Understanding Cancer: Prevalence and Characteristics

Cancer Prevalence

• 1 in 2 males will be diagnosed, prostate cancer is the most common
• 1 in 3 females will be diagnosed, breast cancer is the most common

Defining Cancer

• Characterized by uncontrolled cell proliferation and spread of abnormal cells
• Tumors (neoplasms) can be benign or malignant
• Differentiation assesses how much the cancer cells resemble normal, healthy cells
• Benign cancer cells appear more similar to healthy cells
• Malignant cancer cells appear less similar to healthy cells
• Anaplasia stems from a loss of cell differentiation

Microscopic Characteristics of Cancer

• Hypertrophy involves the cell getting bigger
• Hyperplasia involves too many of the same cells
• Metaplasia involves cells looking different than normal
• Dysplasia involves cells looking very different and in too great a number

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 (often with hemorrhage and necrosis), locally invasive, metastatic, and poorly differentiated

Seven Hallmarks of Cancer Development

• Selective growth and proliferative advantage involves the activation of oncogenes and inactivation of tumor suppressor genes
• Altered stress response includes DNA repair, avoiding apoptosis, enabling replication and immortality
• Sustained angiogenesis, where the cancer creates its own blood supply
• Metabolic rewiring for nutrient uptake, changing pathways for aerobic glycolysis
• Allows signals telling tumor cells to grow/proliferate
• Evading immune destruction by avoiding the immune system
• Activates invasion and metastasis

Genetic Factors in Cancer

• Genetics can cause DNA mutations
• Aging
• Mutagenic chemicals
• Radiation
• Smoking
• UV light can lead to such mutations

Epigenetic Factors in Cancer

• Behaviors and environment can cause changes in gene expression
• These include aging, smoking, chronic inflammation, ulcerative colitis, Hepatitis B and C infections, and H. pylori-triggered gastritis

Cumulative Impact

• Genetics plus epigenetic changes can lead to cancer development
• Modifiable risk factors account for ⅓ of cancer deaths
• Tobacco, alcohol, and obesity contribute to 33% of all cancer deaths

Aging and Cancer Risk

• Being over 50 years of age is a significant risk factor
• The median age for primary prognosis is 66
• Hayflick limit explains how, as telomeres shorten during cell division, cells undergo senescence and apoptosis upon reaching a critical length

Neoplasm Classification

• Carcinomas originate from epithelial tissue, such as skin and linings of organs/cavities
• Sarcomas originate from connective tissue like bone, cartilage, and fat
• Leukemias originate from hemopoietic tissue (blood-forming tissue)
• Lymphomas originate from lymphoid tissue in lymph nodes and the spleen
• Omas originate from nerve tissue in the brain, spinal cord, and nerves

Cancer Staging and Grading

• Staging describes how far the tumor cells have spread
• The TNM system is used to assess the tumor size (T), regional lymph node involvement (N), and distant metastasis (M)
• T: Tumor size ranges from 0-4, with higher numbers indicating larger size
• N: Regional lymph node involvement ranges from 0-2, higher numbers indicate spreading
• M: Distant metastasis ranges from 0-2, higher numbers indicate spread
• Grading describes how fast/aggressive the tumor is growing
• A higher grade correlates with more aggressive cancer
• Tumor Stage:
• Stage 0: pre-invasive
• Stage 1: localized
• Stage 2: early, locally advanced
• Stage 3: spread to the surrounding region
• Stage 4: metastasized to distant sites
• Staging and grading occur independently of each other

Most Common Cancer Sites

• The most common sites are bone, brain, liver, and lung

Clinical Manifestations of Metastasis

• Lung symptoms manifest as a dry, persistent cough, pleural pain, shortness of breath, and hemoptysis
• The liver filters blood from the GI tract
• Symptoms of liver metastasis include abdominal pain, RUQ pain, general malaise, fatigue, anorexia, and weight loss
• Bone metastasis often originates from lung, breast, and prostate cancers, and can also result from others like thyroid, kidney, lymphoma, and melanoma
• Common areas for bone metastasis include the axial skeleton, extending to the pelvis and proximal femur/humerus
• CNS metastasis can involve brain tumors originating (most commonly) from lung, breast, and melanoma cancers
• Spinal cord compression may occur, leading to back pain worsening in a supine position or with weight bearing, sneezing, or coughing
• Lymphatic system involvement may be identified by physical therapists, who may be the first to palpate an abnormal lymph node

Breast Cancer

• Breast cancer can originate from ducts or lobes
• Ductal cancers are the most common form
• The most aggressive breast cancer is ER-, PR-, & HER2-
• ER +/- tumors feed off estrogen
• PR +/- tumors feed off progesterone
• HER2 +/- tumors feed off human epidermal growth factor

