MES 1 | CANCER

WEEK 13

A.Y. 2020-2021

CANCER
• Pathologic process characterized by dysregulated cell growth and systemic spread
• All tissue types have neoplastic potential and can be cancerous
• Tissues distinguished by rapid cell turnover hormone sensitivity and regular exposure to mutagens have higher rate of
malignant transformation
• Disease consideration
- Staging
- Metastasis
- Prognosis

REHABILITATION PLANNING
• Anticipation of problem
- Likely metastasis
- Respond to treatment
- Cumulative toxicities from treatment
- Life expectancy
• Symptom-oriented vs disease-modifying
treatment strategy

PHASES OF CANCER
• Initial diagnosis and treatment
 Aggressive treatment to eradicate disease
 Goal of rehab is to limit functional impact
of cancer treatment
• Surveillance
 Continuous monitoring for emerging
treatment toxicities and cancer recurrence
• Recurrence
• Temporization

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 In patient with recurrence not deemed
curable, goal is to control disease and
symptoms and prevent or
• address disability
• Palliation
 Focused on patient’s comfort
 Goals
 Preserve community integration
 Support and educate caregiver
 Maintain functional autonomy
Pain and fatigue present are the most consistent and
challenging obstacles to successful rehabilitation.
PAIN
• Prevalence is 28% among patients with newly
diagnosed cancer, 50-70% among patients
• receiving anti-neoplastic therapy
• Usually due to tumor effects
• Could be acute or chronic
• Acute pain usually due to complications from
surgery or radiotherapy
- Chronic pain could be due to tumor
compressing visceral structures but most
often due to bone
- metastasis
FATIGUE
• Most common symptom experienced by cancer
patients
• Cancer related fatigue
- An unusual, persistent, subjective sense of
tiredness related to cancer or cancer
treatment that interferes with usual
functioning
CRITERIA FOR CANCER RELATED FATIGUE
• Diminished energy
• Increasing need for rest
• Limb heaviness
• Diminished ability to concentrate
• Decreased interest in engaging in normal
activities
• Sleep disorder
• Inertia
• Emotional lability
• Perceived problems with short term memory
• Post-exertional malaise exceeding several hours
IMPAIRMENT IN CANCER:
TUMOR EFFECTS – PARANEOPLASTIC SYNDROME
• Rare disorders that are triggered by an altered
immune system response to cancer
• Pathophysiology
- Antibodies against tumor mistakenly attack
normal tissues
- Tumor produce hormones, hormone
precursors or enzymes that affects and/or
destroy
• normal tissues
• Triggered during early stages of CA
• Emergence of PND in patient with known CA
should warrant a work-up for recurrence or
• metastasis
• Fever of unknown origin is the most common
presentation
TUMOR EFFECTS – BRAIN TUMOR
• Most commonly metastasis from lung cancer
• Headache > Mental Disturbance > Focal
Weakness > Gait Ataxia > Seizure
• Corticosteroid first line of treatment
- Dexamethasone is the drug of choice
• Untreated patients have median survival rate of 1
to 2 months
TUMOR EFFECTS – BONE METASTASIS
• Most common site of metastatic spread
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• Bisphosphonates for bone support distribution

• High risk for pathologic fracture
• Surgical treatment
- Life expectancy > 1 month for weight
bearing bones
- Life expectancy > 3 months for non-weight
bearing bones

TUMOR EFFECTS – EPIDURAL SPINAL CORD

COMPRESSION

• Most common primary from breast, lungs,

myeloma and prostate
• Compresses the spinal cord or cauda equina
• Pain is the most common initial presentation
exacerbated by Valsalva
• Thoracic spine is the most common site

TUMOR EFFECTS – BRACHIAL PLEXOPATHY

• Most common source is from lungs and breast CA

• Inferior trunk and medial cord commonly involved
 C8-T1
 Median and Ulnar nerves
• Most disturbing symptom is pain (vs numbness in CANCER TREATMENT – CHEMOTHERAPY
radiation plexopathy) • Mainstay of anti-cancer therapy
CANCER TREATMENT – SURGERY • General Uses
i. Induction therapy for advanced
• Affects normal tissue disease
- Removal of unaffected nearby tissues for ii. Adjunct to treatment of localized
prevention of recurrence tumor
• Aesthetic issue iii. Primary treatment of localized
- Mastectomy in breast CA cancer
• Complications whether expected or unexpected iv. Direct installation into site of specific
- Injury to the recurrent laryngeal nerve in body region affected
thyroid cancer • Induction
a. For advanced disease for which no other
CANCER TREATMENT – RADIATION THERAPY treatment exists
• Adjuvant
• Timing a. Done after local control is achieved
 Acute < 4 weeks post RT through surgery or radiation when no
 Early 1-6 months post RT obvious tumor is
 Late > 6 months post RT b. present
• Adverse effects mainly due to affected normal c. Eliminate undetectable micro metastases
tissues or risk of recurrence
• Complications from radiation therapy depends on • Neoadjuvant
the site treated a. Can be used before surgery to reduce
RADIATION INDUCED MYELOPATHY tumor size to decrease the degree of
anatomic disruption
EARLY-ONSET LATE-ONSET
MYELOPATHY MYELOPATHY
• Peak at 4-6 • 9-18 months
months after completion
• Resolves within of treatment
9 months • Irreversible
• Clinical onset is onset of
marked by symptom
paresthesia that usually begins
• radiate from • with LE
cervical spine to paresthesia
extremities followed by
• Paresthesia sphincter
typically • dysfunction and
symmetrical and weakness
does
• not follow a CANCER TREATMENT – LYMPHEDEMA
dermatomal
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• Damaged lymphatics either from surgical removal

or from radiotherapy
• Treatment is complex decongestive therapy
(CDT)
a. Reductive phase
 Decrease lymphedema volume
 45 minutes of manual lymphatic
drainage (MLD)
 Highly specialized
technique designed to
enhance the
sequestration and
transport of lymph
 Application of compression
bandages for 21-24h/day
 Remedial exercises
 Repetitive movements
designed to encourage
rhythmic, serial muscle
contractions in
lymphedematous
territories
b. Maintenance phase
 Compression garments are used
during the day
 Compression bandages overnight
 Remedial exercises daily while
bandaged
 MLDs as needed
c. Teach self-management techniques