Patient/Client Assessment and Diagnosis
Assessment in oncologic physical therapy begins with knowing the diagnosis, histology, stage, grade, and current treatment phase, because these drive every downstream decision. Candidates must distinguish screening for metastatic disease from routine musculoskeletal examination. Red flags that demand physician referral before intervention include unexplained night pain unrelieved by rest, new neurologic signs (bowel/bladder change, saddle anesthesia, progressive weakness), unexplained weight loss, and a history of cancer with new axial pain.
Know the difference between local recurrence, regional nodal spread, and distant metastasis, and which tissues are common metastatic targets (bone, lung, liver, brain). Bone metastases are the classic exam trap: a patient with breast, prostate, lung, thyroid, or kidney primary and new focal spine or long-bone pain needs imaging before aggressive manual therapy or resistive loading.
Traps
- Assuming a benign label ("sciatica," "frozen shoulder") explains symptoms in a patient with cancer history.
- Missing paraneoplastic or treatment-related causes (steroid myopathy, chemotherapy-induced peripheral neuropathy) and attributing deficits to deconditioning.
- Confusing staging language: stage reflects anatomic extent; grade reflects differentiation.
Rule of thumb
If a new symptom in a patient with cancer history is progressive, night-dominant, or unexplained by mechanics, treat it as disease-related until proven otherwise and refer. Document the referral and hold provocation testing.
Worked example
A 58-year-old with treated breast cancer reports 3 weeks of thoracic pain worse at night, unrelieved by position change, with no trauma. Do not mobilize the thoracic spine. Screen neurologic status, refer for imaging, and continue only gentle functional mobility pending clearance.