Medical Interventions for Cancer

• Surgery, radiation therapy, and antineoplastic agents like chemotherapy, hormonal therapy, and immunotherapy
• Targeted therapy can assist by designing antibodies to target specific antigens

Levels of Prevention

• Primary prevention involves screenings and vaccines
• Secondary prevention involves regular check-ups for cancer survivors
• Tertiary prevention involves extra therapy and cardiac rehabilitation

Oncology Care Phases

• Preventative: Prehab, Pre-op assessment, assess baseline and at risk population and provide education
• Restorative: Restore function as close to PLOF, treat functional deficits from surgery, chemotherapy and/or radiation therapy
• Supportive: Adjust to “New Normal" due to CA treatments and maintenance therapy
• Palliative: Comfort measures, maintain independence and caregiver education

Skin Disorder Symptoms

• Urticaria (hives)
• Pruritus (itching) and rash
• Xerosis (dry skin)
• Changes in skin pigmentation
• Unusual moles/cysts
• Changes in nail appearance
• Edema
• Blisters

Aging and the Integumentary System

• Includes epidermal changes, such as decreased immune cells and melanocytes
• Dermal changes include changes in sensory receptors, decreased vascularization, and degeneration of elastin fibers
• Hypodermal changes include a loss of fat leading to a loss of padding and thermal insulation

Dermatitis

• Can be acute, chronic, or recurrent
• Causes include multifaceted genetic, immunologic, and environmental factors
• Symptoms comprise pruritus and dry skin

Cellulitis

• Bacterial skin infection
• Presents as pain, advancing erythema, local edema, elevated temperature, fever, chills, and malaise
• Risk increase in immunocompromised individuals, those with edema, open wounds, obesity, or venous insufficiency

Skin Cancer Risk Factors

• Primary is UV exposure
• Can also be benign moles or premalignant Bowen disease in fair skinned persons

Malignant Skin Cancers

• Pathogenesis: UV exposure results in DNA signalling mutations
• Etiology: 2nd most common skin cancer. Commonly found in sun damaged areas of the face, ear, lips, mouth, and back of the arm.
• Risk factors comprise sun exposure, fair skin, and immunosuppression
• Melanomas originate from melanocytes
• Etiology and risk factors are UV radiation, a fair complexion, multiple abnormal moles, a history of BCC/SCC, and family history of melanoma
• Factors more associated with intensity than duration of sun exposure
• May appear anywhere on the body, but common sites are the head, neck, trunk, and legs

Signs of Skin Cancer

• Asymmetry, border irregularity, color variation, diameter, and evolving nature
• Most common sites are head, neck, trunk, and legs

Pressure Injuries

• Incidence & Prevalence:2.5 million in-patient cases per year
• Risk Factors, mainly mobility and activity limitation, impaired circulation and skin moisture
• Pathogenesis: The main cause is pressure and shear forces
• Clinical Manifestations: Most pressure injuries occur over bony prominences
• Areas of Increased Risk

Pressure Injury Stages

• Stage 1: Skin is discolored but intact; pressure does not change the color
• Stage 2: Broken Skin where broken skin only extends through the epidermis and dermis
• Stage 3: Injury extends to the subcutaneous fat
• Stage 4: Injury extends to the muscle
• Unstageable: Wound that has material blocking it

Blood Formation Basics

• Hematopoiesis uses stem cells transforming into specialized cells and happens in bone marrow
• Except for RBC's, some blood cells are stored and some are in circulation
• Lymphoid: turn into B cell T cells to maintain immunity
• Myeloid: turn into everything else

Components of Blood

• Plasma
• Thrombocytes (platelets)
• Leukocytes (WBC)
• Erythrocytes (RBC)

Erythropoiesis Basics

• Erythropoiesis is how we create RBC’s in the body
• It is based on the need to carry O2
• This process lowers with aging

Blood Transfusion

• S/Sx: fever/chills, nausea/vomiting, tachycardia, headaches, SOB, allergic rxns, anaphylaxis, Septic rxns
• Risk varies based on the facility and patient condition

Low RBC Count

• The disorder is anemia
• Anemia comprises low RBC count (quality or quantity), low endurance, pallor, tachycardia, and decreased activity tolerance
• Symptoms are systems based and require inter-professional review
• With can cause tissue hypoxia (no O2 to tissues), Stroke Volume goes up, and as a result you end up with hyperdynamic circulation (cardiac failure)

WBC Count (High)

• The disorder is Leukocytosis
• Alterations in WBC are measured by the reaction of the body to infection, inflammation, tissue damage, or degeneration

WBC Count (Low)

• Neutropenia WBC count goes past values of Leukopenia (Less than 1.5 or 1500)
• Requires neutropenic precautions which compromises protective gear and dietary limitations
• Neutropenic Fever should be an emergency that PT should defer

Control of Bleeding

Primary Level of Bleeding Control

• Platelets, vWF and the vessel wall lead to forming a platelet plug
• A deficiency in VWF will cause VWD

Secondary Level of Bleeding Control

• Forms a stable Fibrin Clot
• Produces reinforces the platelet plug with Fibrin, stabilizies it. Deficiency can cause Hemophilia.

