormone-related
14 breast 14 prostate 13.5 lung 8.2 colorectal 4.6 melanoma/skin 4.5 bladder 4.3 non-Hodgkin's lymphoma 3.8 kidney 3.2 ovarian 3.1 leukemia 2.8 pancreatic
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factors that influence prognosis |
tissue type of neoplasm staging at dx
other ethnicity, race, SES, psychosocial, comorbidities... |
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cancer development |
cell differentiation altered / lost
normal --> hyperplasia --> dysplasia
hyperplastia increase in mass, malignant or benign
dysplasia metaplasia --> anaplasia |
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tumor aka |
cancer neoplasm, malignancy, carcinoma
benign growth / mass may cause problem d/t size or area |
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naming: malignant v benign |
tissue of origin suffixed with
oma: benign sarcoma / carcinoma: malignant |
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warning signs |
pain, esp at night or nonmechanical skin changes lab value changes fatigue abnormal bleeding from nose or other body openings weight loss that is unintended & significant persistent N/V/retching |
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ACS CAUTION |
C-hange in bowel/bladder A sore throat that doesn't heal U-nusual bleeding or discharge T-hickening or lump (breast or elsewhere) I-ndigestion or dysphagia O-bvious change in wart/mole N-agging cough / hoarseness |
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epithelial v connective tissue |
epithelial=carcinoma gland: adenocarcinoma lymphoma nerve: by type of cell involved astrocytoma
connective=sarcoma
hematopoietic by nature, e.g. leukemia is of leukocytes |
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teratoma |
mixed-tissue cancer |
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staging of solid tumors |
often by TNM system, though other systems exist
T _ _ first slot is x(can't be assessed), 0 (no evidence of primary tumor), 1,2,3,4 (with increasing degree of dysplasia second slot is a letter that describes tumor size
N_ x=unable to assess nodes 0=nodes clear 1-3=increasing lymph node involvement
M_ x=can't assess for metastases 0=no distant mets detected 1=distant mets found |
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common sites for metastases |
areas that are highly vascularized
brain, bone, liver, kidney |
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cancer & aging |
advancing age increases risk of most types accumulation of risks, DNA alterations, telomere theory
> 65 yo 60% of all cancers, 70% of cancer mortality
pediatric is next highest group
epidemiology may differ according to type |
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cancer risk factors |
aging age 40-50 lifestyle: tobacco, ETOH, diet, IV drug use, unprotected sex viral exposure: EBV, HCV, HBV, HPV, H. pylori geography ethnicity SES occupation heredity known precancerous lesion stress |
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metastases |
angiogenesis to feed tumor excreted enzymes erode lymphatic base membrane
generally spreads within 3-5 y
generally spreads to highly vascularized regions |
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clinical sequelae |
effects can be local and/or systemic sx depend on affected tissue
pain in 70-90% CA dx multifaceted, nerve infiltration/impingement, compression, local inflammation
fatigue
paraneoplastic syndrome systemic s/s unrelated to CA or mets |
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CA pain |
among the most common of CA sx
depends on involved tissue
more often autonomic / visceral than skel muscle
can result in HTN, hypotension, tachy or bradycardia, tachypnea, N/V, weakness |
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bony mets |
painful
often related to: lung, breast, prostate, thyroid, lymphatics
40% to pelvis
may yield pathologic innocuous fractures
Rx: plates/screws to regain stability
d/t excessive growth & lysis |
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spinal cord mets |
radiculopathy & weakness
involvement of bladder/bowel
difficult to differentiate from bulging disc clues: Rx response, progression, onset speed
Rx: decompress to relieve pressure, regain stability |
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brain mets |
presents as acquired head injury
effects are specific to area affected
Rx depends on affected area, tumor size & morphology
life-threatening, esp if to brain stem
emotionally debilitating
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CRF |
CA-related fatigue
common sequelae of chemo / myelosuppression / rads
70% of chemo / XRT pts experience
affects can be sensory, emotional, cognitive, physical
can last years after Rx ended |
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paraneoplastic syndrome |
systemic effects that are not directly related to primary tumor / mets
