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Health Ass > Cancer > Flashcards

Cancer Flashcards

1
Q

Most common cancers

A

Lung (#2 in men, increasing in women)

Breast (#1 in women)

Colon/GI (#2 cause of death overall)

Prostate (#1 in men)

Head & Neck Metastatic tumors - brain, liver, spinal cord, superior vena cava compression

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2
Q

Pathological changes in hematologic system

A

Anemia: bone marrow suppression, GI ulcerations and anemia due to invasion Neutropenia Thrombocytopenia Hypercoagulable state: risk of thromboembolic event

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3
Q

What hematologic questions to ask pt?

A

have you been anemic infections do you bruise/bleed easily blood clots

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4
Q

Neuromuscular system pathologic changes

A

myofascial pain, peripheral neuropathies spinal cord compression

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5
Q

What neuromuscular questions to ask pt?

A

do you have numbness/tingling can you move all extremities do you have good strength are you in pain

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6
Q

Pulmonary system pathological changes

A

pulm edema/CHF recurrent pleural effusions (metastasis) pneumonitis pulmonary osteoarthropathy

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7
Q

Pulmonary osteoarthropathy definition

A

condition that affects some lung CA pts: clubbing spoon-shaped nails inflammation/swelling/pain of hands, fingers, knees, ankles

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8
Q

Squamous cell lung CA incidence and effect

A

25-40% hypercalcemia

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9
Q

Adenocarcinoma lung CA incidence and effect

A

30-50% hypercoagulable osteoarthritis

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10
Q

Large cell lung CA incidence and effect

A

10% gynecomastia

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11
Q

Small cell lung CA incidence and effect

A

15-24% inappropriate ADH secretion ectopic corticotropin secretion Eaton-Lambert syndrome (myasthenia syndrome)

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12
Q

Various pathological changes

A

anorexia/weight loss - hyperalimentation (artificial nutrients, typically IV) electrolyte abnormalities - hypercalcemia from bone metastasis Na & K changes from N/V/diarrhea adrenal insufficiency - tumors or corticosteroid therapy ectopic hormone production - from syndromes that release extra hormones (ADH)

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13
Q

Cardiac system pathological changes

A

malignant involvement of the pericardium (pericardiual effusions) electric alternans or paroxysmal A-fib/flutter pericardial tamponade (most common in lung CA) drug induced cardiomyopathy impairment of LVF for 3 years after therapy has stopped SVC obstruction - metastatic to mediastinum venous engorgement above waist: dyspnea, airway obstruction (especially when lying down) facial/neck edema, JVD

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14
Q

What cardiac questions to ask pt?

A

ask about exercise intolerance SOB recent echo manually feel pulse, look for JVD ask about masses

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15
Q

Renal pathological changes

A

decreased clearance drug induced nephrotoxicity/nephrotic syndrome ureteral obstruction - hydronephrosis hyperuricemia

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16
Q

Hepatic pathological changes

A

hepatocyte damage coagulopathies (hypercoagulable state in general) DIC common with hepatic metastasis

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17
Q

metabolic changes in CA pts

A

catabolic state: diarrhea poor nutritional status (check albumin, will affect protein bound drugs) volume depleted state - hypotension

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18
Q

Paraneoplastic syndrome incidence rate

A

8% of CA patients

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19
Q

Paraneoplastic neurologic changes

A

limbic encephalitis cerebellar degeneration myasthenia syndrome and gravis

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20
Q

Paraneoplastic endocrine changes

A

SIADH (headache, nausea, ataxia, lethargy, seizures) hypercalcemia Cushing’s syndrome hypoglycemia

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21
Q

Paraneoplastic renal changes

A

nephritis amyloidosis

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22
Q

Paraneoplastic other changes

A

fever cachexia dermatologic changes rheumatologic changes hematologic changes

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23
Q

Cancer staging

A

TNM T - tumor size 1-4 N - lymph node involvement 0-3 M - metastasis 0-no, 1-yes stage 1 best prognosis stage 4 worst prognosis

