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Screening for Metastasis as a DPT

Chris Wilson, PT, DScPT, DPT, GCS

July 31, 2017

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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. 


chris wilson

Chris Wilson, PT, DScPT, DPT, GCS

Dr. Wilson is an assistant professor at Oakland University and an education coordinator at Beaumont Health, – Troy Hospital where his clinical focus is Geriatrics and Acute Care Palliative Care. He is active in clinical research in the areas of Hospice/Palliative Care and Safe Patient Handling and Injury Prevention. Dr. Wilson received his DScPT from Oakland University.  He received his transitional DPT from University of St. Augustine with a Primary Care Certification and his Masters in PT from Oakland University.  In the past, Chris has served the professional community as an Item Writer for the PT National Licensure Examination. In 2008, Chris obtained his ABPTS Geriatric Clinical Specialist Certification (GCS). Chris has been awarded Signe Brunnström Award for Excellence in Clinical Teaching in 2015 and the APTA Emerging Leader Award for 2009.

He has been a Delegate for the APTA House of Delegates for 10 years.  Chris is currently serving as the Oncology Section’s Hospice SIG Chair and as the coordinator of the Hospice/Palliative Care subgroup for the WCPT’s International HIV, Oncology, Palliative care (IPT-HOPE).  Dr Wilson has recently served on the Michigan Physical Therapy Association’s Board of Directors as Conference Director and recently served as Chief Delegate for Michigan.  Chris has previously completed 2 terms as MPTA Eastern District Chair. He is also the current Treasurer of the MPT-PAC.   Chris has been involved with the APTA at the national level as co-chair of the Midwest Regional Caucus in 2011.


Related Courses

How a Comprehensive Geriatric Assessment Can Improve Clinical Outcomes
Presented by Chris Wilson, PT, DScPT, DPT, GCS
Recorded Webinar

Presenter

Chris Wilson, PT, DScPT, DPT, GCS
Course: #2812Level: Intermediate2 Hours
  'Great review on comprehensive management of an aging population with good references and instructions for outcomes measures'   Read Reviews
This session will describe the concepts of a comprehensive geriatric assessment and how a multi-system, interdisciplinary assessment and management of older adults can assist in improving the quality of life. Concepts will include physical assessment, vision, hearing, frailty pharmacology and home and community assessment and the physical therapist/physical therapist assistant’s role in these areas. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Cancer Rehabilitation Core Concepts
Presented by Chris Wilson, PT, DScPT, DPT, GCS
Recorded Webinar

Presenter

Chris Wilson, PT, DScPT, DPT, GCS
Course: #2675Level: Intermediate2 Hours
  'Went over material that I had limited knowledge or background in'   Read Reviews
This seminar will introduce core concepts in the interdisciplinary management of the patient with cancer, including pre-diagnosis, prevention, active treatment, late effects and end of life care and will include core therapy techniques such as new concepts in manual therapy, lymphedema bandaging, and rehabilitation services during active treatment (surgery, radiation and chemotherapy.) The seminar will emphasize physical therapy patient management in the outpatient, acute care and multidisciplinary clinical settings including case-based activities with an emphasis on exercise and cancer survivorship/wellness. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT and PTA.

Palliative Care Concepts for the Rehabilitation Professional: Adapting to an Evolving Disease Process
Presented by Chris Wilson, PT, DScPT, DPT, GCS
Recorded Webinar

Presenter

Chris Wilson, PT, DScPT, DPT, GCS
Course: #2473Level: Intermediate2 Hours
  'INFORMATIVE, MUCH NEEDED INFORMATION TO BETTER UNDERSTAND AND PARTICIPATE IN THE PROGRESSION OF ILLNESS WITH HC POPULATION'   Read Reviews
This educational session will discuss the palliative care philosophy, similarities and differences between palliative care and hospice care, current physical therapy practice approaches and practice patterns, a focus on quality of life, and integration and complimenting hospital based-palliative care programs. Evidence based palliative care approaches and functional outcome measures will be introduced in a case study format for clinicians to immediately apply to the clinical setting. This course is directly related to the practice of physical therapy and is appropriate for the PT and PTA. This course is open captioned.

Physical Therapy and Safe Patient Handling and Mobility: Optimum Outcomes and Safety for Everyone
Presented by Chris Wilson, PT, DScPT, DPT, GCS
Recorded Webinar

Presenter

Chris Wilson, PT, DScPT, DPT, GCS
Course: #2758Level: Intermediate2 Hours
  'good content'   Read Reviews
This session will discuss the innovative ways that therapists can use safe patient handling equipment (lifts, standing frames, etc) to optimize outcomes in acute care, inpatient rehab and outpatient care. In order to achieve these outcomes, participants will learn about various important concepts to safe patient handling and mobility. This course is directly related to the practice of physical therapy and therefore appropriate for the PT and PTA.

Mindfulness: Beyond Guided Meditation
Presented by Jennifer Stone, PT, DPT, OCS, PHC
Recorded Webinar

Presenter

Jennifer Stone, PT, DPT, OCS, PHC
Course: #3902Level: Intermediate2 Hours
  'she [resented good examples for patient usage'   Read Reviews
Mindfulness can be a really powerful cognitive-behavioral tool and has many relevant applications when treating patients with pain, especially chronic pain. Many courses for rehabilitation professionals teach guided meditation, which is an amazing tool. However, mindfulness has many other applications and opportunities for use in the treatment of patients with pain. This session discusses the history and science behind mindfulness, as well as provides a variety of practical mindfulness tools for the everyday practitioner. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.