10-20% prevalence
may induce changes in other cells can be d/t hormonal changes
e.g. SCLC upregs adrenocorticotropic hormone causing Cushing's
Hodgkin's impacts immune system, causing disorder that presents as nephrotic syndrome |
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medical treatment |
Goals: cure, control, palliation
1st defense: surgery 2nd: rads 3d: chemo: yields systemic impact 4th: alternative medicine, mostly c palliation
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chemo SE's |
alopecia (systemic) N/V/D pancytopenia thrombocytopenia anemia fatigue anorexia altered sense of taste
may vary with agent can vary with biomarker used to id target tissue |
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morbidity |
significant morbidity remains even with full remission
CA-related fatigue, depression, cognitive dysfx, alopecia, cachexia, mucositis, pulmonary fibrosis, neuropathy, myopathy, N/V/D, myelosuppression
depends on affected organs & tissues |
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Karnofsky performance scale |
quantifies pt fx & independence
fxl decline may trigger PT eval / mgmt
100: normal, no complaints, no evidence of disease 50: requires considerable assistance, frequent medical care 10: moribund, rapid progression of fatal processes |
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psychosocial impact |
stigma / death sentence
treatment SE's may lead to physical & psychosocial isolation
loss of independence
changing role in family / society
things that can help: support group hospice plays a role in support |
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chemo brain |
cognitive dysfx as 2° effect of CA treatment
d/t CA itself, chemo, psych aspects
extent inversely related to survival
impacts fx & fxl mobility |
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PT eval |
look at blood labs
anemia ? TherEx if Hgb < 8 g/dL s/s if 8-10: keep to mild/moderate Ex decreases aerobic capacity/endurance, incr orthostatic intolerance, may see fatigue or tachycardia Rx: transfusion of packed RBC's, exogenous erythropoietin
neutropenia no TherEx if WBC < 5000/mm³ fatigue, incr risk of infection mask pt if < 1000/mm³ Rx: granulocytic colony stimulating factor to stim bone marrow to generate WBC
thrombocytopenia AROM only or walking if platelet count 20,000-30,000 <20,000: high risk of bleeding, ADL's only. Do not do: chest PT, joint mobs, ballistic mvmt indicator: bleeding gums, easy bruising, hematoma, prolonged bleeding time |
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PT exam - medical info |
review chart, PET scan, meds, x-ray, CBC c diff (Hgb, Plt, WBC, ANC) |
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PT exam |
review systems
Integumentary: be especially careful c skin around wounds / rads
sensory testing cognitive screening MMT, ROM postural assessment Berg Balance Test or Tinnetti 6-min Walk Test
VS & auscultation
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GPTP patterns |
depend on affected systems
neuromuscular impaired motor +/- sensory, can be assoc c peripheral nerve injury
Cardiovascular/pulmonary impaired aerobic capacity / endurance, may have dysfx of ventilatory or cardiovascular pumps
Integumentary high risk, impaired anthropomorphics assoc c lymphatic disorders
musculoskeletal impairments to posture, muscle performance skeletal demineralization may impair ROM, motor performance, increase fracture risk |
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possible PT intervention |
pain relieving modalities massage, acupressure, heat, cold, TENS, stretch massage depends on s/s, whether incr blood flow could be harmful
balance, strengthening, progressive monitored exercise, MLD, transfers, gait
assistive/orthotic devices
self-care skills
patient/caregiver instructions |
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PT outcomes / goals |
depend on GPTP pattern |
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EBP for TherEx |
long-term gains ↑ QOL, self-care skills
contraindications unsubstantiated, doesn't provide absolute guideline
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CA prevention |
avoid tobacco, carcinogenic chemicals
exercise, maintain ideal body weight
avoid ETOH in excess of 2 drinks / day
limit meat, incr fruit/veg
screening
UV exposure
safe sex |
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PA & CA incidence |
↓ incidence assoc strongly with physical activity in colon*, breast*, prostate, lung, uterus
*30 min mod ≥ 5x/wk OR 20 min vigorous ≥ 3x/wk |
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screening & early detection |
breast mammogram, BRCA1-2, tumor marker 15-3
prostate PSA
colon endoscopy
palpation for breast/testicular
cervical & PAP smear |
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ABCD's of melanoma |
A-symmetry B-order irregularity C-olor discrepancy / change D-iameter: > pencil diameter or growing |
