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5

Oncology

Susan Polich

Introduction

Callcer is a term that applies to a group of diseases characterized by

the abnormal growth of cells. The physical therapist requires an

understanding of underlying cancer pathology, as well as the side

cffects, considerations, and precautions related to cancer care to

enhance clinical decision making to safely and effectively trear the

patient with cancer. This knowledge will also assist the physical thetapist with the early detection of previously undiagnosed cancer. The objectives for this chapter are to provide the following:

I.

An understanding of the medical assessment and diagnosis

of a patienr with cancer, including staging and classification

2.

An understanding of the various medical and surgical

methods of cancer management

3.

A better understanding of a variery of the different body

system cancers

4.

Examination, evaluation, and intervention considerations

for the physical therapist

331

332 AClITE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Definitions

The terms neoplasm, tumor, and cancer are currently used interchangeably. Neoplasm means "new growth" and applies to any abnormal mass of tissue which exceeds the growth of normal tissue,

grows at the expense of itS host, and persists even after the stimulus to

grow is removed. The term /1I1110r originally applied to the swelling

caused by inf1�mmation but now refers only to a new growth. Cancer

is the layperson's term for all malignant neoplasms.''''

Normal cells change in size, shape, and type, known collectively as

dysplasia, if the proper stimulus is provided. Hyperplasia refers to an

increase in cell number. Metaplasia is the change of one cell type to

another. Hyperplasia and metaplasia can be reversible and normalor persistent and abnormaI.1,2,4

Neoplasms, or persistent, abnormal dysplastic cell growth, are

classified by cell type, growth pattern, anatomic location, degree of

dysplasia, tissue of origin, and their ability to spread or remain in the

original location. Two general classifications for neoplasm are benign

and malignant. Bellign tumors are usually considered harmless and

slow growing and have cells that closely resemble normal cells of

adjacent cissue. However, chese benign tumors may occasionally

become large enough to encroach on surrounding tissues and impair

their function. Malignant neoplasms, or malignant tumors, grow

uncontrollably, invading normal tissues and causing destruction to

surrounding tissues and organs. Malignant neoplasms may spread, or

metastasize, to other areas of the body through the cardiovascular or

lymphatic system. '-5

Tumors may also be classified as primary or secondary. Primary

rumors are the original tumors in the original location. Secondary

tumors are those metaStases that have moved from the primary site.4

Nomenclature

Benign and malignant tumors are named by their cell of origin

(Table 5- J). Benign tumors are cusromarily named by attaching

-oma to the cell of origin. Malignant tumors are usually named by

adding carcinoma ro the cell of origin if they originate from epithelium and sarcoma if they originate in mesenchymal tissuc.I-J Variations to this naming exist, such as melanoma and leukemia.