Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Principles > Anesthesia Implications r/t Oncology and Chemotherapy > Flashcards

Anesthesia Implications r/t Oncology and Chemotherapy Flashcards

1
Q

Form normal cells to cancer undergoes what chances

A

Numbers of cells increases vs. how cells are organized increases

normal-> hyperplasia-> dysplasia-> cancer

hyperplasia = extra cell growth but organized

Dysplasia = disorganization starts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cancer is a collection of _____ and what happens to the cells is ______

A

A collection of related diseases
Body cells that begin to divide without stopping and spread into surrounding tissues.
May form solid tumors or not (leukemias)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Generic causes of cancer

A

Inherited from parents
Mutations to DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cancer cells features (3)

A

Less specialized; easier to divide/ ignore apoptosis signals

Abnormally influence normal cells (angiogenesis)

Can evade the immune system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What increases/ speeds up cancer/ increases proliferation of cancer cells

A

Proto-oncogenes

Tumor suppressor genes

DNA repair genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Proto-oncogenes do what?

A

Involved in normal cell growth and division
Become cancer-causing…allow cells to grow and survive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Tummor supressor genes do what?

A

Alterations allow genes to divide uncontrollably

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DNA repair genes do what?

A

Incorrect damage repair; cause other mutations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Basal cell cancer

A

basal (base) layer of epidermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Squamous cell:

A

squamous cells (epithelial cells) that lie just beneath skin
Also line stomach, intestines, lung, bladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Adenocarcinoma

A

cells that produce mucous
Glandular tissue: breast, prostate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Sarcoma

A

bone and soft tissue
Such as osteosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Leukemia

A

begins in blood-forming tissue of the bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Lymphoma

A

begins in lymphocytes (T or B cells)
Build up in lymph nodes and lymph vessles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Absolute risk

A

How many people get “x” in a certain period
If 4 people out of a group of 100,000 get “x” then risk is 4 in 100,000

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Relative risk

A

% of people in exposed group with dz/ % of people in unexposed group with dz

RR>1: trait linked to ⬆️;

RR =1 trait not linked to dz;

RR < 1 trait linked to ⬇️ in dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Tumor staging

A

TNM;

T: size/extent of primary tumor
TX: tumor cannot be measured.
T0: tumor cannot be found.
T1, T2, T3, T4: Refers to the size and/or extent of the main tumor. The higher the number after the T, the larger the tumor or the more it has grown into nearby tissues.

N: # of nearby lymph nodes which are +
NX: cancer in nearby lymph nodes cannot be measured.
N0: no cancer in nearby lymph nodes.
N1, N2, N3: number and location of lymph nodes that contain cancer. The higher the number after the N, the more lymph nodes that contain cancer.

M: is there metastasis
MX:cannot be measured.
M0: has not spread to other parts of the body.
M1: has spread to other parts of the body.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Tumor staging is done when?

A

at diagnosis and not restaged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Localized staging

A

limited to place where it started; no sign of spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

in situ staging

A

abnormal cells are present but have not spread to nearby tissue (can be resected)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Regional staging

A

has spread to nearby lymph nodes, tissues, or organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Distant staging

A

spread to distant parts of body (metastasized)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Unknown staging

A

not enough information to figure out the stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cancer prognosis

