Question
Can you tell us more about screening for metastasis as a physical therapy professional?
Answer
Screening for Metastasis
Any cancer survivor should be monitored for metastatic disease. Even if you're not a cancer therapist, you will undoubtedly be seeing patients with a history of cancer. You need to keep an eye out for metastasis. Unfortunately, some of our patients who are cancer survivors and have been in remission or have been cured of cancer may have a recurrence of cancer. Furthermore, sometimes the initial symptoms of recurrence of cancer are from metastatic change. Examples of these symptoms in the brain may include headaches, seizures or vertigo. In the lungs, it could be a cough, hemoptysis (blood in the sputum) or dyspnea (shortness of breath). They might have lymphadenopathy, hepatomegaly (growth of the liver) or jaundice (yellowing of the skin). Again, if it is skeletal, they could experience pain, fractures, and spinal cord compressions.
Lymph Nodes
If lymph nodes are extremely tender and swollen but mobile, those are generally not signs of a cancer disease process. If they're hard and immobile and not necessarily super tender to the touch, a physical therapist might want to have a conversation with an oncologist or have the patient go in for a follow-up. Of course, that is a difficult conversation to have. I would caution all of you to tread into that conversation lightly. We don't want to alarm our patients, especially if they're cancer survivors. However, we do want to make sure that they're getting a routine checkup by their doctor. It might only require monitoring, but sometimes referral and workup are necessary. Sometimes if the patient has tenderness in the axillary area, or maybe has a swollen lymph node, you as a therapist might monitor that for a couple of days. If they come down with a cold, then you will know it was just an infectious disease process. If it's not necessarily changing, or it's growing without any type of signs of inflammation, like a fever or purulent drainage somewhere, or something that was related to an infection, that's a little bit more cause for concern. At that point, you might want to consult a physician, and they can talk to the patient about scheduling a follow-up visit.
Common Sites and Symptoms of Cancer Metastasis
There are relatively predictable locations where certain cancers will spread. This is useful information, especially when you're starting to work with a patient who might, for example, have lung cancer. Their disease process might spread to the adrenal glands, brain, and bone. If I have a patient with lung cancer, not only am I worried about their lungs and some of the difficulty with the cardiopulmonary system, I am also closely screening them for metastatic disease in the brain (e.g., confusion, disorientation, blurred vision, cognitive related changes). We also need to be cognizant of whether the patient has been recently screened for metastatic bone disease. Breast cancer commonly spreads to bone, liver, lung, and brain. Colon cancer will often spread to the liver. Pancreatic cancer may spread to the liver and lungs. Melanoma spreads mainly to the brain. Ovarian cancer may affect the pleural cavity and liver. Prostate cancer, of course, occurs only in males, often metastasizes to the bone. As a physical therapist, I am always concerned about brain mets and bone mets, because those are the body parts that I'm working with consistently. I want to make sure that they're not impaired.
