D&D FINAL EXAM

#NOTE: when asked to =

List = 1 word points Explain = why? Describe = general information

RESPIRATORY D
#NOTE = questions will be to pick what disease it is

COLD
Inflammation of airways - nose Localised Lacrimation (tearing of eyes) HA/ malaise Afebrile (no fever) Excessive mucous Hoarse sore throat -

INFLUENZA
Inflammation of respiratory mucosa Systemic self limiting HA/myalgia (muscle soreness) Pyrexia (fever) Chilliness Mild sore throat Predisposed to 2ndry infection - pneumonia

MASSAGE Sub-acute stage Inform client massage may temporarily exacerbate symptoms due to detoxification/flushing of system CONTRINDICATED IF FEVER PRESENT

PHARYNGITIS sore throat

Sore throat Fever WBC Swelling in lymph nodes, head & neck Pus purulent exudate -

LARYNGITUS muscles swollen

Inflammation of vocal cord oedema Voice hoarseness/loss - Cough - Scratchy/ painful throat ACUTE = due to cold, sudden temp change CHRONIC = excessive use of voice/heavy smoking MASSAGE

MASSAGE CONTRAINDICATED if infection present perfectly fine as there is no fever or infection

SINUSITIS
- Allergic rhinitis Hay fever - Nasal polyps block sinus openings - Self-perpetuating - Barotrauma ACUTE = facial pain & HA - Purulent nasal discharge - smell, malaise

CHRONIC SINUSITIS
- Nasal obstruction - Post nasal drip - Chronic cough - Loss of smell/unpleasant breath - NO sinus pain dull constant HA #difficult to differentiate from common cold/allergy - Antihistamines make cough worse

MASSAGE - Allergic fine ACUTE/CHRONIC caution if painful/purulent discharge - CONTRA in fever - Helpful in mechanically moving blockages

TONSILITIS
infection/inflammation of tonsils strep infection sever sore throat, fever, HA, malaise difficulty in swallowing earache, enlarged lymph nodes of neck

MASSAGE = CONTRA in ACUTE stage DYSPENEA DYSPHONIA DYSPHAGIA Shortness of breath Loss of voice Difficulty in swallowing

#NOTE: Self-limiting D = a disease that follows a temporary course & usually resolve or come to an end on their own without medical intervention

SKIN DISORDERS
# NOTE = questions will be match/match skin disorders

TINEA - Ringworm

Infection due to direct contact with infected - person - animal - clothes - shower floor Moist conditions (fungus) CLASSIFIED BY LOCATION ON THE BODY Body, skin (not the face, scalp etc.) - spread by scratching - cats, dogs CIRCULER RINGWORM LESIONS

TINEA CORPIS

TINEA CRURIS Jock itch

Hot humid weather - vesicular patches red line demarcation

TINEA PEDIS athletes foot

Between the toes nails, soles of feet - 2nd bacterial infection common Fissured vesicles

TINEA CAPITIS

Scalp & hair - Scaly, itchy scalp, bald spots

TINEA UNGUIM

Nails -

Yellow brown accumulations

TINEA MANUS

Hand - Clusters of itchy dry scaling lesions or clear vesicles Beard, moustache

TINEA BARBAE

Tx: topical antifungals (tea tree) for long period as infections commonly reoccur MASSAGE Locally contraindicated infection spreads by contact

HERPES
Spread by contact with skin - Establishes itself in sensory nerve ganglion - Remains latent between episodes of lesions - Reoccurrence may be due to stress, immune response - Infection in 1 area does not result in immunity in others - 6 types = HSV-1, HSV-2, HHV-6 Cytomegalovirus (cold like symptoms) Varicella-Zoster (shingles/chicken pox) Epstein-Barr (glandular fever)

HERPES SIMPLEX 1 (Oral Herpes)

Oral herpes cold sores - HVS 1 - Around the mouth - sensitivity, mild burning before onset MASSAGE = CONTRAINDICATED Genital herpes - Microbe - Painful itchy weeping blisters on genitals - Extremely contagious ACTIVE - Sexually transmitted - Systemic fever, enlarged lymph glands in groin Outbreak of painful vesicles around nail bed - Health workers susceptible i.e. hairdressers MASSAGE = if client has localised infection avoid the area Shingles - Remains dormant in a person exposed to the chicken pox - Reactivates along dermatomes (area of skin supplied by single spinal nerve) - Itchy painful vesicles - Contact with contagious fluid in vesicles may cause chicken pox MASSAGE = avoid massage during ACUTE stage, be aware they may be on pain killers (see contras for pain medication)