Hemophilia

• Inherited bleeding disorder can lead to spontaneous bleeding as well as bleeding following injuries or surgery, causes intracrania Hemmorrhage
• Exercise, strength training are still recommended (to reduce risk for injury and spontaneous bleeding)

Disorder Where WBC is trending downward

• Thrombocytopenia
• WBC trending downward
• Fatigue, jaundice, risk for bleeding due to lower WBC’s
• Look like little red dots everywhere, excessive bruising
• These were all reasons hematological cancers were on the radar (but only 20% of the time) Hematological Cancers Multiple myeloma, Leukemia, and Lymphoma

Cancer Manifestations

• Multiple myeloma compromises a mutated plasma cell in bone marrow which impacts immune regulation to M proteins, takes up space in bone marrow, which impairs the function of the immune system
• SX vary by type

Multiple Myeloma SX

CRAB C: Hypercalcemia • Due to bone breakdown, drowsiness, constipation R: Renal insufficiency • Due to high levels of proteins (antibodies) A: Anemia • Low RBC count, contributes to fatigue B: Bone lesions • Mostly in spine, ribs, pelvis, contributes to bone pain, fx, & cord compression -MUGS Genetic mutation more prevalent in african american males - which is very likely that you will develop multiple myeloma

Leukemia Symptoms

• AML is the most deadly
• S/Sx: chronic fatigue, swollen lymph nodes, swollen liver & spleen, muscle aches, bone/joint pain & tenderness, tiny red spots on skin, SOB

Lymphoma Types

Hodgkin Lymphoma - Common involved lymph node - Age groups: 20 and 65 y/o. Median age of 39 - Highly curable Non-Hodgkin Lymphoma - Average age of onset: 67 y/o - Usually appears in lymph nodes or other lymph tissues (spleen, bone marrow, thymus, tonsils, digestive tract), sometimes the skin - Most common type: Diffuse large B-cell lymphoma Risk Factors: Includes -Imunosuppression -HIV/AIDS -Epstein-Barr Virus -Autoimmune Disorders

Sickle Cell Disease

• Inherited autosomal recessive trait
• To induce symptoms: physiologic stress from infection, hypoxia, dehydration, extreme temp, fatigue, strenuous physical exertion

##The Lymphatic System

• Function: (1)Maintains Fluid balance via drainage of excess interstitial fluid and returns it to the blood. (2) Creates Immune response via Lymphatic initiation of specific responses against microbes. (3)Transports Dietary Lipids.

Lymphangion: between 2 valves of a lymphatic vessel, surrounded by smooth muscle to assist with contraction for 5-10x/min

Territories & Watersheds: Local lymph nodes process fluids for their specific regions

Disorders

-Lymphangitis: Inflammation of a lymphatic vessel Lymphadenitis: Inflammation of one or more lymph nodes Lymphadenopathy: Enlargement of lymph node Lymphedema: Increased amount of lymph fluid

Lymphedema Basics:

-Lymphedema is a chronic and progressive disease arising from impaired lymphatic drainage causing the accumulation of protein-rich fluid in the interstitial space, which results in tissue swelling and can lead to skin and tissue changes.

-Primary:

• 15% are present at birth
• Those at birth present usually after adolescents
• Has mainly female, as they have smaller more fragile lymphodes than males
• Secondary: caused by surgery from Cancer & radiation

S/Sx:

• Swelling proximally from lower distal (ex. leg to groin, then arm to upper chest/breast)

Stages of Lymphedema

PT Evaluation

• History: PMHx (Cancer), onset,Symptomatology, history of infectionsIs the swelling due to DVT? Clinical assessment: observation and palpation of skin (edema, fibrotic tissue, signs of ulcerationswounds,Measure of limb via circumferential measurement or limb volume displacement Assessment: functional measurement, Patient Reported outcome, Denote a stage of Lymphedema

Management:

Exercises Skin Care Manual Lymph drainage Compression/Banding (for minimal recoil PPT 5: Respiratory System

Ventilation vs Respiration

air moving in and out of lungs : Ventlation\air being inhaled and exhaled Gas exchange : Respiration, (Gas exchange tissues OR cardiovascular system can affect respiration)

Low O2 Basics:

The disorder is classified as Hypoxemia This means Injury to lung -> O2 saturation in blood gets low Ventilation issues: Caused by asthma, bronchitis, pneumonia Decreased O2:

Ventilation issues result in:

