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Health Assessment > Cancer > Flashcards

Cancer Flashcards

1
Q

Cancer is the ___ leading cause of death in US

A

second

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2
Q

Most common cancer types among genders?

A

Male

  • prostate
  • lung
  • colon

Female

  • breast
  • lung
  • colon
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3
Q

What can bleomycin cause?

A
  • Pulmonary hypertension
  • pulmonary fibrosis
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4
Q

What can cisplatin cause?

A
  • Dysrhythmia
  • magnesium wasting
  • mucositis
  • ototoxicity
  • peripheral neuroapthy
  • SIADH
  • Renal tubular necrosis
  • thromboembolism
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5
Q

What can cyclophosphamide (cytoxan) do?

A
  • Encephalopathy/delirium
  • hemorrhagic cystitis
  • myelosuppression
  • pericarditis
  • pericardial effusion
  • SIADH
  • pulmonary fibrosis
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6
Q

What can doxorubicin cause?

A
  • CMP
  • myelosuppression
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7
Q

What can fluorouracil cause (5FU?)

A
  • Acute cerebellar ataxia
  • ischemic and nonischemic EKG changes
  • CP
  • Gastritis
  • myelosuppression
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8
Q

What can methotrexate cause?

A
  • Encephalopathy
  • hepatic dysfunction
  • mucositis
  • plt dysfunction
  • hypersensitivity pneumonitis
  • renal failure
  • myelosuppression
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9
Q

What can tamoxifen cause?

A

thromboembolism

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10
Q

What can vincristine cause?

A
  • Autonomic dysfuction
  • MI
  • peripheral neuropathy
  • bronchospasm
  • SIADH
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11
Q

What was the picture to remember common chemo toxicities?

A
  • C= Cisplatin (aklyating agent)- acoustic n injury + nephrotoxicity
  • V= vincristine and vinblastine (tubulin binding drug_= peripheral neuropathy
  • B: bleomycin (antitumor antibiotic)= pulmonary fibrosis FIO2 <30%
  • D= doxorubicin(antitumoe antibiotic)= cardiotoxic
  • 5= 5FU (antimetabolite)- bone marrow suppression
  • M= Methotrexate (antimetabolite)= bone marrow suppression
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12
Q

Common adverse effects of radiation therapy? (Skin, GI, cardiac, resp, renal, hepatic, endocrine, hematologic)

A
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13
Q

Focuses of preop assessment for Ca patient?

A
  • Malignancy in head/neck
    • airway exam and possible need for trach
    • recurrent laryngeal n damage
  • Mediastinal masses obstructing great vessels
    • dyspnea, dysphagia, stridor, wheezing, coughing–> recumbent positon
    • compression of SVC–< JVD, Facial, chest , neck, UE edema
  • Preop testing: CXR, CT, MRI, EKG, Echo
  • Anesthetic concerns
    • airway cart
    • emergency suppy
    • trach
    • spontaneous awake intubation
    • ENT at bedside
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14
Q

What is SVC syndrome?

A
  • Obstruction of superior vena cava caused by spread of Ca into mediastinum or into caval wall
  • veins above level of heart, particularly with jugular veins and veins in arms, become engorged
  • edema of face and UE prominent
  • increased ICP manifests as nausea, sz, decreased LOC
  • May cause syncope
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15
Q

What is superior mediastinal syndrome?

A

combo of SVC syndrome and tracheal compression

  • HOrseness, dyspnea and airway obstruciton may be present b/c tracheal compression
  • txmt consist of radiation therapy or chemo
  • bronchoscopy/mediastinoscopy to obtain tissue dx can be hazardous
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16
Q

What to look for in airway assessment of Ca patient?

A
  • tracheal deviation or compression
  • SOB
  • dificulty breathing
  • dysphagia
  • cervical ROM, cervical Xray, ENT consult
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17
Q

What can radiation to head neck be concerning for?

A

permanent tissue fibrosis

  • carotid artery dx
  • hypothyroidism
  • difficult vent
  • difficult intubation
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18
Q

Special anesthesia preop consideration of head and neck ca?

A
  • Review imaging studies to determine if alternate airway mgmt plan should b eused
  • question pt regarding dysphagia and difficulty breathing
  • sx blood loss can be sig T&C, CBC
  • Lack of accessibility to airway during case
  • hypercalcemia related to METS
  • alchol induced liver dx
  • chornic smoking hx PFT, pulm toilet, inhalers
  • May need nutritional therapy preop
  • plan for difficult airway
  • may need invasive monitorign ie aline
19
Q

Concerns for geriatrics with ca?

A
  • Greater comorbidities, fraility, polypharmacy
  • risk of delirium
    • chemobrain- chemo induced cognitive dysfunction
20
Q

Education and prevention around sx with ca patient?

A
  • management of comorbidities
  • exercise routine prior to sx- improves surgical recovery and overall survivorship
21
Q

What is important question to ask Ca patient’s (regarding meds)?