HERPES SIMPLEX 2 (Genital Herpes)

HERPES WHITLOW

HERPES ZOSTER (Shingles)

WARTS Human Papilloma Virus (HPV) - Causes common skin warts, planter, (plane) flat warts & genital warts - Benign neoplasms that produce extra keratin - Spread by direct contact = through break in the skin - Auto-inoculation
Grow on soles of feet - May be large & painful

PLANTER WARTS

COMMON WARTS

Multiple growths of irregular cauliflower shaped lesions

HPV

Genital warts - risk of malignant transformation of genital warts to cancer (females) MASSAGE = CONTRA locally with skin warts, as virus is found in shedding skin

NON CONTAGIOUSE SKIN DISORDERS

ATOPIC ECZEMA (asthma on the inside) GENETIC = family history High levels of IgE often present Scratching edema serous discharge crusting & risk of infection High incidence of cataracts

MASSAGE = CONTRA if skin inflamed OK if skin dry & flaky # inform client to have shower after massage to remove oil & prevent infection

ALLERGIC CONTACT DERMATITIS

delayed hypersensitivity (TYPE IV) - Intense pruritus (itching) - Edema - Red rash of varying papules & vesicles may lead to dry scaly or oozing lesions - Scratching may cause 2nd infection - PATCH TEST

IRRITANT CONTACT DERMATITIS

NON immunological inflammation of skin - Causative agents strong alkalis, acids, salts

SEBORRHEIC DERMATITIS (Cradle Cap)

Idiopathic - Scalp, eyebrows, eyelids, ear canals. Nasal folds, chest & back, axilla - Lesions appear from infancy - Scaly whitish, yellowish inflammatory plaques with mild itchiness

MASAGE Caution when using oils especially essential oils (EO) - Take thorough Hx of dermatitis & allergies

STASIS DERMATITIS

Occurs in legs due to poor venous return of blood & edema - Associated with varicose veins, vascular trauma, phlebitis (infection) - Erythema - Dry skin, scaling, itchiness - Petchiae - Hyperpigmentation of the skin - Lesions may become ulcerated ankles & tibia (less blood flow) MASSAGE PROM provided no infection - Direct contact CONTRA if vascular damage or open lesions - Great prophylaxis if past history with no current s/sx

PSORIASIS
Chronic recurrent skin disorder - Genetic link Characterised by varying sizes of well demarcated, silvery, scaling papules & plaques Immune component = excess T-cell stimulation causing inflammation response & cell production Environmental factors = infection, local trauma, smoking, UV light, alcohol Replication of skin cells occurs to rapidly initially small red papules into larger lesions

MASSAGE - CONTRA in ACUTE phases, otherwise OK if skin is not open infection

GENERAL CONSIDERATIONS FOR MASSAGE & SKIN DISORDERS

Be sensitive self-esteem issues LOCALT CONTRAINDICATED = Non-infectious skin D if inflammation present Scaly, flaky akin has risk of 2nd infection advice client to remove oil thoroughly (eczema, psoriasis, dermatitis) Open wounds CONTRA may become infected (school sores, ulcer) Infectious skin disorders CONTRA locally = contagious x contamination (tinea, warts, thrush) SYSTEMIC all massage CONTRA (herpes) Watch for fever, chills malaise

CARDIOVASCULAR SYSTEM
#NOTE - complications, part of the body affected, what they have

ARTERIOSCLEROSIS
Tx = Hardening of arterial walls loss of elasticity Part of normal ageing process Arteries become hard due to calcification Affects Tunica Media Tunica Intima Vasodilators (if due to old age) Adequate rest, exercise Stress avoidance TX = MASSAGE - Beneficial in initial stages to blood flow - CONTRA advanced - Unsure refer/obtain medical clearance - Beware of underling cause & treat accordingly (hypertension, diabetes)

ATHEROSCLEROSIS (Atheroma)
Plaque build-up in the arteries (thickening) Disease process not part of ageing process Arteries become blocked with lipid laden plaques Affects Tunica Intima Tunica Media

