i bc27f85be50b71b1 (107 page)

ONCOLOGY

349

Table 5-10. Surgical Interventions for Genitourinary System Cancers

Surgical lnrervenrion

Excision

Uterus

Hysterectomy

Uterus through abdominal

wall or vagina

Toral abdominal

Body of uterus and cervix

hysterectomy

through abdominal wall

Subcocal abdominal

Uterus (cervix remains)

hysterectomy

Ovary

Oophorectomy

One ovary

Ovaries and

Bilateral salpingo-

Bmh ovaries and oviducts

OVIducts

oophorectomy

Prosrate

Radical prosratecmmy

Entire prostate

Testes

Orchiectomy

One or both testes

• Patients with gastrointestinal cancer may experience

bowel as well as urinary incontinence.

• Both bowel and bladder incontinence can lead to areas

of dampened skin, which are prone to breakdown.25

Therefore, physical therapists should be careful to mlfllmize shearing forces in these areas during mobility.

Table 5-11. Surgical lnrervenrions for Gastrointestinal System Cancers

Area Involved Surgical Intervention

Excision

Stomach

Subtotal gastrectomy

Portion of the stomach

Near-wtal gastrectomy

Body of the stomach

Total gastrecromy

Entire stomach

Gastroduodenosromy

Portion of the stomach and

duodenum

Gasrroj ejunostol11 y

Portion of the sromach and

jejunum

Colon

Hemicolectomy

Portion of the colon

Rectum

Anterior or low-anterior

Upper-third of the rectum

resection

Abdominal perineal

M.iddJe- and lower-third of

resection

the rectum

350 ACUTE CARE HANDBOOK FOR I'HYSICAL THERAPISTS

Hepatobiliary Cancers

Primary liver tumors can arise from hepatic cells, connective tissue, blood vessels, or bile ducts. Primary malignant liver carcinomas are almost always associated with cirrhosis. Benign liver tumors are associated with women taking oral contraceptives.

Most benign liver tumors are asymptomatic.

Hepatic adenomas (benign hepatic cell tumors) are highly vascular, and patients carry the risk of hepatic rupture. Hepatomas, or malignant hepatic parenchymal cell tumors, are closely associated with male gender, excessive ethanol use, hepatitis B, and hepatitis C. Treatment is usually with chemoembolization or tumor resection. Patients with a small, nonmetastasizing hepatoma may

be [rea ted with liver transplantation. Untreated hepatoma has a

very poor prognosis. Five-year survival rates for treated tumors are

15-45%.7

Cancer of the biliary tract is usually found during surgery for

another biliary disease or when metastasizing to other organs,

particularly [he liver. Treatment is by surgery, but prognosis is

poor.

In both hepatic cancer and biliary cancer, laboratory values are

used to diagnose, prognose, and monitor the course of treatment.

Liver function tests may include bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), gamma-glutamyltransfer.se, alkaline phosphatase, coagulation factors, and serum proteins.

Surgical interventions for the hepatobiliary system are outlined

in Table 5-12.

Table 5-12. Surgical lnrerventions for the Hepatobiliary System

Area Involved

Surgical Intervention

Excision

Pancreas

Whipple procedure

Duodenum and proximal

pancreas

Liver

Segmental resection

Complete segmenr of liver

$uhsegmental

Porrion of a segment of liver

resection

ONCOLOGY

351

Clinical Tip

Any patient with hepatic adenoma must be cautioned to

avoid lifting heavy objects or performing maneuvers thar

increase intra-abdominal pressure.

Pancreatic Callcer

The incidence of pancreatic cancer doubled in the late twentieth century.26 Most pancreatic rumors arise from the pancreatic duct and are found in the head of the pancreas. Pain and jaundice are the mOSt

usual clinical manifestations; these symptoms occur as the tumor

invades surrounding tissue, especially the liver and gallbladder. Treatment usually focuses on tumor resection, alleviation of pain, and prevention of gastric outlet obstruction. Surgery (Table 5-12), radiation, and chemotherapy are used as treatment. Recent treatments include

supravolrage radiation plus chemotherapy,27 Patients with non resectable tumors have benefited from placement of a biliary stent or gastric operative bypass." Even so, prognosis is poor because the disease has

usually metastasized by the time it is diagnosed.3

Hematologic Cancers

Hematologic cancers can arise from any blood-forming tissue. These