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23 Cards in this Set
- Front
- Back
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TNM staging system
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TX, T0, T1, T2, T3, T4
Keep the same name given at diagnosis Restaged - use "r" Lower grade = better prognosis |
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Radiation
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non-selective
localized Teletherapy - external beam radiation Brachytherapy - "seeds, beads, catheter" Gamma knife - brain radiation |
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Side effects of radiation
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Visual / hearing problems
Anemia Leucopenia/neutopenia, thrombocytopenia Dysphagia Secondary cancer Fibrosis - healing via replacement with connective tissue (can contribute to lymphedema) Chest radiation: - Pneumonitis - Pulmonary fibrosis - Pericarditis |
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Side effects of chemo
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Anemia (fatigue, dec exercise tolerance)
Leucopenia (dec immunity) Nausea Vomiting Diarrhea Amenorrhea Hair loss Secondary cancer CIPN |
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CIPN
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Chemo-induced peripheral neuropathy
- Similar to diabetic neuropathy - Length dependent so distal > proximal - Cumulative - Sensory goes before motor -> pain - More severe and persistant if pt has pre-existing neuropathy - May or may not be permanent |
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Interventions for CIPL
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Educate for safety
Infrared therapy (MIRE) for pain Sensory and task training may help hand function Strength and balance training may help and should challenge visual/somatosensory/vestibular systems |
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Biotherapy
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Immunotherapy
Hormone therapy, especially for breast and prostate Usually used in conjunction with surgery/chemo Protect pt from infection side effects: 1- taste altered, fever, chills, SOB, hives, chest tightness, hypotension, coughing, decreased urine output, weakness 2- altered labs, infection risk |
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immunocompromized pt
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isolation, hand washing, extra precaution to minimize contact, disinfect surfaces
Occurs with biotherapy |
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Reasons a breast cancer pt would come to PT
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• ROM
o Scar mobilization • Lymphedema • Cancer-related fatigue • Chemo-induced neuropathy • Osteoporosis / fracture |
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Breast cancer interventions
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Surgery
Radiation - external beam mostly Brachytherapy (APBI - accelerated partial beam irradiation) Systemic therapy - chemo |
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Breast Reconstruction
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Not usually done during tumor-removal surgery
TRAM flap—transverse rectus abdominus muscle (most common)—move fat and rectus tissue o Advantage—they can sometimes leave the blood vessel attached to the tissue they move DIEP flap—deep inferior epigastric perforator o Named for the key muscle involved in the procedure o Skin, fat, blood vessels (not muscle) o More complicated than TRAM o Less painful (didn’t move muscle) but still have a large abdominal incision • Latissimus dorsi flap o Skin, fat, and latissimus o Impaired muscle function o Skin on your back won’t look right o Asymmetry in the back |
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Lymphedema
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Abnormal accumulation of high protein fluid due to insufficiency of the lymphatics either as primary (congenital or hereditary) or secondary (acquired after insult to one or more of the parts of the lymphatic system) disorder
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Lymphedema risk factors
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age, obesity, infection
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Initiating factors of lymphedema
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hyperema (heat, aggressive massage, overuse/exertion trauma)
pressure change (flying, scuba, tight clothing, aggressive massage, prolonged sitting) skin integrity problems (scratches, IV, shots) Weight/fluid volume change (pregnancy, venous insufficiency, meds) |
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CDT
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complete decongestive therapy
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MLD
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manual lymphedema drainage
Light strokes-not pushing fluid but stimulating lymphatics Directing fluid to superficial lymphatics |
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Compression
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Short stretch - 23 hr / day
Low tension, multiple layers Low resting pressure, but high working pressure-work well exercise |
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Pneumatic compression
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moves water only, so protein attracts more water
s/s may inc just proximal to sleeve adjunct to MLD May be needed if pt cant or wont bandage Never >60 |
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Exercise with lymphedema pt
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Increased fluid load
Bandages minimize this risk May inc s/s without bandages Avoid eccentrics and DOMS Aquatics are :) |
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Skin care for lymphedema
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Decreased lymphatics = decreased local immunity
Prevention of infection is critical |
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Edema
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Pitting = more accute, transient
Non-pitting = subacute, suggests fibrosis 1+ = barely evident 2+ = slight pitting 3+ = deeper pit (5-30") 4+ = 1.5 - 2x normal size |
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FEWS framework
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Optimize function
Education Promote wellness (& prevent co-morbidities) Safety |
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Does exercise help cancer pts?
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o Exercise shown to incr strength, energy level, mental well-being, function, VO2 max, weight control, self-esteem, & decr nausea, anxiety, depression during treatment, recovery, palliative care
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