Day 4- Cancer

Question 1

Carcinoma

Answer 1

~85% of all cancers
~origin is epithelial tissue, or embryonic ectoderm (skin, large intestine, breast, stomach, breast, lungs)
~Can be fast-growing, as epithelial tissue grows rapidly and replaces itself regularly
~Spreads by invading local tissues and metastasis, usually by lymphatics

Question 2

Sarcoma

Answer 2

~tumors of connective tissues, or embryonic mesoderm (bone, cartilage, muscle, fibrous tissue, fat, synovium)
~Look for persistent swelling or lump in soft tissue, pain, warmth
~Frequently seen in younger folks (

Question 3

What are two different types of bone tumors?

Answer 3

~Osteosarcoma
~Ewing’s sarcoma
**than 1%, but primarily affects children and young adults

Question 4

Osteosarcoma

Answer 4

~also called osteogenic sarcoma
~most common between ages 10-25 y.o., usually around knee in femur or tib/fib
~Appears to be related to growth spurt
~Pain in lesion area, or pathological fracture
~5-year survival is ~70%

*could have a hormonal component

Question 5

Ewing’s Sarcoma

Answer 5

~3rd most common, typically pelvis, femur, tibia, ulna, metatarsus, ages 5-16 y.o.
~Pain, swelling, fever, fatigue
~5-year survival is ~70%
~Fast-growing

Question 6

What do you do if you have a pt with bone pain that persists?

Answer 6

get an xray or bone scan to see if there is cancer in the bones

Question 7

Chondrosarcoma

Answer 7

~most malignant cartilage tumor, #2 behind osteosarcoma

~Slow-growing, but increased risk for thrombus formation and mets to lung

Question 8

Osteoid osteoma

Answer 8

~non-cancerous, benign tumor
~Pain, swelling, warmth, tenderness

***If aspirin/NSAID significantly relieves pain – more than expected – may signal this type of tumor, which is prostaglandin sensitive; this is a RED FLAG TO KEEP IN MIND!

Question 9

Where is intramedullary cancer?

Answer 9

Within the spinal cord

Question 10

Where is extramedullary cancer?

Answer 10

Within the dura mater

Question 11

Where is extradural cancer?

Answer 11

Outside the dura mater

Question 12

Where is intracranial

Answer 12

within the cranium
~80% are intracranial
~Of that, 60% are primary, 40% are mets

Question 13

Neoplasms of the Nerve Tissue

Answer 13

~Benign tumors are dangerous – are space-occupying lesions
**Examples - meningiomas, schwannomas, neuromas
~Primary CNS tumors rarely metastasize beyond the CNS – no lymphatic path, hematologic spread unlikely
~Most common primary malignant tumor is astrocytoma

Question 14

What are the grading for astrocytomas?

Answer 14

~Graded I – IV
~grade IV glioma, such as glioblastoma multiforme (also known as astrocytoma) has very poor prognosis
~Low grade tumors more common in children
~I and II can usually be treated by removing the tumor

Question 15

What ate the major types of blood borne cancers?

Answer 15

~Leukemias
~lymphomas
~Hodgkin’s and non-Hodgkin’s Disease
~multiple myeloma

Question 16

lymphomas and leukemias

Answer 16

~Arise from bone marrow
~% of blast cells present determines whether cancer is leukemia (“liquid”) or lymphoma (“solid”)
metastasis is hematogenous

Question 17

Multiple myeloma

Answer 17

~plasma cells in bone marrow
5-year survival ~ 47%
~Bone marrow transplants improving survival

Question 18

Where are the 2 places that cancer will most likely spread to?

Answer 18

~lung

~bone

Question 19

Why does mets usually go to the lungs?

Answer 19

Most common mets, as venous drainage passes through superior and inferior venae cavae, - lung is the first organ to filter malignant cells

Question 20

Where does lung cancer often metastasis to?

Answer 20

the brain

Question 21

20-25% of patients develop ____ mets

Answer 21

20-25% of patients develop brain mets (lung, colon, kidney, melanoma, breast)

Question 22

Are brain tumors always symptomatic?

Answer 22

Brain tumors may be asymptomatic, or vary widely, depending on location and size

Question 23

S/S of cauda equine syndrome

Answer 23

~LBP
~sciatica
~saddle and/or perianal hypesthesia or anesthesia 
~B/B changes or dysfunction 
~lower extremity weakness 
~gait disturbance
~sexual dysfunction
~decrease rectal tone
~decrease perineal reflexes
~diminished or absent LE reflexes

Question 24

Paraneoplastic syndrome

Answer 24

~Rare disorder, probably due to altered immune system – tumor elsewhere, possibly not diagnosed
~Seen in patients with constitutional, cardiovascular, integumentary, rheumatic, neurologic, hematology, GI, or renal/urologic problems
~Patients with unexplained medical problems should be referred to physician

Question 25

Is primary bone cancer common?

