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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

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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)

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3
Q

Generic causes of cancer

A

Inherited from parents
Mutations to DNA

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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

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5
Q

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

A

Proto-oncogenes

Tumor suppressor genes

DNA repair genes

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6
Q

Proto-oncogenes do what?

A

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

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7
Q

Tummor supressor genes do what?

A

Alterations allow genes to divide uncontrollably

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8
Q

DNA repair genes do what?

A

Incorrect damage repair; cause other mutations

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9
Q

Basal cell cancer

A

basal (base) layer of epidermis

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10
Q

Squamous cell:

A

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

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11
Q

Adenocarcinoma

A

cells that produce mucous
Glandular tissue: breast, prostate

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12
Q

Sarcoma

A

bone and soft tissue
Such as osteosarcoma

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13
Q

Leukemia

A

begins in blood-forming tissue of the bone marrow

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14
Q

Lymphoma

A

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

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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

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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

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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.

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18
Q

Tumor staging is done when?

A

at diagnosis and not restaged

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19
Q

Localized staging

A

limited to place where it started; no sign of spread

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20
Q

in situ staging

A

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

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21
Q

Regional staging

A

has spread to nearby lymph nodes, tissues, or organs

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22
Q

Distant staging

A

spread to distant parts of body (metastasized)

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23
Q

Unknown staging

A

not enough information to figure out the stage

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24
Q

Cancer prognosis

A

Tools lack usefulness

Functional status and laboratory values more important than type

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25
Q

median survival of 6 months or less

A

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

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26
Q

Cancer metastasis

A

Breast, lung, kidney, and prostate

Frequently radiate to bone (painful)
Osteolytic, osteoblastic or both lesions
Hormonal therapy often helpful
Radiotherapy/chemotherapy
NSAID +/- opioids
Vertebroplasty?

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27
Q

Cancer pain originates______

A

invasion of tumor into tissues innervated by afferent neurons; Pleura, peritoneum
directly invades nerve plexus

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28
Q

Does the cancer or the treatment cause pain?

A

Most pain is due to cancer itself not treatment

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29
Q

WHO “Cancer Pain Stepladder” (4)

A

Prompt administration
On schedule; not prn
Add antianxiety drugs as necessary
80-90% effective

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30
Q

Nerve blocks for cancer pain are done when?

A

Usually used when pharmacologic treatment fails
Either persistent pain or excessive side effects

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31
Q

Reason for Nerve blocks for cancer pain

A

Decreases opioid usage but pain relief usually incomplete

Mostly used with short life-expectancy

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32
Q

Celiac plexus block is used for what cancers? (3)

A

Unresectable pancreatic cancer, hepatic or gastric cancer

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33
Q

Celiac plexus block MOA and SE

A

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

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34
Q

Intercostal nerve block is done for what cancer?

A

For rib metastasis

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35
Q

What block can be done for a pelvic tumor?

A

Lumbar sympathetic ganglion

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36
Q

Principle benefit of Continuous catheter techniques (epidural or intrathecal) (2)

A

Decrease in systemic side effects

Technique and equipment ubiquitous

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37
Q

Drawbacks from continuous epidurals/intrathecal

A

Limited duration of therapy d/t migration, granulomas, lack of homogenous drug distribution, infection rates
No RCT’s…

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38
Q

Chemotherapy does what? (4)

A

Kill cancer cells
Shrink tumors
Prepare patients for bone marrow transplant
Control overactive immune disease…lupus, RA

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39
Q

Chemotherapy targets what?

A

Target cells in different phases of cell cycle

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40
Q

Alkylating agents

A

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

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41
Q

Alkylating agents that can cross the BBB

A

Nitrosoureas

Ex: “platins”…cisplatin

42
Q

Antimetabolites MOA

A

Interfere with DNA and RNA
Act as substitute for normal building blocks

43
Q

Antimetabolites are used to treat what?

A

Commonly treat breast, ovary, intestines, leukemias

44
Q

methotrexate, 5-FU is what type of chemo drug?

A

Antimetabolites

45
Q

Anti-tumor antibiotics MOA

A

Interfere with enzymes copying DNA

Widely used for large variety of cancers

46
Q

Anti-tumor antibiotics SE

A

Permanently damage heart in large doses
Have life-time dose limits

47
Q

“rubicins” Doxorubicin; bleomycin, Mitomycin-C are examples of what type of chemo drug

A

Anti-tumor antibiotics

48
Q

Topoisomerase inhibitors treat what?

A

Treat leukemias, lung, ovarian, GI, colorectal, pancreatic

49
Q

Plant alkaloids are what type of chemo drug? and MOA

A

Topoisomerase inhibitors

Plant alkaloids; Prevent strands of DNA from being separated to copy

50
Q

Topoisomerase inhibitors SE

A

Increase risk of a second cancer

51
Q

Mitotic inhibitors MOA

A

Damage cells in all phases by preventing protein synthesis

Treat many types of cancers

52
Q

Mitotic inhibitors SE

A

May cause peripheral neuropathy

53
Q

Targeted therapy

A

Drugs that use specific proteins or receptors on cancer cells

Normal cells are not affected

54
Q

Hormone therapy

A

Prevent body from making hormone

Slow growth of hormonal tumors…breast, prostate, uterine

55
Q

Immunotherapy

A

Drugs that boost immune system

Better recognize cancer cells

56
Q

Normal cells most likely to be damaged during chemotherapy

A

Blood forming in bone marrow

Hair follicles

Cells in mouth, digestive tract, and reproductive systems

57
Q

Side effect of aprepitant (neurokinin-1 antagonist)

A

May inhibit hormonal contraceptives x 28 days

58
Q

Marijuana and n/V with chemotherapy

A

Depressed CNS vomiting center

More effective than phenothiazines (prochlorperazine or chlorpromazine)

Decreases anesthetic requirements 15-30%

59
Q

What to consider with peripheral vasculature in assessment

A

6x increase in embolic events
? Evidence current of DVTs

60
Q

Head/neck cancers assessment

A

Hypothyroidism(Thyroid function test)

Carotid artery disease (Auscultate for bruits, carotid doppler studies)

Airway management issues

61
Q

Chest wall or left breast
assessment related to radiation

A

pericarditis, conduction abnormalities, cardiomyopathy, valvular abnormalities

EKG and the stress test and/or echo as needed

62
Q

Lungs, breast or mediastinal cancer/ radiation consider what complication?

