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Lung

Heavy smoker, older than age 40 yrs

Smoked one pack per day for 20 yrs

Started smoking at age 15 or before

Smoker working with or near asbestos

Breast

Lump in breast

Nipple discharge

History of breast cancer

Filmily history of breast cancer

Benign breast disease

High-far diet

Nulliparous or first child after age 30 yrs

Early menarche or menopause

Colon/rectum

Hiscocy of rectal polyps or colonic adenomatosis

Family histOry of rectal polyps

Ulcerative colitis or Crohn's disease

Obesity

Increasing age

Uterine

Unusual vaginal blood or discharge

History of menstrual irregularity

Late menopause

Nullipariry

Infertility through anovulation

Diabetes, hypertension, and obesity

Age 50-64 yrs

Skin

Excessive exposure to the Slin

Fair complexion that burns easily

Presence of congenital moles or hisCOfY of dysplastic nevi or

cutaneous melanoma

Family history of melanoma

Oral

Heavy smoker and alcohol drinker

Poor oral hygiene

Long-term exposure to rhe sun, particularly to the lips

Ovary

Hiscocy of ovarian cancer among close relatives

Nulliparity or delayed age at first pregnancy

Age 50-59 yrs

336

ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Table 5-3. Continued

Cancer Sire

High-Risk Factors

Prosrare

Increasing age

Occuparions relaring to the use of cadmium

Family hisrory

Sromach

Hisrory of sromach cancer among close relarives

Dier heavy in smoked, pickled, or salred foods

Source: Wirh permission from S Baird (ed). A Cancer Source Book for Nurses (6rh ed).

Arbma: American Cancer Society, 1991 ;32.

Para neoplastic syndromes are symptoms that cannot be related

directly to the cancer's growth and invasion of tissues. They are

thought to be due to abnormal hormonal secretions by the tumor. The

syndromes are present in approximately 15% of persons diagnosed

with cancer and often are the first sign of malignancy. Clinical findings are similar to endocrinopathies (Cushing's syndrome, hypoglycemia), nerve and muscle syndromes (myasthenia), dermatologic disorders (dermatomyositis), vascular and hematologic disorders

(venous thrombosis, anemia), and others,l.7

Diagnosis

After obtaining a medical history and performing a physical examination, the physician uses specific medical tests to diagnose cancer.

These teStS may include medical imaging, blood tests for cancer markers, and several types of biopsy. Biopsy, or removal and examination of tissue, is the definitive test for cancer identification. Table 5-4 lists

common medical tests used to diagnose cancer.

Staging and Grading

After the diagnosis of cancer is established, staging is performed to

describe the location and size of the primary site of the rumor, the

extent of lymph node involvement, and the presence or absence of

metastasis. Staging helps to determine treatment options, predict life

expectancy, and determine prognosis for complete resolurion.

ONCOLOGY 337

Table 5-4. Diagnostic Tests for Cancer

Test

Description

Biopsy

Tissue is taken via incision, needle, aspirarion procedures. A pathologist examines the tissue (Q identify

the presence or absence of cancer cells; if cancer is

presem, the rUlllor is determined to be benign or

malignanr. The cell or tissue of origin, staging, and

grading arc also performed.

Blood rests

Blood can be assessed for the presence or absence of

rumor markers:

Marker

Cancer

Prostate surface amigen

Prostate disease

Carcinocmbryonic

Colon cancer

antigen

Prostaric-acid

Prosrate cancer

phosphatase

Alpha-fcroprorein

Liver cell cancer

CAI2S

Ovarian cancer

CA 19-9

Colon cancer

CAU-3

Stool guaiac

Srool guaiac

Detecrs small quantities of blood in srool.

Sigmoidoscopy

The sigmoid colon is examined with a sigmoidoscope.

Colonoscop}'

The upper porrion of the rectum is examined wirh a

colonoscope.

Mammography

A radiographic method is used to look for a mass or

calcification in breast tissue.

Radiography

X-ray is used ro detect a mass.

Magnetic resonance

These noninvasive imaging techniques are used to

imaging and

assess lesions suspected of being cancerous.

computerized

axial romography

Bone scan

Radionuclide imaging used to detect rhe presence,

amOunt of metastatic disease, or both in bones.

Pap smear

A type of biopsy in which cells from the cervix are

removed and examined.

Sputum cytology

A sputum specimen is inspected for cancerous cells.

Bronchoscopy

A tissue or sputum sample can be taken by rigid or

flexible bronchoscopy.

CA c:trboh),dratc :tntigcn.

=

338

ACUTE CARE HANDBOOK FOR PHYSICAL THERAPISTS

The mostly commonly used method to stage cancer is the TNM

system. Tumors are classified according to the American Joint Committee on Cancer using this system based on the size of the primary tumor (T), presence or absence of tumor in local lymph nodes (N),

and presence or absence of metastasis (M) (Table 5-5).'

Grading reports the degree of dysplasia, or differentiation, from the

original cell type. The higher the grade, the greater the differentiation, or

appearance, from the original cell. In some cases, tumor cells may look so

unlike any normal cell that no cell of origin can be determined. Higher

degree of differentiation is linked to aggressive, fatal tU1110rs (Table 5-6).'

Management

Not all cancers are curable. Physicians may therefore foclls treatment

on quality of life with palliative therapies rather than on curative

therapies. Four major treatment options include:

• Surgical removal of the tumor

• Radiation to destroy or shrink the tumor

•

Chemothera py

•

Biotherapy (including immunotherapy, hormonal therapy, bone

marrow transplantation, and monoclonal antibodies)

Table 5-5. TNM System

T: Primary rumor

TX: Primary tumor cannot be assessed.

TO: No evidence of primary rumor.