Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary, and Renal Disease: Summary 90
Diagnosing Cancer • Blood tests: Complete blood count (CBC); tumor markers—circulating biochemical substances indicative of neoplasia • Imaging: CT/MRI/X-ray • Cytological tests: Biopsies, Pap smear Cancer Survival If no detectable recurrence of CA is seen within 5 years of initial diagnosis, client is considered “cured.” The probability of recurrence decreases with each passing year. Though “cured,” these clients can present with limitations and dysfunctions. Cancer Staging Clinical classification: 0–4 subscripts are used to denote degree of involvement/size 1. Primary tumor (T) 2. Regional nodes (N) 3. Metastases (mets): 30% of clients with newly diagnosed CA have clinically detectable mets ○ 30%–40% of clients clinically free of mets harbor occult metastases ○ Five most common sites of mets: i. L—lymph nodes ii. L—liver iii. L—lung iv. B—bone v. B—brain Metastatic Sites Central Nervous System ○ Primary lung CA accounts for about 50% of all metastatic brain cancers ○ Primary breast CA accounts for 15% of CNS mets ○ Symptoms depend on tumor location
INTRODUCTION Differential diagnosis is defined as the process of examination, evaluation, and medical screening to determine appropriateness of intervention within scope of practice—or need for referral to another practitioner. Provider responsibility is to determine what biomechanical or neuromusculoskeletal problem is present and then provide treatment. Clinicians must be able to identify signs and symptoms of systemic disease. Use of evidence-based practice will enable a provider to build their own screening tools. This course will review differential diagnosis screening for cancer, hepatic/biliary diseases and renal diseases. ONCOLOGY Cancer is defined as uncontrolled growth, reproduction and spread of cells, caused by disturbance in the regulatory functions within the DNA of an individual. Cancer cannot be classified as a singular or specific disease; it is a group of more than 150 disease processes. Cancer typically spreads through blood or lymphatic system. Benign Tumors Differentiated cells that reproduce at accelerated rate • Encapsulated and does not spread; can cause compression of tissue Malignant Tumors Undifferentiated cells that also reproduce quickly and spread to other organs/tissues Primary (Parent) Tumor • Invasion: Locally—grows into adjacent tissue, destroying normal cells • Metastasis : Spread to distant sites— usually first seen in regional lymph nodes Effects of Cancer Local: Pain, obstruction, tissue necrosis • Systemic: Weight loss, anemia, infections, bleeding, paraneoplastic syndromes
LEARNING TIP! Pulmonary (lungs) - most common metastatic site.
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