24
Q

Lung CA surgery considerations

A

associated CAD pulmonary insufficiency after tissue resection potential for massive blood loss special equipment (double lumen ETT)

25
Q

Lung CA surgery preop labs/testing

A

Pulm function tests DLCO VO2 max CXR ABGs baseline O2 sat cardiac stress test H/H, type and cross blood

26
Q

Head and Neck CA surgery considerations

A

review imaging to assess airway needs ask about dysphagia, difficulty breathing potential for significant blood loss (H/H, type and cross) lack of accessible airway, get special equipment hypercalcemia related to metastasis often heavy drinkers, get liver function test

27
Q

Breast CA surgery considerations

A

poor IV access limb at risk of lymphedema think about a PICC line

28
Q

Colon/GI CA surgery considerations

A

possible aspiration risk - give prophylactic meds (no Reglan) possible dehydration from GI obstructions - give preop fluids

29
Q

Prostate CA surgery

A

associated with increased bleeding

30
Q

Cancer treatment types

A

traditional - when you can’t differentiate between cancer and normal cells, increased cell death targeted - given for specific cell division process radiation - external beam, pellet/implant Ablation - thermo, microwave, cold, electric field therapy

31
Q

Doxorubicin & Daunorubicin adverse effects

A

dose related cardiomyopathy acute: 10% (benign and usually resolves in 1-2 months), disrhythmias, QT prolongation chronic/severe: 2%, progessive onset, 60% mortality in 3 weeks (unresponsive to mechanical/drug therapy) enhances myocardial depression with anesthetics acute LV failure during GA 2 months after cessation can develop years after having drugs - get an Echo

32
Q

Fluorouracil adverse effects

A

pericarditis angina coronary artery vasospasm ischemia related ECG changes conduction defects

33
Q

Bevacizumab, trastuzumab, sorafenib adverse effects

A

targeted therapy HTN vascular thromboembolic complications bleeding - must stop 4-8 weeks before surgery!

34
Q

Radiation to chest cardiac adverse effects

A

myocardial fibrosis pericarditis valvular fibrosis conduction abnormalities get EKG, CXR, stress test, ECHO, vital signs, BNP level

35
Q

Bleomycin adverse effects

A

anti-tumor antibiotic dose related toxicity, rare below 150mg/m2 pulmonary lymphomas, reproductive cancers pulmonary endothelial damage (looks like pneumonia, type 1&2 alveolar necrosis - pulmonary fibrosis Pulm hypertension increased A-a gradient induced hyperoxic pulmonary injury: free radical formation (don’t give 100% FiO2) Get PFT, CXR, ABG, SaO2, keep FiO2 < 30% colloid vs crystalloid, corticosteroids

36
Q

Methotrexate adverse effects

A

antimetabolite - toxicity 8% immunosuppressant drug (RA, Chron’s) and chemo drug fulminant non-cardiogenic pulmonary edema progressive inflammation with infiltrates, effusions, pulm. edema

37
Q

radiation to chest pulmonary adverse effects

A

interstitial pneumonitis, pulmonary fibrosis tracheal stenosis get O2sat, CXR, PFT, ABG

38
Q

Cisplatin adverse effects

A

alkaline chemo agent - dose limiting effect decreased GFR within 3-5 days renal insufficiency, hypomagnesemia ATN - acute renal failure requiring hemodialysis peripheral neuropathy

39
Q

Cyclophosphamide adverse effects

A

SIADH syndrome hemorrhagic cystitis (bladder bleeding) plasma cholinesterase inhibitor - succs will be prolonged

40
Q

Ifosfamide adverse effects

A

tubule dysfunction proteinuria, glucosuria

41
Q

High dose radiation renal effects

A

tumor cell lysis will release large amounts of uric acid, phosphate, potassium hyperuricemia - uric acid crystals precipitate in renal tubules - acute renal failure glomerulonephritis, glomerulosclerosis - chronic renal insuffiency, systemic HTN get BUN/Cr, urine analysis, phosphate and potassium levels

