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NERVOUS SYSTEM
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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
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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.