1. Cancer/Oncology

2. Objectives
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

3. Characteristics Invasive Second leading cause of death in U.S.
Etiology unknown
Environmental or viral carcinogens
Genetic
Dietary
Psychological

5. Warning signs 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

6. Terms Benign: non-invasive Malignant: invasive
Carcinoma
Sarcoma
Lymphoma
Leukemia and myeloma
Metastasis: invades into another part of the body

7. Staging TNM classification Tumor, (lymph) Node, Metastasis
Stages I-IV indicate severity overall
ie: T2, N1, M1

8. Medical Interventions
Surgery
Radiation
Chemotherapy
Immunotherapy (interferon, stem cells, etc.)

9. Infusaport

10. Infusaport for chemo

11. Radiation Tattoos

12. Side effects impacting PT
Local and systemic effects of treatments
Radiation burns, sickness, CNS effects
GI concerns, immunosuppression, neuropathies with chemotherapy
Fatigue, nutritional deficits, fever, low blood counts

13. Blood Counts
WBC: 5000 – 10,000
RBC: 4.7–6.1 million (male); (female)
Hct: % male; 37-47% female
Hemoglobin: male; female
Platelet Count: 150, ,000
Significance of too high or too low?
Impact on exercise/activity level

14. Significance 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

15. Dehydration -Effects on blood counts?
RBC, Hemoglobin and Hematocrit will be elevated
WBC will be elevated
BUN will be elevated

16. The terminally ill patient
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?

17. Brain Cancer Primary or metastatic
Symptoms based on the part of the brain affected

18. Breast Cancer 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

19. Cervical Cancer Symptoms include pelvic and low back pain
Good prognosis with early intervention
Patient education for annual pap smears

20. Colorectal Cancer 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

21. Leukemia
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

22. Lung Cancer Rapidly metastasizes
Environmental and genetic risk factors
Early signs include cough, dyspnea, hemoptysis
Poor prognosis (14% for 5 year survival)

23. Lymphoma Hodgkin’s and non-Hodgkin’s Disease
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

24. Osteogenic Sarcoma 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

25. Pancreatic Cancer High mortality rate, high rate of metastasis
Symptoms include weight loss, jaundice, and epigastric pain
Poor prognosis

26. Prostate Cancer Men over 50 yo typically affected
Symptoms include urinary urgency, pain, and decreased stream of urine
Good prognosis with early treatment

27. PTA role? 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

28. PTA considerations in treatment
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

29. Considerations 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

30. Interventions Education and support Skin care and protection
Edema control and positioning
Pain control
Massage
AROM/PROM exercises
Strengthening

31. Interventions 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

32. Rehabilitation for the pt. receiving chemo or radiation
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)