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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

Chris Wilson PT, DPT, DScPT is an Associate Professor and Director of Clinical Education in the Physical Therapy Program at Oakland University in Rochester, Michigan, and was the founding Residency Program Director for the Beaumont Health Oncology Residency, the first accredited residency program for physical therapists in the United States. His clinical focus is Acute Care Oncology and Palliative Care. He is active in clinical research in the areas of Oncology, Hospice/Palliative Care, and Geriatrics. Dr. Wilson received his Doctor of Science from Oakland University.  He received his transitional DPT from the University of St. Augustine with a Primary Care Certification and his Masters in PT from Oakland University.  He has been Board Certified as a Geriatric Clinical Specialist since 2008. Chris has been awarded the Flomenholft Humanitarian Award from the Academy of Oncologic Physical Therapy in 2022 and the Signe Brunnström Award for Excellence in Clinical Teaching in 2015 from the American Physical Therapy Association. Dr. Wilson is a prolific writer and researcher.  He published the book entitled Physical Activity and Rehabilitation in Life Threatening Illness by Routledge in 2021 and is the co-editor of the forthcoming textbook entitled Oncology Rehabilitation: A Comprehensive Guidebook for Clinicians to be released by Elsevier in Fall 2022.  He has published over 35 full-length peer reviewed articles and many invited publications. Chris was the primary author and sponsor of the APTA’s positions on hospice/palliative care, diet and nutrition, and medical necessity in the presence of declining conditions.


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