Directed at complications, heart failure, stroke, angina Cholesterol (lipid lowering)drugs

MASSAGE - Impossible to know if client has subclinical build-up of plaques if they can manage physiological changes caused by massage i.e. fatigued, weakness, nausea OK - As per complications stroke, hypertension - Beware medications - side effects e.g. aspirin, warfarin, Lipitor - Ask if received massage before & how they felt after, since onset of D - Unsure medical clearance

RAYNAUDS D
Spas am of the arterials in the extremities - Organic change in fingertips small ulcers - Bilateral - Cold burning pain - Exposure to cold - Disease in own right - idiopathic MASSAGE -

RAYNAUDS PHENOMENON
2nd to other causes i.e. Atherosclerosis, DM CT D lupus Long standing = organic changes in the vessel, trophic skin changes, gangrene

CARPEL TUNNEL SYNDROME (CTS)

compression of the median nerve in the CT Usually no organic change in fingers Usually unilateral Hot burning pain Genetic, RSI

MASSAGE With caution, cause needs to be determined CTS due to subluxation respond well to massage/traction CTS due to fibrosis no benefit

blood flow to periphery SNS stimulation which relaxes smooth muscle of blood vessel walls No heat/cold to affected areas if client having intense spasms Avoid stimulating techniques (trigger to SNS) Deep tissue work CONTRA if health of tissue is compromised by blood flow

RAYNAUDS PHENOMENON UNDRLYING CASUES DETERMINE TREATMENT

If massage recreates symptoms STOP

INTERMITNAT CLAUDICATION Obstruction of arterial blood flow in iliofemoral vessels pain with ambulation (movement)

MASSAGE CONTRA locally = work above blockage as condition predisposed to emboli May be on anticoagulants communicate with client regarding pressure bruise easily

DEEP VEIN THROMBOSIS (DVT) Thrombus formation in 1 of the deep veins most commonly the iliac & femoral veins - General anaesthetic, pregnancy, local trauma, smoking CLINICAL MANIFISTATIONS - Tenderness(deep calf), pain soreness while walking - Edema - Local warmth, skin discoloration - Prominent superficial veins Tx - Medical emergency = pulmonary emboli may develop VARICOSE VEINS blood pooling in superficial veins (saphenous vein longest) - Becomes elongated, dilates & tortuous incompetent valves reversing flow - Associated with valvular dysfunction - Progressive & incurable CLINICAL MANIFESTATIONS - Aching - Fatigue - Heat/pain relieved by elevating leg, compressed stockings Tx - Light weight compression stockings - Avoid long periods of standing - hydrotherapy MASSAGE CONTRA locally for veins that are elevated, visibly distorted work proximal with light techniques Very light pressure to surrounding tissue, if only slightly darkened, not elevated or causing pain Ask client degree of discomfort, ask if had leg massage MASSAGE Medical emergency CONTRAINDICATED as area is painful/tender May dislodge thrombus Medical clearance if being treated with anticoagulants Communicate with client regarding pressure

IDIOPATHIC TELANGIECTASIA - SPIDER VEINS Fine intracutaneouse angiectases (dilation of venules) - No serious consequences but may be extensive & unsightly - Idiopathic - Asymptomatic, may have burning sensation or pain Tx - Hypertonic saline 23.4% THROMBOSIS = Blood clot EMBOLISIM = Traveling blood clot i.e. foreign body TACHYCARDIA = Excessive heart rate ARRHYTHMIA = irregular heart beat DYSRHYTHMIA = abnormal cardiac rhythm HYPOTENSION = low BP MASSAGE Safe to massage most times unless client experiencing discomfort Be sensitive

HEMATOLOGICAL DISORDERS
HEMOSTASIS
Vessel damage Platelets adhere to damaged area Chemicals released to attract more platelets CASCASDE pile up of platelets Feedback ends with clot formation 1. Vessel spasm constriction of vessel to blood flow 2. Formation of platelet plug 3. Blood coagulation formation of fibrin clot 4. Clot retraction pulls edges together 5. Clot dissolution activation of plasma dissolves clot blood flow resumes healing Positive feedback system = an unusual event changes that result progress in the same direction cascade effect, ends when clot is formed

Bleeding Disorders
THROMBOCYTOPENIA
NO of circulating platelets spontaneous bleeding from small blood vessels small purplish blotches Due to /suppression/destruction of bone marrow (cancer etc.)

