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What is cancer?
Uncontrolled cell proliferation that continues after the stimuli that initiated the new growth ceases; the spread of abnormal cells.
Different types of cancer?
malignant neoplasm, tumor, carcinoma, malignancy
Benign vs. malignant tumor?
- benign: does not invade and destroy adjacent normal tissue
- malignant: locally invasive and destructive growth
shifting of a disease from one part of the body to another
primary vs secondary tumor?
- primary: arises from cells that are normally localized to a given structure
- secondary: arise from cells that have metastasized from another part of the body
Second leading cause of death in the US, one of every four deaths. over 1,344,100 new cases in US yearly.
Why is cancer screening so important?
50% of all new cases can be detected with screening. 5 year survival surrently at 82%. with effective screening and early diagnosis, 5 year survival could improve to 95%.
Cancer risk factors?
- older than 40 (MOST important)
- ethnicity (african american: 10% higher incidence and 30% higher death)
- family history (1st generation)
- obesity, diet, and exercise
- nitric oxide
At what age are 77% of all cancers diagnosed
age 55 or older
lifetime cancer risk of males vs females?
- men - 1 in 2
- women - 1 in 3
name the age related cancers.
Out of genetic, environmental, and lifestyle risk factors, which plays the biggest role?
LIFESTYLE (ex: tobacco use, adlt diet, sedentary lifestyle, alcohol, job related factors, etc.)
what could prevent 20% of all cancers?
eating at least 5 servings of fruits and veggies a day
specific risk factors for cancer?
- adenomatous polups (colon cancer)
- high dietary fat intake (prostate)
- alcohol (breast, head or neck, GI)
- work environment/occupation
What is a carcinoma?
From epithelial cells (breast, colon, lung, skin, and stomach)
What is a glioma/neuroglioma/neuroblastoma?
from nervous system tissues
What is a Sarcoma?
from connective tissue (muscle, bone, cartilage, synovium)
What is a lymphoma?
From lymphatic tissue (lymph nodes, spleen, intestinal tract)
What is Leukemia?
hematologic system (bone marrow: spreads by invastion and infiltration)
What is multiple myeloma?
arises from plasma cells
Early warning signs of cancer?
- Changes in bowel or bladder habits
- A sore that does not heal in 6 weeks
- Unusual bleeding or discharge
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in wart or mole
- Nagging cough or hoarseness
PT related signs of cancer?
Proximal muscle weakness (tredelenburg, MMT, difficulty getting up from sitting and climbing stairs, respiratory muscle weakness) and a change in 1 or more DTR.
What percent of newly diagnosed cases have detectable metastasis?
30%, 30-40% of the rest of these clients harbor occult (hidden) metastasis
When does metastatic spread occur?
within 3-5 years of initial diagnosis and treatment
How is metastatic spread oc cancer removed?
it is not possible to effectively remove metastatic cancer by surgical intervention, thus use chemo
5 most common sites of metastasis?
- lung (most common)
- lymph nodes
Signs of lung metastasis?
shortness of breath (dyspnea), pleural pain, and hemoptyosis (blood in sputum).
Most initial pulmonary metastases are asymptomatic until tumor cells have obstructed bronchi or until the tumor mass is rubbing on the parietal pleura
What is the most common tumor to metastasize to the CNS?
lung cancer (breast and malignant melanoma also metastasize)
what can metastases to the brain cause?
increased intracranial pressure, mentation and cognitive impairments, sensory and motor function affected
What can metastases to the spinal cord cause?
cord compression, gradual onset of distal weakness and sensory changes
Signs of CNS primary cancer and metastases?
- confusion/increase confusion
- blurred vision
- balance/coordination problems
- change in memory
signs of hepatic metastases (most ominous sign of advanced cancer, from stomach, colorectum, and pancreas):
- general malaise
- weight loss
- early satiety
- right upper abdominal pain and tenderness
- carpal tunnel syndrome
normal vs. metastatic lymphnode?
normal nodes are soft and nonpalpable, nodes involved with metastatic cancer are hard (rubbery), fixed to the underlying tissue and painless. may see lymphatic dysfunction resulting in lymphedema.
what are nodes involved in acute infection like?
tender (painful) and enlarged
Signs of bone metastases (from lung, breast, and prostate)?
