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______: a new or abnormal formation of tissue, as a tumor or growth. It serves no useful function, but grows at the expense of the healthy organism.
_____ neoplasm: dosordered cell growth that remains encapsulated and does not spread by infiltration or metastasis. Because it is space-oppupying it may compress vital organs, vessels,or nerves.
_____ neoplasm: = cancer: growth that infiltrates tissue, metastasizes and often recurs after attempts at surgical removal.
_____: in latin means swelling and is on of the four signs of inflammation (suffix= oma)
4 signs of inflammation:
1. rubor (redness)
2. calor (warmth)
3. dolor (pain)
4. tumor (swelling)
_____ is physical wasting and weight loss (anorexia or starvation is a non-oncology manifestation of this). The tumor is growing and using an excessive amount of nutrients and energy to continue its unchecked growth. This reduces the nutrient and energy supply available to healthy cells and causes global fatigue for the person.
_______ syndrome: tumor produces hormones or cytokines that circulate and have adverse effects on the function of tissues and organs that are remote from the tumor or metasteses.
- an individual with cancer is said to be in _____ when laboratory or imaging fails to find evidence of cancer cells, or cancer cell activity.
- an individual who has had active cancer is said to be _____ when they have been in remission for 5 years. It should be understood that any statement about _____ is based on probability and statistics.
______: arises from epithelial cell (skin or gland cells/embryologically ectoderm). Malignant cells form a solid tumor. Located in the skin, various glands, in the lining of the breast, lung, colon stomach etc. Most common malignant neoplasm (80%). Metastasizes via the lymph system.
______: arises from muscle, bone, cartilage, and fat(embryologically mesoderm). Make up approximately 10% of malignant neoplasms. Metastasizes via the vnous system.
______: arises from lymph nodes, spleen, intestinal lining; hodgkin's and non hodgkin's. (it killed spartacus)
_______: arises from hematopoietic stem cells; AML, ALL, CML, CLL etc.
______: establishes degree of malignancy; how well differentiated cells ar, using grades I-IV.
__: well differentiated (look completely different from cells of other type= good)
__: moderately differentiated
__: poorly differentiated
__: undifferentiated (look much like cells from other types: bad prognosis)
_____: clinical extent of disease
TNM system definitions:
T= tumor size; is the tumor within or beyond the membrane.
N: number of nodes involved
M:metastasis: present or not
T: tumor size; is the tumor within or beyond the cell membrane
T_: tumor cannot be evaluated
T_: in situ-no penetration, <2cm
T_:beyond membran; >2cm<5cm
T_:through layers >5cm
T_:into surrounding structures
N= number of nodes involved
N_: nodes cannot be evaluated
N_:no evidence of node involvement
N_-_: increasing increments of involvement
N_: both sides of the body involved
(obj 2) Staging:
M: metastasis present or not
M_: metastasis cannot be evaluated
M_: no metastasis
M_: distant metastasis
Staging of Hodgkin's/Non-Hodgkin's
Stage_: single lymph
Stage_: two or more regions-same side of the diaphragm
Stage_: regions on both sides of the diaphragm
Stage_: diffuse with extra lymphatic organs involved (bone marrow)
______ _____: the most serious form of skin cancer
-10x white>black population
-risk factors: exposure to UV, multiple moles
-soles of the feet is common site of occurrence
Screening for Melanoma :
(A)_____: lopsided in shape, one half unlike the other half
(B)_____: irregular edges, scalloped, notched or poorly defined edges
(C)_____: a variety of colors on the same mole: black, brown, red, white, blue
(D) _____: larger than a pencil eraser
(E) _____: depending on the source, E can mean _____ or _____.
Caution: screeing for cancer
-_____ in bowel or bladder
-_ sore that does not heal
-_____ bleeding or dishcarge
-_____ or a lump in a breast
-_____ or difficulty swallowing
-____ change in wart/mole
-_____ cough or hoarseness
________: since the bone marrow is one of the main blood forming organs, this depression results in decreased productoin of all the blood components. It is important to examine the complete blood count before each rehabilitation session, since vigorous exercise or activities requiring sharp tools may be contraindicated if blood counts are low.