IMPAIRED LIVER FUNCTION

inability to produce pro-coagulation factors severe bleeding cause range from antibiotics to a baby, vit K deficiency, hepatitis, cirrhosis

HEMOPHILLA

genetic disorder results in absence of certain coagulation factors Minor trauma can lead to bleeding into tissues life threatening MASSAGE STRICTLY CONTRINDICATED

ANTICOAGULANTS & MASSAGE Affects blood ability to clot risk of severe bleeding 3 GROUPS - inhibits production of certain clotting factors i.e. warfarin - thrombin inhibitors i.e. heparin - Anti-platelet drugs prevent aggregation i.e. aspirin

MASSAGE Bleeding/ bruising most common side effects, check with client & adjust pressure accordingly Other side effects may mimic typical presentations i.e. back pain, HA Keep in mind especially if client is not getting any permanent relief

MECHANISIMS

ANEMIA
O2 carrying capacity of blood due to RBC, HCT or Hb content Not a disease in own right, usually 2ndry BLOOD LOSS Acute = bleeding from injuries, childbirth Chronic = blood loss more rapid than can be replaced i.e. peptic ulcers, cancer, heavy menstrual bleeding DEFICIENT ERYTHROPOIESIS - Many etiologies - Imp[aired erythropoiesis abnormal RBC size/shape - Iron deficiency, aplastic anaemia, vit B12 deficiency EXCESSIVE HEMOLYSIS - Premature RBC destruction - Bone marrow hyperactive number of reticulocytes Intrinsic = abnormalities of RBC - Membrane abnormalities - Metabolic disorders - Sickle cell disease Extrinsic = autoimmune- mismatched blood transfusion - Parasitic - Virus - Bacteria CLINICAL MANIFESTATIONS - Fatigue, Lethargy - Pallor of skin - Dizziness, HA Depression, heart palpitations

FE DEFICIENT ANEMIA
Most common type of anemia Hypo chromic, microcytic anemia - Inadequate intake of FE - Poor absorption of FE - Slow blood loss (heavy period)

CLINICAL MANIFESTATIONS - Glottis - Pica desire to eat non-food substances i.e. ice, glue, dirt

FOLIC ACID DEFICENT ANEMIA Poor diet low in green leafy vegetables, legumes Excessive Alcohol intake -

Git symptoms diarrhoea, smooth painful inflamed tongue Increase green leafy vegies Folic acid tablets

B12 DEFICAN T ANEMIA

Diet vegans Gastrectomy Intestinal bowl disease Lack of intrinsic factor Neurological symptoms clumsiness, coordination, muscle spasm Change diet, B12 injections

APLASTIC ANEMIA Bone marrow failure disturbance involving proliferation of stem cells caused by radiation, toxins, tumours

Platelets, RBC, WBC not made - RBC anemia WBC susceptible to infections Platelets abnormal bleeding

Tx = bone marrow transplant

MASSAGE May bruise easily, need to communicate with them about this Check with client underlying cause, may have other treatment implications CONTRA locally for bleeding ulcers/deep wounds Check with client about deep abdominal massage during menstruation or endometriosis, fibroids Client has menorrhagia - client should seek medical advice to cause (endometriosis etc.) More susceptible to infection clean conditions If profound massage may fatigue client

POLYCYTHAEMIA abnormally RBC mass Excessive use of diuretics dehydration Heart & lung disease, smoking haematocrit

THROMBOCYTOPENIA = IN PLATLETS GLOTTIS = Opening between vocal cords at upper part of larynx

GIT DOSRDERS
GASTRITIS
Inflammation of gastric epithelium can be acute, chronic, erosive or non-erosive or mucosa may be atrophic Causes - Infective gastroenteritis - bacterial (H. Pylori most common, viral, fungal) - Autoimmune - Age related changes (atrophic) ACUTE - Sudden onset - Usually short duration - prognosis depends on cause - Anorexia - Pain/ tenderness over epigastric region - Persistent vomiting systemic electrolyte changes CHRONIC - Usually asymptomatic - May lead to pernicious anemia (intrinsic factor deficiency) if mucosa is atrophic - May be precursor of peptic ulcer/ gastric cancer MASSAGE - Cause should be determined contraindicated if infection present - could be contagious, radiotherapy (cancer), caustics (medical emergency) - CONTRA locally - Irritation due to NSAID, aspirin, alcohol - CONTRA locally If client is anemic may bruise easy

