1
Q
What is the goal in preventive cancer rehab?
A
Achieve maximal function in patients considered to be cured or in remission
2
Q
What is the goal in Supportive cancer rehab?
A
Providing adaptive self-care equipment to offset steady decline in a patient’s functional skills. ROM and bed mobility in bed rest patients
3
Q
What patients is Supportive cancer rehab meant for?
A
Patients whose cancer is progressing
4
Q
What is the goal in Palliative cancer rehab?
A
Improve or maintain comfort and function during the terminal stage of the disease
5
Q
What can swallowing disorders be associated with?
A
Cognitive impairment
CNS involvement
Radiation treatment
Generalized deconditioning secondary to bed rest
6
Q
What should be done to extremities with concern of possible tumor involvement while work up is done?
A
Positioned in non-WB and ROM withheld
7
Q
What are the top two primary tumors in children?
A
- Leukemia
2. Brain tumors
8
Q
What are the most common posterior fossa tumors in childhood?
A
- Cerebellar astrocytoma (best prognosis)
- Medulloblastoma (most prevalent in <70)
- Brain stem gliomas
9
Q
What are the MC tumors that metastasize to the brain in men?
A
Lungs, gastrointestinal, and urinary tract tumors
10
Q
What are the MC tumors that metastasize to the brain in women?
A
Breast, lung, gastrointestinal, and melanoma
11
Q
What are signs and symptoms of brain tumors?
A
HA (MC sx)
Weakness (MC sign)
Seizures (1st presenting)
12
Q
What is the best diagnostic test of brain metastasis?
A
Contrast MRI
13
Q
What are the majority of spinal cord tumors?
A
Extradural (95%) and arises from the vertebral body
14
Q
What % of metastatic tumors are in the thoracic cord?
A
70%
15
Q
When does radiation induced transient myelopathy present?
A
1 to 30 months, with a peak onset at 4 to 6 months after radiation
16
Q
What is the prognosis of radiation induced transient myelopathy?
A
Resolves over a period of 1 to 9 months
17
Q
When does delayed radiation myelopathy present?
A
9 to 18 mo after radiation
Most w/in 30 mo
18
Q
What is the presentation of radiation myelopathy?
A
LE paresthesias followed by bowel dysfunction and weakness
19
Q
What cancers are peripheral polyneuropathy associated with?
A
Lung
Multiple myeloma
Breast
Colon
20
Q
What is the presenting symptom of brachial plexopathy 2/2 direct tumor extension?
A
90% pain
21
Q
What is the presenting symptoms of brachial plexopathy 2/2 radiation?
A
Numbness and paresthesias
22
Q
What part of the brachial plexus is involved in direct tumor invasion?
A
Lower trunk
23
Q
What part of the brachial plexus is involved in radiation?
A
Upper trunk
24
Q
What is a Pancoast tumor?
A
Tumor invasion (bronchial carcinoma) into the superior pulmonary sulcus
25
Q
How does a Pancoast tumor present?
A
Pain in shoulder, vertebral border of scapula, C8–T1 nerves (lower trunk plexopathy) as well as Horner’s syndrome
26
Q
What is pathognomonic of radiation plexitis on EMG?
A
Myokymia
27
Q
Describe Cognitive effects of radiation.
A
Dose related
Children at higher risk d/t developing myelin susceptible to insult
Presents slowly and delayed
28
Q
What is Carcinomatous myopathy?
A
Seen in metastatic disease that is consistent with
muscle necrosis and presents with proximal muscle weakness
29
Q
What is Carcinomatous neuropathy?
A
Affects peripheral nerves and muscle
30
Q
What is the clinical presentation of Carcinomatous neuropathy?
A
Distal motor and sensory loss, proximal muscle weakness, and dec reflexes
Type II muscle atrophy and distal peripheral polyneuropathy
31
Q
Which cancer is most associated with Carcinomatous neuropathy?
A
Lung cancer
32
Q
What does Chemotherapy-related and steroid myopathies result from?
A
Atrophy of Type II muscle fibers in proximal muscles
33
Q
How does lymphedema occur?
A
Direct tumor invasion or lymph node drainage blocked causing accumulation of protein in the interstitium changing colloidal pressure and detracts fluid into the interstitial space
34
Q
When is upper extremity lymphedema MC seen?
A
Breast cancer in patients who have had a nodal dissection or radiation therapy to the axilla
35
Q
What cancers are associated with lower extremity lymphedema?
A
Uterine
Prostate
Lymphoma
Melanoma
36
Q
What causes lower extremity lymphedema in melanoma?
A
Nodal dissection
37
Q
What causes lower extremity lymphedema in prostate cancer?
A
Whole pelvic radiation or surgery
38
Q
Describe Acute, transient and mild lymphedema presentation in cancer.
A
Occurs a few days post-operatively
39
Q
Describe Acute and painful lymphedema presentation in cancer.
A
Occurs 4 to 6 weeks post-operatively resulting from acute phlebitis or lymphangitis
40
Q
Describe Erysipeloid form lymphedema presentation in cancer.
A
Results from minor trauma
Superimposed on chronic edema
41
Describe Insidious and painless lymphedema presentation in cancer.
A
No erythema
Happens years after first treatment
Most common form
42
Q
Describe Grade 1 (mild) edema.
A
■Pitting edema that can be reversed by elevation of the extremity
■Present in distal arm or leg
■Circumference diff <4 cm
43
Q
Describe Grade 2 (moderate) edema.
