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ONCOLOGY 345
surgical procedures used in their management. Recent surgical
advances include the use of video-assisted, non-rib spreading lobectOmy ro remove rumor and the lise of an intraoperative ultrasound probe to aid in tumor localization.14•IS
Clinical Tip
• Thoracic surgery may involve a large incision on the thoracic wall. Surgical incisions into the pleural space will cause deflation of the lung. Deep-breathing exercises, along with
mucus clearance techniques with incisional splinting and
range-of-motion exercises of [he upper extremity on the side
of the incision, are important to prevent postoperative pulmonary complications and restore shoulder and trunk mobility.
• Patients may have chest rubes in place immediately afrer
surgery (see Appendix III-A).
•
Oxygen supplementation may be required in post-thoracic surgical patients. Oxyhemoglobin saturation (Sao,)
should be monitored to ensure adequate oxygenation,
especially when increasing activity levels.
• Caution must be taken when positioning patients after
pneumonectomy. Placing patients with the existing lung in
the dependent position may adversely affect ventilation, perfusion, and, ultimately, oxygenation. Positioning guidelines should be clarified with the surgeon, if not already stated.16
Musculoskeletal Cancers
Tumors of bone are most commonly discovered after an injury or
fracture or during a medical work-up for pain. Some tumors in the
bone or muscle may arise from other primary sites. Common primary
tumors that metastasize to bone include breast, lung, prostate, kidney,
and thyroid tumors.17 Treatment of musculoskeletal tumors can
include radiation, chemotherapy, amputation, arthroplasty (joint
replacement), and reconstruction using an allograft (cadaver bone).
Types of primary orthopedic cancers are described in Table 5-8.
Although not all metastases to bone cause pathologic fractures,
surgical intervention can be used for a patient with a bone metastasis
because of the risk of pathologic fracture. These procedures may
346 AClJTE CARE HANDBOOK FOR PHYSICAL THERAPISTS
Table 5-8. Orthopedic Cancers
Common Site of
Type of Tumor
Common Age Group
Tumors
Osteosarcoma
Young children and
Distal femur, proximal
young adults
tibia
Commonly metastasize
to lung
Chondrosarcoma
Adul"
Pelvis or femur
Fibrosarcoma
Adul"
Femur or tibia
Rhabdomyosarcoma
Children and adolescents Trunk. pelvis, and long
(Ewing's sarcoma)
bones
include the use of intramedullary rods, plates, and prosthetic devices
(e.g., total joint arthroplasty) and are described in hapter 3 under
Fracture Management, Appendix, and Total Joint Arthroplasty sections, respectively.
Clinical Tip
• A patient with bone metastases must receive clearance
from the physician before mobility, along with clarifying
the patient's weight-bearing status.
• Patients commonly experience fractures owing to metastatic disease in the vertebrae, proximal humerus, and
femur.'s Therefore, patients should be instructed in safety
management to avoid falls or trauma to involved areas.
• Check the weight-bearing status of patients after bone
grafting, as weight bearing may be restricted.
Breast Cancer
Breast cancer, although more prevalent in women, is also diagnosed in
men to a lesser extent. It may be discovered during routine breast
examinations or mammography. Common surgical procedures for the
treatment of breast cancer are listed in Table 5-9.