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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