A

Tools lack usefulness

Functional status and laboratory values more important than type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
median survival of 6 months or less
pt in bed > 1/2 the day serum calcium > 11.2 mg/dl DVT/PE 2 or more brain metastases SC compression w/ limited mobility maligant pericardial effusion Hetapic, bone, or adrenal metastases Recurrence of dz after chemo serum albumin < 3.5 mg/dl or wt loss > 10% in 6 month
26
Cancer metastasis
Breast, lung, kidney, and prostate Frequently radiate to bone (painful) Osteolytic, osteoblastic or both lesions Hormonal therapy often helpful Radiotherapy/chemotherapy NSAID +/- opioids Vertebroplasty?
27
Cancer pain originates______
invasion of tumor into tissues innervated by afferent neurons; Pleura, peritoneum directly invades nerve plexus
28
Does the cancer or the treatment cause pain?
Most pain is due to cancer itself not treatment
29
WHO “Cancer Pain Stepladder” (4)
Prompt administration On schedule; not prn Add antianxiety drugs as necessary 80-90% effective
30
Nerve blocks for cancer pain are done when?
Usually used when pharmacologic treatment fails Either persistent pain or excessive side effects
31
Reason for Nerve blocks for cancer pain
Decreases opioid usage but pain relief usually incomplete Mostly used with short life-expectancy
32
Celiac plexus block is used for what cancers? (3)
Unresectable pancreatic cancer, hepatic or gastric cancer
33
Celiac plexus block MOA and SE
Neurolysis sympathetic fibers of T5-T12 and parasympathetic celiac plexus fibers lysis is done with Alcohol/ destroys nerve fibers->pain relief 3-6 months Side effects of blocking celiac plexus: diarrhea and hypotension
34
Intercostal nerve block is done for what cancer?
For rib metastasis
35
What block can be done for a pelvic tumor?
Lumbar sympathetic ganglion
36
Principle benefit of Continuous catheter techniques (epidural or intrathecal) (2)
Decrease in systemic side effects Technique and equipment ubiquitous
37
Drawbacks from continuous epidurals/intrathecal
Limited duration of therapy d/t migration, granulomas, lack of homogenous drug distribution, infection rates No RCT’s…
38
Chemotherapy does what? (4)
Kill cancer cells Shrink tumors Prepare patients for bone marrow transplant Control overactive immune disease…lupus, RA
39
Chemotherapy targets what?
Target cells in different phases of cell cycle
40
Alkylating agents
Damage cell DNA-> Unable to reproduce Work in all phases of cell cycle Treat many types of cancers SE; Dose dependent leukemia 5-10 years after treatment
41
Alkylating agents that can cross the BBB
Nitrosoureas Ex: “platins”…cisplatin
42
Antimetabolites MOA
Interfere with DNA and RNA Act as substitute for normal building blocks
43
Antimetabolites are used to treat what?
Commonly treat breast, ovary, intestines, leukemias
44
methotrexate, 5-FU is what type of chemo drug?
Antimetabolites
45
Anti-tumor antibiotics MOA
Interfere with enzymes copying DNA Widely used for large variety of cancers
46
Anti-tumor antibiotics SE
Permanently damage heart in large doses Have life-time dose limits
47
“rubicins” Doxorubicin; bleomycin, Mitomycin-C are examples of what type of chemo drug
Anti-tumor antibiotics
48
Topoisomerase inhibitors treat what?
Treat leukemias, lung, ovarian, GI, colorectal, pancreatic
49
Plant alkaloids are what type of chemo drug? and MOA
Topoisomerase inhibitors Plant alkaloids; Prevent strands of DNA from being separated to copy
50
Topoisomerase inhibitors SE
Increase risk of a second cancer
51
Mitotic inhibitors MOA
Damage cells in all phases by preventing protein synthesis Treat many types of cancers
52
Mitotic inhibitors SE
May cause peripheral neuropathy
53
Targeted therapy
Drugs that use specific proteins or receptors on cancer cells Normal cells are not affected
54
Hormone therapy
Prevent body from making hormone Slow growth of hormonal tumors…breast, prostate, uterine
55
Immunotherapy
Drugs that boost immune system Better recognize cancer cells
56
Normal cells most likely to be damaged during chemotherapy
Blood forming in bone marrow Hair follicles Cells in mouth, digestive tract, and reproductive systems
57
Side effect of aprepitant (neurokinin-1 antagonist)
May inhibit hormonal contraceptives x 28 days
58
Marijuana and n/V with chemotherapy
Depressed CNS vomiting center More effective than phenothiazines (prochlorperazine or chlorpromazine) Decreases anesthetic requirements 15-30%
59
What to consider with peripheral vasculature in assessment
6x increase in embolic events ? Evidence current of DVTs
60
Head/neck cancers assessment
Hypothyroidism(Thyroid function test) Carotid artery disease (Auscultate for bruits, carotid doppler studies) Airway management issues
61
Chest wall or left breast assessment related to radiation
pericarditis, conduction abnormalities, cardiomyopathy, valvular abnormalities EKG and the stress test and/or echo as needed
62
Lungs, breast or mediastinal cancer/ radiation consider what complication?
radiation pneumonitis assess Oxygen sats, CXR, PFT’s if needed
63
Adriamycin SE
Cardiomyopathy
64
Bleomycin SE
Pulmonary toxicity keep them close to 21% because the oxygen makes them toxic