GASTRIC ULCERS

DUODENAL ULCERS

Stomach H. Pylori responsible for 70% in HCA Pain food occurs with eating weight Vomiting

Duodenum Epigastric region Pain eating, milk or alkali weight Blood in Stool

MASSAGE Contraindicated locally

CHOLECYSTITIS
inflammation of the gall bladder Obstruction (e.g., gallstone or tumor) Obesity and high calorie/cholesterol diet Chills and fever Nausea, vomiting, belching, indigestion (especially after eating fatty foods) -

CHOLELITHIASIS
Formation of gallstones (biliary calculi) May be 1 stone/ several hundred, large or small Gallstones made up of cholesterol, bilirubin, calcium May be asymptomatic or small stones may enter cystic duct obstruction of the bile duct inflammation, pain

CLINICAL MANIFESTATIONS - Pain under right ribcage - radiates to right shoulder - around the back due to contraction of inflamed gallbladder

MASSAGE - Not in an attack - Local caution - Costal angle on the right side in a person with known cholecystitis/lithiasis Right shoulder pain/ pain radiating around to back between scapulae may be only signs of attack massage will not make this better - REFER

ENDOCRINE DISORDERS
HYPERTHYROIDISM (overactive)
Underweight appetite Heat intolerance Warm moist skin Palpitations/tachycardia Heyperflexia Thyroid storm Agitated, irritable, insomnia Restless Shorter lighter menstrual period -

HYPOTHYROIDISM (underactive)
Overweight appetite Cold intolerance Dry skin Bradycardia (enlarged heart) Hyporeflexia Myxoedemic crisis Depressed Lethargic, slowed thinking Heavy menstrual period

CAUSE - Graves disease bulging eyes, dermopathy (red hands), Goiter - Cancer of thyroid MASSAGE - Customise massage according to clients complaints - Light draping, leave arms & legs uncovered with a cool wash cloth placed on forehead or across base of neck to prevent overheating client - If client has Graves dermopathy use an emollient cream (coco or shea butter)to soften skin - Perform massage in supine or side lying position if client uncomfortable laying prone - Ask about vitality & sensitivity to presser - Be sure to address other associated conditions i.e. goiter, anemia in treatment plan

CAUSE - Low iodine - Vit A, E & zinc deficiency - X-ray radiation MASSAGE - Gentle relaxing massage, with time to rise from the table slowly & change positions gradually - May be more vigorous if client is feeling up to it - Cold intolerance need extra draping &warm room to keep them comfortable - Dry skin responds well to massage oil - Shorter session so as not to over fatigue - Goiter carful prone position to avoid pressure on site - Be aware of other conditions i.e. anemia, arteriosclerosis when applying pressure adjust accordingly & be aware of bruising

HYPERFUNCTION
Autoimmune stimulation Secreting tumours Idiopathic -

HYPOFUNCTION
Autoimmune inhibition Non-secreting tumours Surgical removal Ischemia, infarct Receptor defects

Most microscopic & asymptomatic Idiopathic Local expansion both neurologic & secretory dysfunction (removed only if it causes other symptoms

PRIMARY ADENOMA
Slow benign growing tumour of anterior pituitary

ENDOCRINE MANIFESTATION - Hyposecretion of anterior pituitary hormones - Decreased GH - Decreased LH & FSH menstrual irregularities - Decreased libido - Decreased TSH hypothyroidism - Decreased ATCH hypocortisolism (Cushings syndrome) exposure to high levels hormones NEUROLOGIC MANIFESTAION - HA, fatigue, neck pain, seizures - Pressure on optic chasm - Infiltration of other cranial nerves respective function affected proximity

MASSAGE - Will neither help or hurt Cautions as per clinical manifestations i.e. thyroidisim