A

radiation pneumonitis

assess Oxygen sats, CXR, PFT’s if needed

63
Q

Adriamycin SE

A

Cardiomyopathy

64
Q

Bleomycin SE

A

Pulmonary toxicity

keep them close to 21% because the oxygen makes them toxic

65
Q

Cisplatin or vincristine SE

A

Peripheral neuropathy

66
Q

Lab abnormalitiesr/t chemotherapy

A

Preoperative anemia, neutropenia, and/or thrombocytopenia

hypercalcemia

Adrenal insufficiency

67
Q

Resection is a risk factor for what cancer concern?

A

Tumor recurrence

Tumor cells can spread through circulation

Minimal residual disease can remain behind

Localized spread can occur via the lymphatic system

68
Q

Causes of immunosuppression

A

Inflammatory response???
Surgical stress???
Effects of anesthesia ???
Administration of opioids???

69
Q

Inflammation from tissue trauma and physiological stress

A

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
Q

Beta adrenergic receptors signaled by fight or flight response
causes…….

A

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
Q

Inflammation/ stress response can last for _____

A

weeks

72
Q

meningionma

A

cancer in the tissue covering brain and spinal cord

73
Q

Leading cause of cancer deaths in both genders

A

Lung cancer

74
Q

Causes of lung cancer

A

Tobacco smoke…90%
3 decade lag time
Asbestos
Radon gas (uranium decay)

75
Q

Types of lung cancer

A

Small-cell (SCLC)

Non-small-cell (NSCLC)…..75-80%
-Squamous
-Adenocarcinoma
-Large-cell

Less common carcinoid, mesotheliomas

76
Q

Small cell lung cancer originates where

A

Neuroendocrine in origin

77
Q

Small cell lung cancer features

A

Considered metastatic on presentation
Medical disease
Staging is only ”limited” or “extensive”

78
Q

Small cell lung cancer treatment

A

Chemotherapy
Radiation of tumor and cranium (prophylactically)
Always recurs and is resistant to further treatment

79
Q

Side effects of SCLC

A

Hyponatremia (SIADH )

Hypercortisolism (Cushings disease)

Lambert-Eaton syndrome

80
Q

Lambert-Eaton syndrome

A

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
Q

Carcinoid tumors features (3)

A

Neuroendocrine tumors
Mostly benign
5 year survival > 90%

82
Q

Carcinoid syndrome (usually caused by tumors of gut not lung)

A

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
Q

Non-small-cell (NSCLC) features

A

5 year survival
10% without surgery
40% with surgery

84
Q

Squamous cell grow _____ but_____

A

Grow to a large size but metastasize late

85
Q

Squamous cell Symptoms related to _____

A

mass effect;

Hemoptysis
Obstructive pneumonia
Superior vena cava syndrome
Endobronchial tumor

86
Q

Most common type of lung cancer

A

metastasize early

Brain, bone, liver, adrenals

Chest wall, diaphragm, pericardium

87
Q

Adenocarcinoma often secretes______ causing …….

A

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
Q

Least common of NSCLC’s

A

Large-cell

89
Q

Large-cell lung cancer features

A

Metastasize rapidly

Large cavitating tumors

90
Q

Assessment of patients with lung cancer

A

Mass effect

Metabolic abnormalities

Metastases

Medications

91
Q

Preopconsiderations for cancer pts

A

Care with sedation (ease off)
Antisialogogue
SCIP antibiotics
Assess difficulty of lung isolation: CXR/CT
Assess risk of hypoxemia during 1-lung ventilation

92
Q

Factors Predicting 1-lung desaturation (3)

A
  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
Q

ppoFEV1 %

A

PPOFEV1 % = Preoperative FEV1% x (1-%functional lung tissue removed/100)

94
Q

Post thoracotomy/thoracoscopy analgesia

A

Epidural
Paravertebral blocks
NSAIDS
Opioids

lowers ppoFEV1 if supressed or can be higher if they are pain free

95
Q

indications for paravertebral block

A

Fractured ribs
Benign/malignant neuralgia
Lung contusions
Major surgeries

96
Q

Contraindications for paravertebral blocks

A

Infection at site
Empyema
Tumor in the paravertebral space
Chest deformities (kyphoscoliosis)

97
Q

Paravertebral blocks MOA

A

Block spinal nerves as they exist intervertebral foramen

Lack fascia…more sensitive to LA

Single shot covers 4-6 dermatomes

98
Q

Paravertebral block for sternotomy, thoracotomy, and abd procedures

A

Level of block
T4 for sternotomy
T6 for thoracotomy
T10 for abdominal procedures

99
Q

Intercostal nerve block MOA

A

Innervates musculature of chest and abdominal wall

Requires blockade of 2 dermatomes above and 2 dermatomes below incision

100
Q

Indications for intercostal nerve block

A

Thorax and upper abdomen surgery

Mastectomy

101
Q

Disadvantages of Intercostal nerve block

A

Disadvantages
Risk of pneumothorax
LA toxicity with multiple levels of blockade

102
Q

How to do a Intercostal nerve block

A

Identify spinous process, tip of scapula, angle of rib

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