Normal: ____-____ per cubic mm
Low values :thrombocytopenia:
-Between ____-____ per cubic mm :a resistive exercise program should be changed to active exercises without resistance due to risk of internal hemorrhage. Amulation activities may continue.
-Below ______ cubic mm: gentle exercise at bedside.
-Below _____ cubic mm: minimal exercise-always consult the nurse or doctor before activity with platelets this low.
30,000-50,000= only active exercise
below 30,000= gentle exercise at bedside
below 20,000= minimal exercise: consult nurse or doctor
(obj 4) WBC/Leukocytes
Normal values : _______-_______ per cubic mm
Low values :leukopenia
-since leukopenic patients are extremely susceptivle to infections, contact with other persons should be limited and strict hygiene procedures observed.
5,000-10,000 per cubic mm
-Hct (packed RBC volume): male and female?
-Hemoblogin: male and female? less than
___ hold aerobic exercise.
-RBC: male and female?
Hematocrit: male=42-52% female: 37-47%
Hemoglobin :male: 14-18gm/100ml female: 12-16 gm/100ml/ hold if less than 10 gm/100ml
RBC: male: 5.0 million/cubic mm female: 4.5 million/cubic mm
(obj 4) RBC/Erythrocytes
______: these types of patients have elevated pulse and respiratoin rates due to the body's effort to maintain an adequate oxygen supply. The therapist should carefully monitor pulse, and often blood pressure before and after an exercise or activity. Patient may also be easily fatigued with minimal exertion, so that a maintenance, bedside exercise program is recommended.
(obj 4) Drugs
-Cardiac toxicity: _____: or daunorubicin may cause irreversible cardiac damage. Complicatoins such as CHF can develop, so check vital signs frequently, monitor for SOB, diaphoresis, chest pain, and increased pulse with minimal change in activity.
Adriamycin (think of Rocky yelling ADRIAN and beating his chest)
(obj 4) drugs
Pulmonary fibrosis: _____ may cause this side effect, with resulitng restrictive lung disease and impaired gas exchange. Monitoring of SOB with increased effort to breath, cyanosis, confusion, chest pain, dizziness, increased heart rate. Other drugs include: methotrexate, cisplatin, busulfan.
Bleomycin (think lungs blow)
(obj 4) drugs
Peripheral Neuropathy: ______ particulary may cause weakness (distal greater than proximal) and paresthesias. Loss of strength in the intrinsics of the hand, wrist drop, and foot drop may result in varying combinatoin snd degrees.
Vincristine (i have a horrible way to remember this one but im not gonna share it)
(obj 4) Principles of care for the patient undergoing chemotherapy:
- know that chemo regiment the patient is on, what side effects you observe
-save all urine for all cancer patients. Most are on accurate I and O. Ask nurse if urine should be sent back with patient.
-Attempt to schedule therapy before any chemo which will cause nausea/vomitting is given
-Allow the patient to set the limits
Im gonna rage
(obj 5) Early PT intervention:
- Skin and wound care, self-ROM exercises, gentle strengthening (no ______) pain management(it says meds prior to exercise), energy conservation.
- Decreased local vascularity impedes ____'s ability to diffuse hieat and cold, therefore use no ______ modalities; no _____; only use approved skin lotions.
-skin's ability to diffuse heat and cold
-no thermal modalities or massage
-must include intervention to address loss of __ keepin in mind that gains will be less and take longer to achiee than seen in normal tissue.
-____: pnf (D1/D2)
-_____ training (low-mod intensity)
-___-tissue mobilization: stretching of scar tissue, cross friction massage
-_______: self ROM, ther ex, scar mob, scar massage, energy conservation
- if swelling occurs in affected arm, may be a sign of ______.
(obj 5) Skin reactions due to Chemo (there are 9 so name a few)
-alterations in pigmentation
-flaking or peeling
-loss of perspiration or sebaceous excretion
-changes in superficial blood vessels
______: subjective, mulicausal, multidemensional; no biophysical markers correlate with presence or severity or pain; typically is described in terms of experiences; how they feel.