GENITOURINARY DISORDERS
Occur sue to bacteria in the valve tiny bits of faeces enter urethra during unprotected anal sex, STD or toilet splashback Men less susceptible to UTIs as womans urethra shorter than males easier for bacteria to get into bladder (urethra closer to anus) E.coli, pseudomonas

URINARY TRACT INFECTIONS

Bacterial infection anywhere in the urinary tract, deposited by bloodstream or ascends up urinary tract -

MANIFESTAIONS

CYSTITIS

MILD = Perineal pain, tenderness, fever, Dysuria = painful urination

- Suprapubic & lower back pain SEVERE = GI symptoms, renal papillary necrosis, ARF, oedema, hematuria, pyuria (WBC in urine)

MASSAGE CONTRA fever may make client feel worse

NON-BACTERIAL CYSTITIS - URETHRAL SYNDROME

Symptoms of cystitis with negative urine cultures Inflamed/infected Para urethral glands female prostate [PSI] Frequency, dysuria, urgency

NON-BACTERIAL CYSTITIS - INTERSTITIAL CYSTITIS

Inflammation & fibrosis of bladder wall accompanied by hemorrhagic ulcers Idiopathic - Autoimmune suspected Deranged bladder wall make it more permeable to infection Bladder fullness, frequency, urine volume, lower abdominal pain

MASSAGE Contraindicated = Not in acute and/or infection

Dysuria = difficult, painful urination Haematuria = blood in urine Pyuria = WBC in urine

DISORDERS OF THE REPRODUCTION SYSTEM PRIMARY/SPASMODIC DYSMENORRHEA

Menstrual pain, uterine in origin, occurs 1st day of menstruation, associated with ovulatory cycles Not a disease Symptoms start a few years after menarche (with ovulation) some have painful periods from onset Idiopathic may be related to prostaglandin synthesis causing in uterine contraction Pain, Cramp like or colicky Referred to dermatomes T10-L1 (low abdomen, genitals, lower back, inner thigh Relieved by 1st pregnancy - cervix softens HA, nausea MASSAGE (Primary) Locally contraindicated (abdo massage) during 1st 2 days of menstruation or until pain subsides - (Secondary) Ok when it is not linked to a pathology that contraindicates massage - Contraindicated on days when bleeding is heavy

SECONDARY DYSMENORRHEA
Dysmenorrhea related to a specific cause i.e. Endometriosis, Fibroids, PID (Pelvic Inflammatory Disease) , or IUD

FIBROIDS
Single or multiple, hard spherical uterine tumors, ranging in size from ,consisting of muscle & fibrous connective tissue Found: - Subserous under parametrium - Intramural within uterine wall Submucous under endometrium Ultrasound, CT, MRI

Usually occurs in about 1/3 of women over age of 35 Asymptomatic Increased menstrual flow Colicky uterine pain Obstructive symptoms & signs Distended abdomen, Aching pain Urinary frequency (pressure on blood) Varicose veins Dull dragging ache during menses Anemia (if blood loss heavy)

MASSAGE - Deep abdo massage CONTRA locally for large diagnosed tumours - Most tumours small/asymptomatic = massage Ok Ensure client comfort(pillow positioning) pressure on abdomen may cause pain

ENDOMETRIOSIS
Presence of functional endometrial tissue located either myometrial or extra uterine - ovaries, ducts, ligaments, colon, cervix, bladder, umbilicus laparoscopy -

Idiopathic - genetic possibility Broad spectrum Asymptomatic even when quite extensive Severe pain during heaviest flow, Worsens over years Abnormal menstruation General malaise Intestinal or uterine obstruction Hematuria (blood in urine) Can mimic acute appendicitis when cyst bursts May cause infertility

MASSAGE - Work with client closely check stage & condition, s/sx - Severity may not be indicative s/sx depending on where endometrium is lodged i.e. abdominal organs, small/large bowl (may cause constipation light massage may be useful use caution) - Usually not during menstruation - Ensure client comfort (pillow positioning) if bloated or abdomen pain

MENOPAUSE
Reduced endogenous estrogen may lead to: The Cessation of periods, not a disease but a stage - Psychological, emotional instability of life when menses stop abruptly or gradually, may symptoms occur due to premature ovarian failure probably Nervousness, irritability, depression autoimmune or due to removal of ovaries occasionally suicidal tendencies; insomnia Tremor, hot flushes, cold sweats - Blood test estrogen, FSH & LH Obesity onset or exacerbation Hair growth upper lip, chin Osteoporosis occurs in shortly after menopause Osteoarthritis worse in obese