- Bone pain with weight bearing or deep/boring pain
- muscle pain and weakness
- pathologic fracture
4 common sites of bone metastases?
- Vertebrae (thoracic most often) - 69%
- pelvis - 41%
- Posterior ribs - 25%
- proximal femur - 25%
- others: sternum, skull
metastatic uterine cancer
most common symptom of cancer. Multifaceted. The characteristics of the pain depending upon the tissues involved. Pain may also result from the treatment interventions.
What is a common cause of cancer pain?
metastasis of cancer to bone (movement, weight bearing, and ambulation exacerbate the pain)
When tumors produce signs and symptoms at a site distant from the tumor or its metastasized site. These are not direct effects of either the tumor or its metastases.
Example of paraneoplastic syndrom?
small cell cancer of the lung produces ACTH which causes excessive secretion of cortisol resulting in Cushing's syndrome.
Signs and symptoms of paraneoplastic syndrome?
fever, skin rash/pigmentation changes, clubbing of the fingers, arthralgias, paresthesia, proximal muscle weakness, anorexia, malaise, weight loss, signs and symptoms of hypercalcemia, change in DTRs
Curative vs palliative cancer treatments?
- curative: intent to cure
- palliative: provide symptom relief but does not cure
Therapies as cancer treatment?
surgery, radiation, chemo, biotherapy (immuno), angiogenesis therapy, and hormonal therapy.
When is surgery used with cancer?
- Typically used in combination with other therapies.
- used for tumor biopsy and tumor removal/surgery for palliatice relief of pain. Also used to correct obstruction or alleciate pressure (debulk tumor)
What does radiation do for cancer?
destroys rapidly dividing cancer cells by destroying the hydrogen bonds between DNA strands. Can include external beam radiation or intracavity and interstitial implants (pellets). tnd to focus on a specific location. Typically normal cells recovery from raiation exposure faster than malignant cells.
What does biotherpy do to combat cancer?
strengthen the host's biologic response to the tumor cells and promote immunological attack (interferons direct antitumor effect and interleukin-2 triggers the immune attack)
in biotherapy, what dies bone marrow and stem cell transplantation do?
remediate the radiation/chemo induced destruction of the bone marrow
What are monoclonal antibodies (MAbs) used for?
to target specific cancers while leaving the normal cells alone.
thalidomide, used in the past as a sedative, has strong antiangiogenic properties - starving the tumor of its blood supply, thus slowing tumor growth
Hormonal therapy for cancer?
used for cancers that exhibit hormone sensitivity. Tamoxifen, an estrogen antagonist, is used in certain forms of breast cancer, blocking the estrogen receptors in breast tumor cells that require estrogen to thrive.
destruction of bone marrow so diminished blood clotting, diminished immune function, anemia
contractures, sensory loss, pain, fatigue, DVT, lymphedema
what could metastatic diseases in boes result in?
increased risk of bone fractures and osteoporosis
What should PTs monitor with cancer patients?
laboratory values and vital signs, observing for signs of infection, bleeding, or arrhythmias
What should people with cancer not be treated with?
electrical or deep-heating (ultrasound, diathermy) agents and NO heat modalities with radiation patients (tends to enhance the effect of radiation)
chemotherapy and exercise?
do not exercise within 2 hrs of receiving radiation or chemo.
contraindications of exercise with cancer patients?
- platelets < 50,000/ml
- hemoglobin < 10g/dl
- white blood cell count <3000/ml
- absolute granulocytes <500/ml
positives of physical activity for cancer patients?
improves energy level, reduces fatigue, reduces nausea, increase muscle mass, and increase daily activities without increasing fatigue
What must PTs monitor during cancer patient exercises?
oxygen saturation, monitor HR, BP, Breathing frequency, and perceived exertion (borg scale)