(obj 6) Patterns of fatigue following tx
______: peaks within days; worse in late afternoon and evening; returns to pre-treatment levels in 3-12 wks.
______: progressive and cumulative; peaks 4-6 weeks; 3-12 months duration.
_____: increased water in the intersitial space; improves with elevation; usually symmetrical; usually bilateral; systemic or local; dyanamic insufficiency of lymph system; pitting always present; negative stemmer's; compressoin garment worn only during waking hours.
_____: increased water and protein in the interstitial space; elevation may initially help but will not with chronic; asymmetrical; unilateral; local; mechanical insufficiency of the lymph system; pitting in stages I and II; positive stemmer's; wear compression garment 23 hrs per day
______: has positive stemmer's
______: respons to compression therapy in a mtter of hours, whereas _____ can require weeks or months to respond.
Intermittent compression is controversial in treatment for ______ (never greater than 40mm).
______: usually not associated with wounds, and is often presents asymmetrically or unilaterally.
______: may respond to elevation initially only, whereas ____ always benefits.
(Obj 11)Metastatic Bone Cancer (most comomon type of bone cancer.
-Cancers most likely to metastasize to bone: 3?
breast, lung, and prostate
_____ bone cancer: these have lower occurences rate than bone cancer resulting from metastasis.
(Obj 11) 3 different bone cancer scenarios:
1. patient has _____ cancer :continuous deep aching pain; nighttime pain; not responding to tx; constitutional S&S; worse with weight bearing; not relieved by positional changes>refer.
2. Patient has _____ cancer that is localized: radiation therapy to site with the goal killing metastatic cells; prothetic replacement if needed.
3. Patient has ____ cancer that is advanced/non operable: radiation therapy may be applied with the goal of palliatoin to the most painful site. PT should help maximize mobility.
1. undiagnosed cancer
2. diagnosed cancer that is early and well localized
3. diagnosed that is advanced
(Obj 11) CT for bone density and WB consideration:
-If ___-___% of the cortex of the bone is degraded, then PWB precautions should be instituted.
-If greater than __% bone degradation, then touch-down or NWB precautions are recommended.
Most common Fx sites: 4
ribs, femur, vertebral body, humerus
(Obj 11) Safety measures for bony mets or primary bone cancer:
1. Avoid ____; avoid pivot transfers with planted feet; avoid fwd flexion of spine.
2. Avoid movements that ____ the joint (hip flex end range)
3. Observe ____ limits.
4. ___ roll
5. When sitting on a commode, use raised ___ ___.
6. Use a ____ stool/commode to reduce transfer distance.
7. Use ____ to transfer sit-->stand; offloads some WB in legs. Likewise an ____ ____ (cane) can offload LE WB if UE are not full of metastases.
4. log roll
5. raised toilet seat
6. high stool/commode
7. arms/ ambulation aid
(obj 12) Brain Ca
- in contrast to CVA, brain tumors are a ____ neuromuscular disease.
-Cancers most likely to metastasize to the brain are: _____&______>
-Brain Ca stays in the CNS and will not ____.
-Complications of Brain tumors: cerebral____; ______ cranial pressure; hydrocephalus; seizures
_____ is most effective for a single primary CNS brain tumor. Not effective when a non-CNS tumor metastasizes to the brain.
______ : helps primary brian tumor patient who is experiencing rapid disease progression. It is given in the 1st 3-4 wks. It causes lethargy for several weeks, and then improves in 6-8 weeks.
(Obj 12) Brain Tumors: symptoms depend on the location: 3 bolded in notes
seizures (without previous history)
(obj 13) Modalities
______, both superficial and deep, is contraindicated over active tumor or metastatic site or an areawith node involvement. When considering safe modalities for the oncology patient, thermotherapy would be appropriate if:
1.no new or active tumor
2. no node involvement
3. a "sufficient" amount of time after surgery
4. no tissue damage from "recent" radiation
5. no decreased sensation
(Obj 13) modalities
___ would be a safe option (counter irritant stimulatio, however _____ (increased circulation) would not.
Clinical judgement would be needed to detemine appropriateness of modalities depending on the circumstances.