MASSAGE - Client may be prone to hot flushes during or after massage due to blood circulation &BMR - Ensure client comfort, if suffer from bloating (pillow positioning) - Massage may help elevate emotional symptoms, intensity & duration of hormonal HA, aide lymphatic draining due to fluid retention - May be particularly sensitive be a good listener - As per clinical manifestations

CARCINOMA OF THE CERVIX

Most common genital tract neoplasm. Squamous cell origin

Pap Smear, colposcopy, cone biopsy If pap smear comes back positive 2nd test usually taken

Related to intercourse with early first coitus, marriage, childbirth Herpes simplex II virus HPV virus (16 & 18) Age getting younger (younger age of girls having intercourse) Bleeding after intercourse Unexplained vaginal spotting/ bleeding often after urination - foul vaginal discharge Pelvic pain, leakage of urine or fecal matter from vagina Weight loss, anorexia, bone metastasis (pain more advanced symptom)

MASSAGE - Depending on type of cancer & physical state of client techniques may have to be modified Pressure, speed of stokes may have to be so as not to fatigue i.e. induce pain, flu like symptoms, bruising - Discuss risks & benefits - Dr permission/recommendation - Treatment goal is to help client to feel relaxed, energetic and nurtured

BREAST CANCER
Neoplastic disease of breast tissue - can effect men & women

Mammogram Aspiration Biopsy

Any age - rare before 30 Prognosis poor in men - spreads more quickly due to smaller amounts of breast tissue Less likely in women who were pregnant (carried to term) in their teens Lump in the breast (skin or breast wall) Occasionally prickling pain associated Occasionally discharge Signs and symptoms of lymphatic spread

MASSAGE - Depending on type of cancer & physical state of client techniques may have to be modified - May have local edema due to lymph gland removal/blockage treat proximally with drainage techniques Scar tissue may be present along rib cage/pectoral region (due to radiation treatment)be sensitive
Note - May suffer from lymphedema after tx

BENIGN PROSTATIC HYPERPLASIA (BPH)

Enlargement of prostate which is not malignant or inflammatory S/sx Tx Flomax (may interact with hypertension medication/kidney function) Physical Exam Ultrasound Idiopathic - Age related Men < 50 years of age frequency, urgency & nocturia (urinating at night) size & force hesitancy &intermittency Split stream/ dribbling Pain &/or hematuria from straining Urinary tract infections

PROSTATITIS
Acute or chronic inflammation of prostate which may or may not be due to infection Ix Urinalysis Blood test Common s/sx dysuria or burning, frequency & urgency If due to infection chills, high fever Perineal, low back pain Cystitis usually follows prostatitis in bacterial infection

MASSAGE (Prostatitis) Contraindicated in fever - Frequency/urgency are common, so client may need to go to toilet during treatment - Ensure client comfort (pressure on bladder, referred, lack pain, etc.,) Lower back pain sx of prostatitis, BPH & prostrate cancer may also be symptom of something else i.e. arthritis, muscle spasm if possible try to differentiate & treat accordingly

PROSTATE CANCER
Slow growing adenocarcinoma occurring usually in those > 50 years of age. Idiopathic but suspected to be hormone related Ix - Physical exam - Blood test - PSA (prostate specific antigen) NOTE: PSA can be elevated also in BPH &prostatitis - Biopsy

Can be asymptomatic but cause obstruction of bladder or ureters, hematuria, pyuria (WBC in the urine) Can spread to cause pain in the pelvis, ribs, or vertebrae

MASSAGE Depending on type & physical state techniques may have to be modified - Frequency/urgency common, client may need to go to toilet during treatment - Ensure client comfort (pressure on bladder, referred, lack pain, etc.,) Lower back pain sx of prostatitis, BPH & prostate cancer may be symptom of something else i.e. arthritis, muscle spasm if possible try to differentiate & treat accordingly -

CANCER
CANCER
All neoplasms are characterized by the loss of contact inhibition i.e., they no longer governed by regulatory influences that control normal cell growth & division

