Transcript Spinal Cord Tumor and Cancer

Becca Shonsey
DPT 774
Put yourself in his shoes
Imagine feeling weak
 Imagine being told nothing is wrong
 Imagine a month goes by and you start
to get leg numbness
 1 week passes and you can’t walk
 Each step of the way something
changes
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PURPOSE
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Our prime purpose in this life is to help
others. And if you can't help them, at
least don't hurt them. ~Dalai Lama
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Help you help your patient with a spinal
compression and lymphoma in acute
care
Objectives
The student will be able to identify the
signs and symptoms of spinal tumor
compression
 The student will be able to differentiate
between spinal tumor signs and lymphoma
signs
 The student will be able to develop a
treatment plan for a patient with cancer in
an acute care setting
 The student will be able to determine the
prognosis of a patient with both a spinal
tumor and lymphoma
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Patient History
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42 year old white male
Homeless
12 pack of beer each week
25 packs of cigarettes a year
Mid thoracic and abdominal pain,
decreased renal function (April)
CT on chest, abdomen and pelvis (April)no significant findings
Pt reports: 1 week ago LE numbness, 48
hours ago LE weakness
Examination
PIP: Progressive weakness and inability to
walk
 HR: 82
 Oxygen Saturation: 94%
 BP: 140/77
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Negative: hypotension, fever, chills, sweat,
weight loss, nausea, vomiting, headache,
facial paresis, spinal tenderness with
palpation
Examination
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Positive:
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Renal function decrease
Numbness below nipples to saddle
Reflexes 3+
UE strength 5/5
LE Strength :
○ Bilateral hip flexion 2/5
○ Bilateral knee extension 3/5
○ R dorsiflexion and plantarflexion 2/5
○ L dorsiflexion and plantarflexion 4/5
Knowing spinal compression
15% of all CNS tumors are primary
spinal tumors3
 Spinal cord tumors
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 Primary are rare?
 Compress the cord and surrounding nerves
 Sx: pain or numbness in back, arms or
legsX
 Decreased ms strengthX
 Loss of bowel or bladder control
(sometimes)X
Physiotherapy Functional Mobile Profile
(PFMP): 26/63
The intra-rater reliability ICC=.99 and
inter-rater reliability ICC= .97 in acute
care setting1
 Quick and easy to perform
 Has been used on patients following
surgery of the spine2
 Higher score means higher function/
independence
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Evaluation
Weakness, numbness, renal decrease =
possible spinal tumor
 Decreased independence with bed
mobility, sit to stand and walking
according to PFMP
 Further examination: MRI thoracic and
lumbar
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○ Mid thoracic dorsal and right lateral mass
○ At T7
Treatments
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Medically:
Immediate surgery
performed followed
by radiation
○ Review of patients
with spinal cord
compression. 46%
after surgery were
able to walk and 49%
after radiation4
Treatments
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Physical Therapy (Day 2)
 Increase mobility
○ At an oncology unit the policy was changed to have
PTs see pts within the 1st 48 hours. Pts were getting up
sooner and ambulating. The results were a 14%
decrease in patient length of stay within 1 year5
 Increase ambulation
○ Increase strength
○ Gait training
 Case series of 79 patients with spinal cord compression
treated by radiation with 9 receiving an operation. Median age
of 60 years. The collaborative team determined that walking
was the most important factor. 90% of patients who walked
before radiation walked after radiation6
Changes
Day 4: medication decreased and
patient has increased R LE numbness,
patient returned to max A for all
activities, another MRI
 Day 5: Oncology reports no MRI
changes
 Day 6: PET/CT = lymphoma axillary,
groin and behind the heart
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 Refused PT
Lymphoma7
56,000 people in the US each year
 Signs and symptoms
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Painless/swollen lymph nodes
Unexplained weight loss
Fever
Night sweats
Chest pain
Weakness and FatigueX
Abdominal or back painX
Re-examination and evaluation
Pt feels pins and needles
 Decreased proprioception/ foot slap
 Min A with most ADLs and mobility (PFMP
46/63)
 Strength
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L Hip flexion and knee extension 3/5
L dorsiflexion and plantaflexion 3+/5
R Hip flexion and knee extension 3-/5
R dorsiflexion and plantarflexion 3/5
Possible discharge
New treatment (Day 7-9)
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Gait training/ walking
 A systematic review of cancer patients reported that studies
have found a decrease in symptoms and increase in function
with patients participating in a walking program8
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Wheelchair training
 A retrospective cohort study looking at 83 patients post spinal
surgery. Therapy included respiratory exercises, bed mobility, sit
to stand, walking in the room and hall, stairs and wheelchair
ambulation. Those patients in their 40s and had operations at
one level had the most significant increase in PFMP scores
(P<0.05) with wheelchair locomotion, bed mobility and walking2
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Day 10: Discharge to transitional care unit and then to
Washington with father to begin chemotherapy
 PFMP 52/63
Prognosis
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Poor
 In a case series all three patients had spinal
tumors removed surgically followed by
radiation. A 61 year old died after 6 months,
a 23 year old after 1 year and a 51 year old
after 11 months9
 A retrospective cohort study reported on 60
patients whose mean survival was 3-4
months10
 Drinker, smoker, lymphoma, uninsured
Summary
Important to recognize signs of spinal
tumor compression and cancer
 In acute care focus on patient function
 More research needs to be done on the
best treatment in acute care
 In the future a quality of life outcome
measure may be useful
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Your understanding
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Your patient with back pain comes in and
reports progressive weakness in their UE,
having difficulty urinating, and having
numbness
 Refer them to get tested (MRI, PET, CT)
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A patient is in the hospital with cancer and
is going through radiation. Do you walk
them or let them rest in bed all day?
 Walk them while monitoring symptoms
References
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1. Brosseau L, Laferriere L, Couroux N, Marion M, Theriault J. Intra- and
inter-rater reliability and facorial validity studies of the physiotherapy
functional mobility profile (PFMP) in acute care patients. Physiotherapy
Theory and Practice. 1998;15:147-154.
2. Yildirim Y, Kara B, Arda M. Evaluation of patients with spinal operation
according to functional mobility. Neuro Rehabil. 2009;24: 341-347.
3. Class notes and expert opinions of Julia Osbourne, PT, CLT-LANA.
4. Prasad D, Schiff D. Malignant spinal-cord compression. Lancet Oncol.
2005;6:15-24.
5. Crannell C, Stone E. Bedside physical therapy project to prevent
deconditioning in hospitalized patients with cancer. Oncol Nurs Forum.
2008;35(3):343-345.
6. Kovner F, et al. Radiation therapy of metastatic spinal compression:
Multidisciplinary team diagnosis and treatment. J Neuro Oncol. 1999;
42:85-92.
7. Non-Hodgkins Lymphomas Page. Available at:
http://www.medicinenet.com/non-hodgkins_lymphomas/page3.htm.
Accessed July 3, 2010.
8. Visovsky C. Exercise and cancer recovery. J Issues in Nursing.
2005;10(2):1-8.
9. Arnold P. Floyd H, Anderson K, Newell K. Surgical management of
carcinoid tumors metastatic to the spine: resort of three cases. Clin Nuerol
Neurosurg. 2010;112:443-445.
10. Guo Y, Young B, Palmer J, Mun Y, Bruera E. Prognostic factors for
survival in metastatic spinal cord compression: a retrospective study in a
rehabilitation setting. Am J Phys Med Rehabil. 2003;82:665-668.
QUESTIONS
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