-Caused by lack neurological stimulation of the respiratory center

• This is a result of lack of Over sedation of the Over sedation -Caused by abnormal alveolar flow like in emphysema

Stunt Basics

Caused by issues with distress

Respiratory System

Air levels by percentage- all for a normal lung that operates without isssues- below is impaired -80-100normal -60-80= tachy, with increased -50-60: Malaise, nausea, vertigo, etc -35-50: Confusion, arrhythmias, labored breathing

• 25-35: Code

Responses to Lack of O2

Reduced response to hypoxia (lack of O2) & hypercapnia (increase of CO2 because you can’t expel it) though normal breathing- pneumonia

Acute lung injury Causes viral or bacterial Acquired pneumonia is also deadly

Risk Factors

• older patients
• smokers
• malnurished patients
• previously had pneumonia
• COPD patients
• Asthmatic: COPD patients
• Patient has issues maintaince oral hygene (can’t brush well) The above

Pneumonia S/Sx

• Those under 5 can’t clear themselves of the chest infection

Symptoms of respiratory dysfunction:

• Productive cough of some kind that could be seconday a URI
• viral would show watery Difficulty breathing, Tachypnea, Crackles, Fatigue, Fever, Chills, Generalized myalgias

Symptoms

• Elderly vs Youths = Elderly have lower amount of symptoms
• Tuberculosis

Infectious disease causes glaucomas Pulmonary Function: Test of the month on lungs and the air that is inhaled

TB factors

• Symptoms consist of constant cough for 3 weeks, lost of wight without knowing why, night sweat, fever HIV Patients Prisons Nurses Etc’

Acute Bronchitus Cystic Fibrosis COPD Acute Bronchitus -Symptoms consist of viral COPD- almost ALWAYS from smoking

Airways (Abnormal)

• Not Fully Expanded due to damaged alveolar sac
• Air is not fully emptied due to loss of sac function(reduced expiritory flow) Narrowed/Smaller area, so air volumes decrease (volume decreases- air is trapped) Patients dont get enough air, patients will use more muscle, patients have Cachexia Doctors will see results with Pulmonary Function Test/Spirometry

COPD S/Sx

(same for all respitatory) with extra- Dyspnea, Chronic Cough, Spurtum Production Goal with those patients is to- oxygenate/lower carbon/help patients breath the best- reduce wheeze with sterioids

Emphysema

Loss of air, and alveo collapse Barrell CHEST is huge factor with these patients because air is trapped Air is trapped Dyspnea- labored breathing, Tachy To help- persed lip breathing

Asthma type factors

• Reversable issue that stems small muscle reactivity that results from

Infections Pollution Food, Weather

Dysnea Chrinic Coughs Spurtim production

restrictive pulmonary Types

• Patient has a hard time making a big breath, due can’t pull muscles
• Dysnea is main part
• Most causes has to with musculoskeletal that has to do with -ALS -Spinal cord injuries -Gullian Bahre -Ankylos
• Rapid heart rate
• Short breath,

##Cystic Fibrosis Basics + Factors Disorder that affects the lining or reprocutive and digestion tracts Patient has inherited traits, is normally obstructed

##Atalatsis collapse lung sacs, can lead to severe fatigue

##VTE

Risk Factors

20% VTE come from upper extermity Most from Deep veins originte Hyperthyroid issues

pulmonary HTN

Causes from high bp in lungs Can lead to enlarged, hypertrophed heart and eventually fatigue/death

Pnuemo SX

Pain that becomes severe Hard to inhale, short breath/symptoms same

Cardio Overview(PPT 6)

Layers of Heart: Congestive- all four lead to congestive issues

1. The main cause is pressure and shear forces, with that in mind risk is highest in Sacral Heels Ears

General heart Disease types

Risk of heart-hypertension, high blood thickness, lack of exercise The above are lifestyle which causes the largest mortality rate related to CAD

The main types

Angina- lack of O2 with constant contraction Palpitations, - heart beat is constant Dynesa- is short/labored breathing without lung tissue

SOB is main for left sided heart failure- can’t operate to send o2 Heart stops sending blood Leads to heart failure- syncope

Pulmonary Faints Integ General vasoval issues

VTE

Buring and crapping Functional over life

• Bike test

Cardio Bi markers can be measured, CRP tested for high, low blood levels

Old people operate less Small pump- leads to hard

Females- vessels smaller Males= longer heart/2x more likely

Hormone: Estrogen for cardioproceting for women Ateries - calcium can be blockers for women

Oral Contraceptives - heart attacks increase (over the age of 35) A

Explore cancer prevalence, defining characteristics such as uncontrolled cell proliferation, and tumor classifications. Learn about microscopic changes including hypertrophy, hyperplasia, metaplasia and dysplasia. Differentiate between benign and malignant tumors based on growth, differentiation, and invasiveness.