Download Cancer/Oncology

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Understand terminology associated with oncology
diagnosis and staging
Describe common oncology pathologies and how the
diagnosis impacts functional mobility and
independence
Identify early warning signs of cancer
Discuss the role of the PTA in education and
prevention of disease
Discuss therapeutic interventions and
precautions/contraindications for patients with an
oncology diagnosis
Describe special considerations when treating
patients receiving chemotherapy or radiation therapy
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Invasive
Second leading cause of death in U.S.
Etiology unknown
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Environmental or viral carcinogens
Genetic
Dietary
Psychological
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Unusual bleeding/discharge
Unexplained lump
Non-healing sore
Persistent hoarseness/cough
Difficulty swallowing/indigestion
Change in a mole’s appearance
Unexplained weight loss
Unexplained pain
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Benign: non-invasive
Malignant: invasive
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Carcinoma
Sarcoma
Lymphoma
Leukemia and myeloma
Metastasis: invades into another part of the
body
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TNM classification
Tumor, (lymph) Node, Metastasis
Stages I-IV indicate severity overall
ie: T2, N1, M1
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Surgery
Radiation
Chemotherapy
Immunotherapy (interferon, stem cells, etc.)
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Local and systemic effects of treatments
Radiation burns, sickness, CNS effects
GI concerns, immunosuppression,
neuropathies with chemotherapy
Fatigue, nutritional deficits, fever, low blood
counts
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WBC: 5000 – 10,000
RBC: 4.7–6.1 million (male); 4.2-5.4 (female)
Hct: 42-52% male; 37-47% female
Hemoglobin: 14-18 male; 12-16 female
Platelet Count: 150,000-450,000
Significance of too high or too low?
Impact on exercise/activity level
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Low WBC: immunosuppressed
High WBC: fighting infection; leukemia
Low RBC: anemia, bleeding
High RBC: pulmonary fibrosis, dehydration
Low Hct: anemia, leukemia
High Hct: burns, polycythemia, dehydration
Low Platelet count: risk for bruising/bleeding
High Platelet count is often a sign of
malignancy
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RBC, Hemoglobin and Hematocrit will be
elevated
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WBC will be elevated
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BUN will be elevated
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Palliative care (symptom management vs.
curative management)
Hospice
Multidisciplinary
Support in the form of psychological,
emotional, financial, spiritual, social, etc.
Unknown length of time
Use of modalities?
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Primary or metastatic
Symptoms based on the part of the brain
affected
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Occurs in females and males
If recurs, usually within the first 2 years
Current 5 year survival rate is 92% if tumor is
localized
Patient education for self exams
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Symptoms include pelvic and low back pain
Good prognosis with early intervention
Patient education for annual pap smears
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15% of cancer deaths annually
High fat/low fiber diet is risk factor
Presents with fatigue, weight loss, anemia,
rectal bleeding
Good prognosis with early detection and
treatment
Patient education to follow recommended
screenings
Immature white blood cells multiply and halt
the growth of normal cells
ALL (acute lymphocytic leukemia) and AML
(acute myeloid leukemia) occur mostly in
children
Sudden onset fever, fatigue, joint pain
Blood work confirms diagnosis
90% remission of ALL, 70-80% of AML
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Rapidly metastasizes
Environmental and genetic risk factors
Early signs include cough, dyspnea,
hemoptysis
Poor prognosis (14% for 5 year survival)
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Non-Hodgkin’s more common
Cancer in the lymphatic system
Risk factors are environmental, viral, and
auto-immune disease
Distinguished by the types of cells present
(Reed-Sternberg cells = Hodgkin’s)
Highly treatable
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Found in epiphyses of long bones
Common in children
Signs include a painful mass, diagnosis with a
biopsy
Amputation or limb-salvage surgical
procedures
Rehab
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High mortality rate, high rate of metastasis
Symptoms include weight loss, jaundice, and
epigastric pain
Poor prognosis
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Men over 50 yo typically affected
Symptoms include urinary urgency, pain, and
decreased stream of urine
Good prognosis with early treatment
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Preventative/Pre-diagnosis
Education
Be aware of red flags or pain that doesn’t
correlate with musculoskeletal diagnosis
Listen to your patient and their complaints
Refer to PT when suspicious/concerned
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Monitor typical vs. atypical pain pattern
Vital sign monitoring
Monitoring of lab values and blood counts
Submaximal level of exercise
RPE not above 12
Report changes immediately to PT
◦ Progressive muscle weakness
◦ Diminished DTRs
◦ Cerebellar impairments
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Low blood counts: “My counts are low”
WBCs: increased infection risk
RBCs: anemia/decreased aerobic capacity
Platelets: increased bleeding/bruising (no ex.
if <20,000)
Patients may have restrictions on activity level
or weight bearing. Consult with PT/MD
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Education and support
Skin care and protection
Edema control and positioning
Pain control
Massage
AROM/PROM exercises
Strengthening
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Cardiovascular endurance (submaximal)
ADLs and functional mobility and ambulation
Coordination and balance training
Pacing and energy conservation
Specific post-op protocols (BMT, mastectomy)
Modalities within contraindications
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Avoid strenuous activities (40-65% HRmax)
Be aware of fatigue level
Skin care
Awareness of skin tatoos for radiation
Contraindications of modalities
Be aware of sensory impairments and
peripheral neuropathies
Cognitive impairments (chemo brain)