65
Cisplatin or vincristine SE
Peripheral neuropathy
66
Lab abnormalities r/t chemotherapy
Preoperative anemia, neutropenia, and/or thrombocytopenia hypercalcemia Adrenal insufficiency
67
Resection is a risk factor for what cancer concern?
Tumor recurrence Tumor cells can spread through circulation Minimal residual disease can remain behind Localized spread can occur via the lymphatic system
68
Causes of immunosuppression
Inflammatory response??? Surgical stress??? Effects of anesthesia ??? Administration of opioids???
69
Inflammation from tissue trauma and physiological stress
Occurs because of the Activate overexpression of COX2 genes Catalyzes prostaglandins and thromboxane from arachidonic acid Elevated levels promote cell survival and growth of cancer cells May suppress NK cells
70
Beta adrenergic receptors signaled by fight or flight response causes.......
receptors at sites of tumor growth and metastasis Upregulate biological activity of cancer cell types Driven by nerve fiber delivery of NE not blood delivery
71
Inflammation/ stress response can last for _____
weeks
72
meningionma
cancer in the tissue covering brain and spinal cord
73
Leading cause of cancer deaths in both genders
Lung cancer
74
Causes of lung cancer
Tobacco smoke…90% 3 decade lag time Asbestos Radon gas (uranium decay)
75
Types of lung cancer
Small-cell (SCLC) Non-small-cell (NSCLC)…..75-80% -Squamous -Adenocarcinoma -Large-cell Less common carcinoid, mesotheliomas
76
Small cell lung cancer originates where
Neuroendocrine in origin
77
Small cell lung cancer features
Considered metastatic on presentation Medical disease Staging is only ”limited” or “extensive”
78
Small cell lung cancer treatment
Chemotherapy Radiation of tumor and cranium (prophylactically) Always recurs and is resistant to further treatment
79
Side effects of SCLC
Hyponatremia (SIADH ) Hypercortisolism (Cushings disease) Lambert-Eaton syndrome
80
Lambert-Eaton syndrome
Called myasthenic syndrome Proximal lower limb weakness/fatigability Similar to myasthenia gravis but Improves with exercise Doesn’t improve with acetylcholinesterase inhibitors Extremely sensitive to non-depolarizing NMBDs
81
Carcinoid tumors features (3)
Neuroendocrine tumors Mostly benign 5 year survival > 90%
82
Carcinoid syndrome (usually caused by tumors of gut not lung)
Serotonin, histamine, tachykinins, kallikrein, prostaglandins.  Hemodynamic collapse…unresponsive to vasopressors Coronary artery spasm Treated with antagonists…octreotide/somatostatin Inhibits tumor growth, angiogenesis, and secretion of hormones from tumor
83
Non-small-cell (NSCLC) features
5 year survival 10% without surgery 40% with surgery
84
Squamous cell grow _____ but_____
Grow to a large size but metastasize late
85
Squamous cell Symptoms related to _____
mass effect; Hemoptysis Obstructive pneumonia Superior vena cava syndrome Endobronchial tumor
86
Most common type of lung cancer
metastasize early Brain, bone, liver, adrenals Chest wall, diaphragm, pericardium
87
Adenocarcinoma often secretes______ causing .......
Often secrete growth hormone and ACTH Insulin resistance…to diabetes Dyslipidemia Moon facies Buffalo hump Delayed wound healing Avascular necrosis of the femoral head Osteoporosis
88
Least common of NSCLC’s
Large-cell
89
Large-cell lung cancer features
Metastasize rapidly Large cavitating tumors
90
Assessment of patients with lung cancer
Mass effect Metabolic abnormalities Metastases Medications
91
Preopconsiderations for cancer pts
Care with sedation (ease off) Antisialogogue SCIP antibiotics Assess difficulty of lung isolation: CXR/CT Assess risk of hypoxemia during 1-lung ventilation
92
Factors Predicting 1-lung desaturation (3)
1. High % of ventilation or perfusion to the operative lung on preop V/Q scan 2. Poor PaO2 during 2-lung ventilation 3. Right-sided thoracotomy
93
ppoFEV1 %
PPOFEV1 % = Preoperative FEV1% x (1-%functional lung tissue removed/100)
94
Post thoracotomy/thoracoscopy analgesia
Epidural Paravertebral blocks NSAIDS Opioids lowers ppoFEV1 if supressed or can be higher if they are pain free
95
indications for paravertebral block
Fractured ribs Benign/malignant neuralgia Lung contusions Major surgeries
96
Contraindications for paravertebral blocks
Infection at site Empyema Tumor in the paravertebral space Chest deformities (kyphoscoliosis)
97
Paravertebral blocks MOA
Block spinal nerves as they exist intervertebral foramen Lack fascia…more sensitive to LA Single shot covers 4-6 dermatomes
98
Paravertebral block for sternotomy, thoracotomy, and abd procedures
Level of block T4 for sternotomy T6 for thoracotomy T10 for abdominal procedures
99
Intercostal nerve block MOA
Innervates musculature of chest and abdominal wall Requires blockade of 2 dermatomes above and 2 dermatomes below incision
100
Indications for intercostal nerve block
Thorax and upper abdomen surgery Mastectomy
101
Disadvantages of Intercostal nerve block
Disadvantages Risk of pneumothorax LA toxicity with multiple levels of blockade
102
How to do a Intercostal nerve block
Identify spinous process, tip of scapula, angle of rib

Principles (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions