Oncology: Tumor characteristics

Oncology Prevalence and Basics

• Cancer affects 1 in 2 males; prostate cancer is most common
• Cancer affects 1 in 3 females; breast cancer is most common
• Cancer involves uncontrolled cell proliferation and spread

Cancer Terminology and Cell Characteristics

• Tumors (neoplasms) can be benign or malignant
• Differentiation is whether a cell resembles its original form, yes is benign and no is malignant
• Anaplasia is the loss of cell differentiation
• Hypertrophy involves cells increasing in size
• Hyperplasia involves cells increasing in number
• Metaplasia involves cells appearing different than normal
• Dysplasia involves cells being too numerous and appearing abnormal

Benign vs Malignant Tumors

• Benign tumors are small, well-demarcated, slow-growing, noninvasive, non-metastatic, and well-differentiated
• Malignant tumors are large, poorly demarcated, rapidly growing (with hemorrhage and necrosis), locally invasive, metastatic, and poorly differentiated

Seven Hallmarks of Cancer Development

• Selective growth and proliferative advantage through oncogene activation or tumor suppressor gene inactivation
• Altered stress response involving DNA repair, apoptosis avoidance, replication-enabling senescence, and immortality
• Sustained angiogenesis through new blood supply creation
• Metabolic rewiring for nutrient uptake and aerobic glycolysis pathway changes
• Abetting microenvironment with signals promoting tumor cell growth
• Evading immune destruction by avoiding or remaining unmarked by B and T cells
• Activation of invasion and metastasis

Genetic and Epigenetic Factors in Cancer

• Genetics cause DNA mutations due to aging, mutagenic chemicals, radiation, smoking, and UV light
• Epigenetic changes are how behaviors and environment cause changes in gene expression; includes aging, smoking, chronic inflammation, ulcerative colitis, Hep B/C infection, and H. Pylori-triggered gastritis
• Genetics + Epigenetic Changes may result in cancer development

Modifiable Risk Factors for and classifications neoplasm

• Modifiable risk factors account for ⅓ of cancer deaths; tobacco, alcohol, and obesity cause 33% of all cancer deaths
• Risk factors: age over 50, with a median age of 66 for primary prognosis; Hayflick Limit impacting cellular senescence
• Neoplasm classifications are based on cell type of origin, including carcinoma (epithelial tissue), sarcoma (connective tissue), leukemia (hemopoietic tissue), lymphoma (lymphoid tissue), and oma (nerve tissue)

Cancer Staging and Common Sites

• Staging assesses how far tumor cells have spread, using the TNM system (Tumor, Regional Lymph Nodes, Distant Metastasis)
• Grading assesses how fast or aggressive the tumor is growing; higher grade tumors have more aggressive nature
• Cancer stages range from 0 (pre-invasive) to 4 (metastasis to distant sites)
• Most common cancer sites are bone, brain, liver, and lung

Metastatic Manifestations and Breast Cancer

• Lung metastasis symptoms: dry persistent cough, SOB, pleural pain, hemoptysis
• Liver metastasis symptoms: abdominal pain, RUQ pain, malaise, fatigue, anorexia, weight loss; liver filters blood from stomach colon and pancreas
• Bone metastasis locations include: axial skeleton, pelvis, and proximal femur/humerus; lung, breast, and prostate are prevalent
• CNS symptoms of spinal cord compression (back pain worsening with supine position or weight bearing), lung cancer (most common), breast cancer and melanoma
• Lymphatic system: PTs may discover abnormal lymph nodes
• Breast cancer origins include ducts or lobes; the most common type is ductal
• Aggressive cancer subtypes: ER-, PR-, and HER2-

Cancer Hormone Receptors and Medical Interventions

• ER +/- indicates tumors likes to feed off estrogen
• PR +/- indicates tumors likes to feed off progesterone
• HER2 +/- indicates tumors likes to feed off human epidermal growth factor
• Medical interventions: surgery, radiation therapy, antineoplastic agents (chemotherapy, hormonal therapy, and immunotherapy with targeted therapy for specific antigens

Cancer Prevention and Oncology Care Phases

• Primary prevention involves vaccines and screenings
• Secondary prevention involves regular survivor check-ups
• Tertiary prevention involves additional therapy, like cardiac rehab
• Phases of oncology care include preventative (prehab, assessment, education), restorative (function restoration), supportive (adjusting to new normal), and palliative (comfort, independence, caregiver education)

Integumentary System and Skin Disorders

• Skin disorder symptoms include urticaria (hives), pruritus (itching), rash, xerosis (dry skin), skin pigmentation changes, unusual moles/cysts, nail changes, edema, and blisters
• Age-related epidermal changes include decreased immune cells and melanocytes, and thinning of dermis
• Age-related dermal changes include changes in sensory receptors, decreased vascularization, and collagen and elastin degeneration
• Age-related hypodermal changes include loss of fat, resulting in padding and thermal insulation loss

