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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.