42
Q

Ca treatment hepatic adverse effects

A

Methotrexate - associated with acute liver dysfunction radiation - associated with sinusoidal obstruction syndrome (severe liver dysfunction) get liver function test, albumin levels

43
Q

Ca treatment airway/oral cavity issues

A

mucositis - from high dose chemo and radiation radiation - permanent tissue fibrosis limited mouth opening limited neck ROM limited tongue mobility tracheal stenosis pre - op airway assessment, cervical ROM, xray, ENT consult

44
Q

Ca treatment GI/Endocrine adverse effects

A

N/V/Diarrhea, enteritis common with chemo/radiation abd radiation can produce permanent adhesions and stenotic lesions on GI tract hyperglycemia from glucocorticoid therapy SIADH with cyclophosphamide, ifosfamide, cisplatin hypothyroidism from radiation to neck get thyroid function test, chem panel, glucose level, urine specific gravity

45
Q

Ca treatment hematologic system adverse effects

A

chemo: myelosuppression thrombocytopenia/platelet dysfunction tumors releasing procoagulants radiation: coagulation necrosis of vascular endothelium post radiation bleeding get CBC, PT/PTT, INR

46
Q

Ca treatment nervous system adverse effects

A

high dose Cyclophosphamide - acute delirium, encephalopathy, ataxia Methotrexate - dementia Vinea Alkaloids (Vincristine) sensorimotor peripheral neuropathy autonomic neuropathy - usually reversible cisplatin - dose dependent damage to dorsal root ganglia - large fiber neuropathy Alkylating Agents (Cytoxan) plasma cholinesterase inhibition anticholinesterase effects - succs is prolonged

47
Q

CA Nausea/Vomiting management

A

metoclopramide, droperidol, zofran provide reassurance that measures will be taken to control n/v

48
Q

CA pain management

A

will have increased requirements for analgesia opioids are drug of choice dilaudid vs fentanyl non-opioids? antidepressants/convulsants, maybe Ketamine nerve blocks - neurolysis corticosteroids adrenal insufficiency preop supplemental steroids

49
Q

Specific electrolytes to double check pre op

A

Na, K, Mg, and Ca if metastasis to bone

50
Q

Full list of pre op lab values and studies to check for CA patient

A

CBC - anemia, thrombocytopenia, neutropenia Coags - PT, PTT, INR Complete Metabolic Panel - with Mg, Ca, BUN/Cr, Albumin, glucose Liver function tests, AST, ALT ABG CXR 12 lead EKG ECHO Pulmonary Function Test

51
Q

What are you looking for in a CXR

A

tracheal deviation/compression masses aortic aneurysm cardiomegaly pulmonary edema pneumonia atelectasis chronic diseases

52
Q

What are you looking for in an EKG

A

A fib/flutter, heart blocks, ST-T changes anything indicating ischemia, infarct, recent PE, PV, PACs, LVH, RVH, WPW, prolonged QT, shortened PR interval, peaked T waves

53
Q

Primary location/Metastasis/treatment side effects

A

lung - oxygenation, cough, hemoptysis, wheezing, stridor, dyspnea, hoarseness mediastinum - SVC syndrome GI/Liver - metabolic/electrolyte/fluid changes Brain - headaches/seizures Throat/thyroid - dysphasia, stridor, hoarseness

54
Q

CA patient airway evaluation

A

tracheal deviation/compression SOB dyspnea dysphagia colon obstruction? (aspiration risk) will they need one lung ventilation?

55
Q

CA patient physical exam

A

breath sounds heart sounds airway exam jaundice? edematous? assess for IV insertion difficulty muscle weakness (myasthenia gravis like complications from ectopic hormonal release) fingernail clubbing

56
Q

Pre op correction of abnormalities

A

nutrient deficiencies - give IVF electrolyte abnormalities - EKG changes anemia - type and cross - watch for transfusion problems coagulopathies - increased risk of bleeding intraop

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