Answer 25

~Primary bone cancer is uncommon

~bone mets are very common, especially to vascular bone (vertebrae, pelvis, ribs, skull, proximal femur)

Question 26

Describe bone pain

Answer 26

~deep
~intractable
~poorly localized
~episodic “stabbing” pain
~worse at night- wakes person up

**Pathologic fractures, back pain, hypercalcemia from osteolytic lesions (muscle pain, spasms, arrhythmias, nausea, vomiting, dehydration, thirst)

Question 27

Liver- where were the mets likely come from?

Answer 27

~Liver filters blood from GI tract

~collects mets from stomach, colorectum, pancreas

Question 28

Liver- s/s

Answer 28

~RUQ pain
~malaise
~fatigue
~may refer to R shoulder
~Bilateral carpal tunnel syndrome – really an ammonia abnormality due to liver dysfunction

Question 29

side effects of cancer

Answer 29

~Bone marrow suppression – infection control needed! (Leukopenia, Anemia)
~Fatigue
~Cardiopulmonary dysfunction
~Radiation skin reactions, nausea, vomiting (no topicals without physician permission)
~Radiation osteonecrosis, irreversible

Question 30

Winningham Contraindications for Aerobic Exercise

Answer 30

~Platelets

Question 31

What is the “seed” for cancer?

Answer 31

Limit cell proliferation by killing or attenuating the growth of cancerous cells (“seed”)

Question 32

What is the “soil” for cancer?

Answer 32

Make the environment inhospitable for cancer cells (“soil”)

Question 33

What are s/s to look for in chemo patients?

Answer 33

~Severe toxic effects for GI, blood, profound fatigue
~Neurotoxic effects, peripheral neuropathies, CNS abnormalities (convulsions, ataxia, confusion, anxiety)
~“chemobrain”
~Nadir

Question 34

What is nadir?

Answer 34

~lowest point in blood count as a result of chemo or radiation therapy
~10-14 days after the chemo

Question 35

What are some things to keep in mind when you are working with cancer pts?

Answer 35

~May use physical agents for pain relief – clear any choices with physicians, especially if using a steroid, such as iontophoresis
~Strict infection control procedures
~Gradual increase in exercise and activity
~Recognize that patients may have mild, persistent cognitive deficit

Question 36

What are 3 basic clues when screening for cancer?

Answer 36

~PMH
~clinical presentation
~associated s/s

Question 37

What are things to look for in screening? (there are lots)

Answer 37

~Age 50 or older
~Previous PMH, especially in presence of bilateral carpal tunnel symptoms, back pain, shoulder pain, or joint pain of unknown cause at presentation
~PMH of cancer treatment (late physical and psychosocial complications of disease and treatment can present as somatic problem)
~Any woman with chest, breast, axillary, or shoulder pain of unknown cause, especially with previous hx of cancer and/or over age 40
~Anyone with back, pelvic, groin, or hip pain accompanied by abdominal complaints or palpable mass
~Recent weight loss of 10% of total body weight (or more) within 2-4 weeks, without trying
**Weight gain is more typical in musculoskeletal dysfunction, as pain limits activities
~Suspected musculoskeletal symptoms that are made better or worse by eating or drinking (GI involvement)
~Pain (especially in shoulder, hip, back, pelvis, or sacrum) accompanied by changes in bowel/bladder function, or stool/urine
~Hip or groin pain reproduced by heel strike/hopping test or translational/rotational stress (bone fractures may be metastatic)
~When a back “injury” is not improving as expected, or symptoms are increasing
~Constant pain, unrelieved by changes in position or rest
~Intense pain at night (7/10 or higher)
~Signs of nerve root compression – r/o cancer as a cause (PMH, clinical presentation, associated signs/symptoms)
~Change in size, shape, tenderness, consistency of lymph nodes
~Disproportionate pain relief with aspirin/NSAID may be a sign of bone cancer (osteoid osteoma) ((Salicylates may inhibit prostaglandins produced by the tumor))
~Signs/symptoms out of proportion to injury, or persisting longer than expected for physiologic healing
~Any changes in the status of a patient/client currently being treated for cancer

Question 38

What is something to look for in women?

Answer 38

prolonged/excessive menstrual bleeding (or breakthrough bleeding for a postmenopausal women who is not on HRT)

Question 39

What is something to look for in men?

Answer 39

Additional presence of sciatica and PMH of prostate cancer

Question 40

Winningham Contraindications for Aerobic Exercise

Answer 40

~platelets