Dermatitis and Skin Infections

• Dermatitis is acute, chronic, and or recurrent with multifaceted causes including genetic factors and environmental factors
• Dermatitis symptoms is itching and dry skin
• Skin infections: bacterial like cellulitis; viral like herpes zoster and warts; and fungal like ringworm, athlete's foot, and yeast infections
• Cellulitis symptoms: pain, erythema, local edema, elevated temperature of affected skin, fever, chills, malaise
• Cellulitis increased risk factors: immunocompromised, history of diabetes, cancer, steroid,edema, open wounds, obesity, and venous insufficiency

Skin Cancer Types

• Major skin cancer risk factor: UV exposure
• Benign: moles
• Premalignant: Bowen disease linked to UV exposure/HPV, with increased risk for fair-skinned people
• Malignant basal cell origin with UV exposure leading to damaged DNA signaling; common in older individuals and fair-skinned people
• 23-39% risk for Caucasians; Pathogenesis: UV exposure results in DNA signaling mutations
• Squamous cell carcinoma etiology: the second most common cancer in sun-damaged areas and sun exposure, fair skin, and immunosuppression are risk factors

Melanoma, Pressure Injuries and Stages

• Melanoma origin from melanocytes; it follows from fair-skinned individuals with UV exposure for etiology and risk factors
• Melanoma intensity to UV exposure ratio is important
• Implications for therapists: can appear anywhere in the body. Common sites are head, neck, trunk, and legs
• Skin cancer signs: asymmetry, border irregularity, color variation, diameter, evolving appearance
• Incidence of pressure injuries: 2.5 million hospitalized patients per year Risk factors: bedbound status, impaired circulation, skin moisture, age, poor nutrition, neuropathy, incontinence, altered mental status/cognition
• Pressure and shear forces leading to ischemia and tissue necrosis, with increased risk of bacterial infection
• Clinical manifestation mostly over bony prominences
• Clinical manifestation mostly over bony prominences, sacral ulcers are common, and necrotic tissue is insensate with surrounding painful tissue
• Stage 1 pressure injury: skin is discolored, but intact and no color change with pressure

Higher Stage Pressure Injuries

• Stage 2: broken skin through epidermis and dermis ONLY (cut/ blister)
• Stage 3: also affects subcutaneous fat
• Stage 4: includes muscle, tendons, bone
• Unstageable: something blocking the wound (debris)

Hemotologic system

• Hematopoiesis: stem cells specialize into blood in bone marrow; RBC's circulate at 100% to carry O2 and nutrients
• Lymphoid production results in B and T cells for immunity
• Myeloid produces most everything else

Blood components and regulation

• Blood includes plasma, thrombocytes, leukocytes, and erythrocytes
• Erythropoiesis regulated by erythropoietin from kidneys and liver
• Aging lowers RBC and WBC production

Blood Transfusions and RBC Disorders

• Blood transfusion symptoms: fever/chills, nausea/vomiting, tachycardia, headaches, SOB, allergic/septic reactions
• Anemia is a RBC disorder with a low RBC count (quality or quantity)
• Anemia presents with: low endurance, pallor, tachycardia, decreased activity tolerance
• Clinically, patients with anemia have low RBC and hemoglobin levels, which causes tissue hypoxia, increased stroke voluime, and cardiac failure

WBC Disorders

• Leukocytosis: WBC count increasing due to reaction from inflammation, infection, tissue damage, for degenaration
• Leukopenia: WBC count is going down. and more decreased as Neutropenia- Requires that the PT wear gloves and a mask and they need to keep
• neutropenic precautions and a thick covering for fruit. Neutropenic fever is an emergency

Hemostasis Disorders and Platelet Plugs

• Primary hemostasis involves platelet plug formation (platelets, von Willebrand factor, and vessel wall), with VWF deficiency causing von Willebrand disease
• Von Willebrand Disease causes bruising and improper clotting
• Secondary hemostasis involves stable fibrin clot formation to reinforce platelet plug, with deficiency causing hemophilia
• Hemophilia: is a inherited bleeding disorder with a risk for intracranial hemorrhage. Can exercise and strength train to reduce risk of injury/spontaneous bleeding

Additional Hemo Disorder

• Thrombocytopenia is the WBC trending downwards with fatigue and jaundice. Will have excessive brising

Hematological Cancers: Multiple myeloma, Leukemia

• Mutated plasma cell creating excessive M proteins in bone marrow that impairs the immune system, more commin in men

• CRAB s/sx: Hypercalcemia, Anemia, Bone Lesions, and Renal issue

• Leukemia-AML is the most deadly

• Leumeia: chronic fatigue, swollen lymph nodes, swollen liver and spleen, muscle aches, bone/joint pain & tenderness, tiny red spots on skin, SOB

