Differential Diagnosis for Physical Therapy: Cancer, Hepatic/Biliary, and Renal Disease: Summary 94
Preventative (testing) ○ BRCA 1 and 2 gene mutations—higher risk of breast and ovarian CA. This test is only done for people with a strong family history of breast/ovarian cancer. Risk of breast or ovarian cancer is higher if individual has BRCA1 or BRCA2 gene changes. More common among Jewish women. Treatment Side Effects • Overlap of toxicity may result, since most cancers are treated with a combination of drugs • Bone marrow suppression is a commonly seen serious side effect • Extremely important to monitor hematology values in these clients before beginning any therapy session • Decreased immunologic resistance • Aerobic exercise is contraindicated in clients with the following lab values: ○ Platelet count: <50,000/mm3 ○ Hemoglobin: <10 g/dL ○ White blood cell count: <3,000/mm3 ○ Absolute granulocytes: <2,500/mm3 (neutrophil count) Signs of Metastatic Cancer • Unexplained weight loss • Inadequate relief with rest • Failure to improve with four weeks of therapy Oncologic Signs/Symptoms • Constant, intense pain, especially bone pain at night • Unexplained weight loss (10% of body weight in 10 to 14 days); most clients in pain are inactive and gain weight • Loss of appetite • Excessive fatigue • Unusual lump(s), thickening, change in a lump or mole, sore that does not heal • Unusual or prolonged bleeding or discharge anywhere • Older than age 50 • Previous CA history
○ Combination of two to four drugs given that interfere with DNA
replication (antibiotic , antimitotics, antimetabolites, and alkylating agents) ○ Protocols depend on type of tumor ○ Side effects: Similar to radiation therapy • Radiation therapy: May be used alone or in conjunction with other therapies ○ Causes mutations in targeted DNA, leading to immediate cell death ○ Most effective on rapidly duplicating cells ○ Can be done through external sources (cobalt machine) or internally through needle ○ Gamma knife: High radiation, tightly focused on small tumors or other lesions in the head or neck, so very little normal tissue receives radiation ■ The gamma rays are aimed at tumor from many different angles ○ Adverse effects ■ Bone marrow suppression— increased risk of infection and bleeding ■ Cell damage—damage to blood vessels and skin, hair loss; also digestive tract damage ■ Fatigue • Hormones—prednisone decreases mitosis, increases RBC, and improves appetite • Tamoxifen—estrogen-blocking drug for breast cancer • Angiogenesis inhibitor drug—blocks blood vessel formation, limiting blood flow to tumor cells • Tumor ablation—achieved by using cold (cryogenic), chemicals, focused ultrasound, microwaves, or radiofrequency • Gene therapy—boosts immune system, makea CA cells more responsive to treatment • Targeted therapy—drugs designed at molecular level of cell to specifically attack and kill only CA cells
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