A
  • Prior ca treatments and dates
    • long term s/e
    • acute s/e
22
Q

Concerns during assessment of CV system in Ca patient?

A
  • HR, pulse, carotid arteries
  • if bruits present-> ask patient to stop breathing 15 sec
    • if severe stenosis and large intraop fluid shifts are expected, revascularization is considered
    • mild stenosis= pharm therapy
  • sig fatigue and loss of functional status
    • echo ordered and result WNL may not mean much under stress of sx
  • Cardiac stress testing might be considered?
  • maybe BNP
23
Q

What is one drug that strongly affects CV system?

A

doxorubicin (adriamycin)

  • Acute/chronic
  • QT prolongation
  • dysrhythmia
  • ischemia-related EKG changes
  • HTN (monoclonal antibodies and tyrosine kinase inhibitors)
24
Q

Considerations for respiratoyr system assessment for Ca pt?

A
  • Baseline and serial PFT
  • Chest radiography
  • pleural effusion
  • bleomycin?
25
Q

What are some complications with adenocarcinoma? large cell lung Ca? small cell lung Ca?

A
  • Adenocarcinoma (30-50%)- blood clots
  • large cell- gynecomastia
  • small cell- muscle weakeness, paraneoplastic syndromes
26
Q

Which cancers are known for secreting ADH?

A
  • Duodenal
  • lung (small cell)
  • lymphoma
  • pancreatic
  • prostate
27
Q

Which cancers can secrete human chorionic gonadotropin?

A
  • Adrenal
  • breast
  • lung (large cell)
  • ovarian
  • testicular

causes gynecomastia, galactorrhea, precocious puberty

28
Q

Which Ca can secrete adrenocorticotropic hormone?

A
  • Carcinoid
  • lun g(small cell)
  • thymoma
  • thyroid

manifestation: cushing syndrome

29
Q

How can the renal system be impacted with cisplatin and cyclophosphamide?

A
  • Cisplatin (and methotrexate)
    • renal insuff– usually resolve with cessation of drug
  • Cyclophosphamide
    • SIADH
    • cystitis
    • medication concern: mivacurium, succinylcholine
    • renal labs
  • tumor cell lysis
    • uric acid crystal buildup
30
Q

How many days after chemo does nadir happen?

A

7-14 days

31
Q

What are some various neuro system implications with vincristine, coritcosteroid and radiation+ methotrexate

A
  • Vincristie- parasthesias, peripheral neuropathy, encephalopathy
  • corticosteroid- induced neuromuscular toicity (prednisone 60-100mg/day)
  • radiation +methotrexate–> irreversible dementia
32
Q

GI system consideration for Cancer patient?

A
  • Almost all chemo and radiation produce GI se
    • mucositis
    • n/v/d
  • electolyte imbalances, dehydration, malnutrition
  • radiation–> stenotic lesions throughout GI tract
    • sinusoidal obstruction syndome–> can be fatal
    • reactivation hep B
33
Q

Why are steroids used during Ca txmt?

A
  • Addition to chemotherapy regimen–> reduce inflammation, reduce N/V, boost appetitis
  • might unmask undx diabetes
  • might make known dm more difficult to tx
  • increase risk of adrenal insufficiency (suppression of HPY axis)
  • radiation to neck might alter thyroid function
34
Q

What is the multiple hit hypothesis for cancer deconditioning?

A
  • Chemo
  • radiotherapy
  • sx
  • cancer
  • age
  • medical comorbidities
  • sedentary lifestyle
  • cancer fatigue
35
Q

What are some preoperative considerations to optimize patient for sx?

A
  • Nutrient deficiencies
  • electrolyte abnormalities
  • anemia
  • coags
  • steroid replacement
36
Q

Common sites of mets for breast ca? prostate ca? lung ca? colon ca?

A
  • Breast ca–> bone
  • prostate ca–> bone
  • lung ca (Esp small cell)–> brain
  • colon ca–> liver
37
Q

What are you looking for on CXR for Ca patient?

A
  • Tracheal deviation or compression
  • masses
  • aortic aneurysm
  • fractures (ribs, clavicle, vertebrae)
  • cardiomegaly
  • pulmonary edema
  • PNA
  • atelectasis
  • chronic dx
38
Q

Spinal cord compresion in Ca?

A
  • urinary or bowerl incontinence
  • peripheral neuropathies
  • gait distubrances
39
Q

Cardiac tamponade s/s?

A
  • muffle heart tones
  • elevated JVD
  • distended neck veins
  • progressiv edyspnea
40
Q

Neutropenia sepsis s/s?

A
  • Low grade fever or none
  • cough
  • arthralgia
41
Q

CNS metastasis s/s?

A
  • HA
  • visual disturbance
  • balance and gait disturbance
  • confusion
  • n/v
42
Q

Tumor lysis syndrome s/s?

A
  • Elevated uric acid, K, phos level
  • often seen 12-72 hours post chemo tx for hematologic malignancy
    *
43
Q
A

Health Assessment (7 decks)

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