CELL DIFFERENTIATION Well differentiated - resemble normal cells Poorly differentiated - very little resemblance to normal cells Moderately differentiated - in between well differentiated & poorly differentiated Undifferentiated - do not resemble any cell of origin (anaplastic)

TWO CLASSIFICATIONS 1. Carcinoma - Malignant epithelial neoplasm invades surrounding tissue & metastasize to distant regions of body - Frequently develops in skin, large intestine, lungs, stomach, prostate, cervix, or breast - Tumor is firm, irregular, nodular, well-defined border 2. Sarcoma - Malignant neoplasm develops in CT, fibrous, fatty, muscular, synovial, vascular, neural tissue - May be highly invasive - manifests as a painless swelling - managed by (cutting out), post-operative radiotherapy - sarcomas of the extremities may require amputation - by irradiation, & combination chemotherapy

HOW CANCER SPREADS SEEDING - Invasion into a neighboring body cavity HEMATOGENOUS SPREAD - Usually sarcomas, but carcinomas can also spread through this pathway - arteries are less readily penetrated due to thicker walls than veins - cancer cells follow venous flow draining the site of the neoplasm i.e. liver & lungs

7 WARNING CLINICAL MANIFESTATIONS Change in bowel or bladder habits A sore that will not heal Unusual bleeding or discharge Thickening or lump in any location Indigestion or difficulty swallowing Obvious change in a wart or a mole Nagging cough or hoarseness

CLINICAL STAGING Physical findings Lab tests Imaging studies TNM (tumor, node, metastasis) staging system Biopsy

CANCER TREATMENT OPTIONS Risks vs. benefits Side Effects many & varied may include affects - GIT (nausea mouth ulcers) - bone marrow (decreased immunity) - hair (loss), skin (bruising) - reproductive tract (infertility) [depending on the therapy used] - May require to have other medication to combat side-effects -

MASSAGE BENEFITS - pain, stress levels, blood pressure (B.P.), muscle tension, fatigue anxiety, depression, nausea - natural killer T cell activity, may also improve sleep, neuropathy, mental clarity, alertness, quality of life, meaningful social interaction - Treatment goal to help client feel relaxed, more energetic, nurtured MASSAGE Depending on type of cancer, physiological state of client techniques MAY have to be modified Pressure, speed of strokes may have to be so as not to fatigue; induce pain, flu-like symptoms, bruising or a sense of invasiveness Discuss risks/ benefits with client Dr. permission/ recommendation worthwhile if unsure

POTENTIAL RISKS/ ISSUES Lymphoedema - if lymph nodes removed work gently, proximally Fragile Bones (some tx radiation, medication) or disease itself may cause fragility so caution with stretching or undue pressure Neuropathy - Certain chemo tx can cause long term paresthia in hands, feet so client may not be able to give appropriate feedback Immunocompromised - Ensure clean conditions & good health so client is not at risk MT needs also to be in good mental and emotional health to support client effectively

BENIGN
Well-differentiated lost ability to suppress genetic program for cell replication but retains program for normal cell differentiation Progressive, slow growing - may come to stand still or regress Grows by expansion

MALIGNANT
Mostly undifferentiated highly specialized cells only slightly undifferentiated can have severe consequences Erratic, fast growing but many exceptions to rule

Grows at the periphery by sending out processes

Does not infiltrate surrounding tissue Ability for metastasis - absent Tumor encapsulated - well demarcated borders Localized phenomenon does not usually interfere with vital functions - depends on location Does not usually cause damage unless location interferes with blood flow

Infiltrates & destroys surrounding tissue Ability for metastasis - present Lesions not encapsulated - irregular borders Can be systemic especially in late stages - often causes anemia, weight loss, weakness Usually causes extensive damage tumor out grows blood supply; encroaches on blood flow; may also produce toxins that cause cell damage Usually causes death unless growth is controlled

Absent unless its location interferes with vital functions

Cancer = Latin meaning crablike - cancerous growth spreads by sending crablike projections into surrounding tissues. Carcinogenesis = process of development of malignant cells from normal ones Carcinogens = substances, agents that cause development, or increase incidence of cancer Oncology = study of tumors Oncogenes = cancer-inducing genes Oncogenesis = genetic mechanism whereby normal cells are transformed into cancer cells