• Lymphoma: Most common is Node

  • hodgkin lymphoma, ages: 20/65 y/o. Highly Curable
  • Non-Hodgkin Lymphoma: Age of onset is usually 67 years old, women have better. Risk factors is immuno and autoimmunity

sickle cell and Lymphatic System

• Sickle Cell Disease- Recessive trait and to induce symptoms: stress, infection, hypoxia, dehydration, extreme temp, fatigue, strenuous physical exertion

• Lymphatic Sys- Maintains fluid balance, Carries out immune response , transports dietary lipids

• Lymphangion: contraction between Lymph by ANS (5-10x/min)

• Lymphangion: Arm and chest drained by Armpit (territories and watersheds)

Lymphatic System Disorders

Lymph disorders include:

• Inflammation of lymphatic vessel (Lymphangitis)
• Lymphadenitis which is inflation of one or more lymp nodes
• enlargement of lymph node (Lymphadenopathy)
• Lymphedema is amount of lymph fluid due to impaired lymphatic drainage

Lymphedema Classification

• Types include: Primary (present at birth 15%) and Secondary (Obesity, higher BMI and History of Cancers) -Secondary results as a tumor pressure, lymph dissections, etc. Trauma, Cancer and infections can cause this
• Infection and immobility can lead to issues such as Filariasis, Prolonged limb immobility, Cellulitis

Lymphedema S/Sx and Stages and Pt evaluation tips

• Start somewhere low and progresses proximally

• Swelling proximally, Distal swelling in extremities, Restricted joint and discolored skin

• PT Evaluation: Past Medical History: Cancer. Is swelling due to DVT?

• Assess: Functional assessment, circumferential measure and stage

• Stages are based on Lymph Capacity.

Lymph and skin management for PT's

• Exercises and Progress and assess gradually and proximal to distal movements
• Diaphragm breathing can enhance
• compression to reduce
• Education, Hygiene and skin maintenance can help
• No exercising with bandages

Ventilation and PaO level

• ventilation, which is air flow and respiration, which is gas exchange
• A pt's respiratory may also be connected to cardio
• Hypoxemia is when injured lungs result in less saturation and injured tissues
• pulmonary stunting due to the following issues and causes

Pulmonary types

• know normal ranges to identify normal rates:

Level:

• 80-100 = Noraml 60-80 = Tachy and distress Below 25 is No Bueno.

• chronic/obstructive/restrictive/ infect/ oncologic are types to know Obstructive, does not allow the lungs to exhange and Restrictive doesn't allow expanding!

• Cough and Shortness of breath is common

Types to know

know that clear means: airway irritation, color, color infection

• tachypnea also means higher grade Types = Pnuemonia, tension pnuemothorax, restrictive
• Chronic with anxiety and abnormal sputum (chest pains)

-Pnuemonia causes; Air or Injury can cause Pneu

• Aging can cause lowe O2 and More Work

Pneumonia, Tuberculosis and Bronchitis

• lung Injury is due to infections or toxic gas Clinical Mainfestions: Most is secondary to URP, tachpnea or crackles

• Tuberculosis are infectious and AIRBORNE, also need to know risks (HIV) and manifestations ( night and chest pains and productive for 3 weeks)

• Acute Bronchitits is short and is triggered or caused by viral infection, it's is usually after a few days. S/sx low muscle w/ URI, infection or cold

• Know Copd as Air flow issues that lead to infections and genetics

• Can lead to reduced lung function Emphsema is loss of collapse causing airtrapping

Emphysema and asthma

• causes BARREL chested to the lung being trapped
• Tx smoking stopping and dilating using breathing techniques

Classifications of ASTHMA Extriniscs = allergies Adult onesert due the lungs Airway and smoking casues airways

• know Asthma and apnea are types which can restrict breathing

Restrictive type lungs

• Someone who can't expand their lungs from issues. Rapid shallow respiratory pattern -Guion - barr, Spinal cord injury, can cause them There is also Atelectasis and embolisms Most will have lung and breathing dysfunctions with pain

• 90 percent of those who have surgery in this surgery has this Pulmonary Embolism comes from the VESSE; which can result in heart vessels and fat from bloodclots

pulm artery to the blood cloggin; leads to preventions

Cardiac, blood stasis,. Hyper coag

Heart and Vessels

Congestive heart failure
fibrous

• Pericardium sacs muscles Htn, inact, lifestyle

• Angina (painful) can radiate to the lower arm- Angina typically results in left side, and is more known for its high multi segmental innervation as chest pains occur

• women's extreme cause rate to mortality: Aortic aneurysmw, Palpitations may occur

3. Dyspnea (Respiratory) = is a result of SOB
4. Vasovagal Syncope - Non Emergency
5. Cardivascula syncope
6. Cyanosis 7 Peripheral edema R ventricular. Pitting edema in depend position

Bike test for Stenosis

-Women and Man have different functions that are affected by genetics

Cancer prevalence, terminology, and cell characteristics. Benign tumors are slow-growing and non-invasive, while malignant tumors grow rapidly and are invasive. Key terms include anaplasia, hypertrophy, hyperplasia, metaplasia, and dysplasia.