A
■Non-pitting, brawny edema not reversible with elevation of the extremity
■ Skin hardened 2/2 development of fibrotic tissue due to chronic excess protein in the interstitial spaces and deposition of adipose tissue
■ Edema moderate, reversible with effort. Involves entire limb or corresponding trunk
■ Infection: none to occasional
■ Circumference diff 4-6 cm
44
Q
Describe Grade 3a (severe) edema.
A
■Lymphostatic elephantiasis
■Edema in one limb and its associated trunk
■Non-pitting
■Edema minimally reversible or not reversible
■ Cartilage-like
■Infection 2/2 skin breakdown
■ Circumference diff >6 cm
45
Q
Describe Grade 3b (Massive) edema.
A
Same symptoms as stage 3a except that two or more extremities are affected
46
Q
Describe Grade 4 (Gigantic) edema.
A
■ Complete obstruction of the lymphatic channels
■ Edema is severe and irreversible
■Edema may involve face and head
■ Infection >4x/year
47
Q
Describe compression therapy.
A
Sequential graded pumps effective in reabsorption of water from the interstitium into the venous capillaries
48
Q
What happens when there is >1 lympedematous area?
A
No place for fluid resolution and other areas may become edematous
49
Q
What are immediate post-operative therapies after mastectomy?
A
Hand pumpingHand and elbow ROMPositioning techniquesPostural exercisesShoulder ROM exercises to 40° of flexion and abduction
50
Q
When can Active assistive exercises be started after mastectomy?
A
When the surgical drains have been removed
51
Q
What is the most consistent symptom of metastatic bone disease?
A
Pain that is most severe at night or upon WB
Pain lying down and improves with sitting in spine
52
Q
What are high risk factors for fracture in metastatic bone disease?
A
Highly anaplastic and rapidly growing vascular lesions, which are usually osteolytic
High stress areas such as lesser trochanter
53
Q
What is the most common site of pathological fracture?
A
Proximal femur
54
Q
Describe locations of bone metastasis.
A
Axial skeleton
Proximal femur
Humerus
70% thoracic spine, 95% extradural and involve vertebral body anterior to the spinal canal
55
Q
Where do most cancers metastasize in the upper extremity?
A
90% of upper extremity metastases involve the humerus
56
Q
Which cancers metastasize to the upper extremity?
A
- Breast cancer
- Multiple myeloma
- Renal cancer
57
Q
Where do most cancers metastasize in the lower extremity?
A
Hip and femur
58
Q
Which cancers metastasize to the hip?
A
Breast
Lung
Lymphoma
Prostate
59
Q
Which cancers metastasize to the femur?
A
Breast
Prostate
Multiple myeloma
Renal
60
Q
What if the bone scan is negative in a cancer patient with bone pain?
A
Get an x-ray which may be positive
61
Q
When is the spine considered unstable?
A
> 2 columns involved
Middle column involved
20° of angulation
62
Q
What are indications for surgery in metastatic bone disease?
A
- Intractable pain
- Impending pathological fracture
- Pathological fracture has occurred
63
Q
What are indications for surgery in metastatic bone disease of the upper extremity?
A
Lesion size >3 cm
>50% cortex involved
64
Q
What are indications for surgery in metastatic bone disease of the lower extremity?
A
Lesion size >2.5 cm
>30-50% cortex involved
65
Q
What are indications for surgery in metastatic bone disease of the femur?
A
Lesion size >1.3 cm
>1.3 cm axial length cortex involved
66
Q
How do osteolytic lesions present?
A
Net loss of bone by osteoclast mediated bone reabsorption
Dec strength and stiffness of bone
67
Q
How do osteoblastic lesions present?
A
Sclerotic areas of bone formation
Dec stiff but do not change strength
68
Q
Which type of bone lesion is more prone to fracture?
A
Lytic lesions
69
Q
What are typical causes of lytic lesions?
A
– Myeloma – Lung – Kidney – Thyroid – Malignant lymphomas – Breast
70
Q
What is the median survival rate of lung cancer with bone mets?
A
6 months
Aggressive course
Mets higher risk of fx
Cortical metastases are common in lung cancer
71
Q
What is the median survival rate of renal cancer with bone mets?
A
Variable, depends on medical condition
May be as short as 6 months
72
Q
What is the median survival rate of prostate cancer with bone mets?
A
40 months
90% Blastic lesions
73
Q
What is the median survival rate of breast cancer with bone mets?
A
24 mos
60% blastic lesions
74
Q
What is the most common primary malignant bone tumor in children?
A
Osteosarcoma
75
Q
Describe imaging in multiple myeloma.
A
Bone scans may be normal
Skeletal survey may reveal diffuse “punched out” lytic lesions with black sclerotic borders
76
Q
Describe Step 1 on the WHO analgesic ladder.
A
Mild/moderate pain are treated with nonopioid analgesics (acetaminophen, ASA, NSAIDs)
77
Q
Describe Step 2 on the WHO analgesic ladder.
A
Mild to moderate pain despite taking a non-opioid analgesic, the dose of the non-opioid analgesic should be maximized with addition of a weak opioid (codeine, hydrocodone, oxycodone, tramadol).
78
Q
Describe Step 3 on the WHO analgesic ladder.
A
Moderate to severe pain despite therapy with Step 2 opioids require an increase in the dose of opioid or a change to Step 3 opioid when pain is severe (morphine, oxycodone, methadone, levorphanol, fentanyl).
79
Q
What is the agent of choice on Step 3 on the WHO analgesic ladder?
A
Morphine is the agent of choice. Its dose should be maximized before other agents are added
80
Q
Which NSAID has the least incidence of thrombocytopenia?
A
Ketoralac
