Cancer Flashcards
Cancer is the ___ leading cause of death in US
second
Most common cancer types among genders?
Male
- prostate
- lung
- colon
Female
- breast
- lung
- colon
What can bleomycin cause?
- Pulmonary hypertension
- pulmonary fibrosis
What can cisplatin cause?
- Dysrhythmia
- magnesium wasting
- mucositis
- ototoxicity
- peripheral neuroapthy
- SIADH
- Renal tubular necrosis
- thromboembolism
What can cyclophosphamide (cytoxan) do?
- Encephalopathy/delirium
- hemorrhagic cystitis
- myelosuppression
- pericarditis
- pericardial effusion
- SIADH
- pulmonary fibrosis
What can doxorubicin cause?
- CMP
- myelosuppression
What can fluorouracil cause (5FU?)
- Acute cerebellar ataxia
- ischemic and nonischemic EKG changes
- CP
- Gastritis
- myelosuppression
What can methotrexate cause?
- Encephalopathy
- hepatic dysfunction
- mucositis
- plt dysfunction
- hypersensitivity pneumonitis
- renal failure
- myelosuppression
What can tamoxifen cause?
thromboembolism
What can vincristine cause?
- Autonomic dysfuction
- MI
- peripheral neuropathy
- bronchospasm
- SIADH
What was the picture to remember common chemo toxicities?
- 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
Common adverse effects of radiation therapy? (Skin, GI, cardiac, resp, renal, hepatic, endocrine, hematologic)
Focuses of preop assessment for Ca patient?
- 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
What is SVC syndrome?
- 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
What is superior mediastinal syndrome?
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
What to look for in airway assessment of Ca patient?
- tracheal deviation or compression
- SOB
- dificulty breathing
- dysphagia
- cervical ROM, cervical Xray, ENT consult
What can radiation to head neck be concerning for?
permanent tissue fibrosis
- carotid artery dx
- hypothyroidism
- difficult vent
- difficult intubation
Special anesthesia preop consideration of head and neck ca?
- 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
Concerns for geriatrics with ca?
- Greater comorbidities, fraility, polypharmacy
- risk of delirium
- chemobrain- chemo induced cognitive dysfunction
Education and prevention around sx with ca patient?
- management of comorbidities
- exercise routine prior to sx- improves surgical recovery and overall survivorship
What is important question to ask Ca patient’s (regarding meds)?
- Prior ca treatments and dates
- long term s/e
- acute s/e
Concerns during assessment of CV system in Ca patient?
- 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
What is one drug that strongly affects CV system?
doxorubicin (adriamycin)
- Acute/chronic
- QT prolongation
- dysrhythmia
- ischemia-related EKG changes
- HTN (monoclonal antibodies and tyrosine kinase inhibitors)
Considerations for respiratoyr system assessment for Ca pt?
- Baseline and serial PFT
- Chest radiography
- pleural effusion
- bleomycin?
What are some complications with adenocarcinoma? large cell lung Ca? small cell lung Ca?
- Adenocarcinoma (30-50%)- blood clots
- large cell- gynecomastia
- small cell- muscle weakeness, paraneoplastic syndromes
Which cancers are known for secreting ADH?
- Duodenal
- lung (small cell)
- lymphoma
- pancreatic
- prostate
Which cancers can secrete human chorionic gonadotropin?
- Adrenal
- breast
- lung (large cell)
- ovarian
- testicular
causes gynecomastia, galactorrhea, precocious puberty
Which Ca can secrete adrenocorticotropic hormone?
- Carcinoid
- lun g(small cell)
- thymoma
- thyroid
manifestation: cushing syndrome
How can the renal system be impacted with cisplatin and cyclophosphamide?
- 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
How many days after chemo does nadir happen?
7-14 days
What are some various neuro system implications with vincristine, coritcosteroid and radiation+ methotrexate
- Vincristie- parasthesias, peripheral neuropathy, encephalopathy
- corticosteroid- induced neuromuscular toicity (prednisone 60-100mg/day)
- radiation +methotrexate–> irreversible dementia
GI system consideration for Cancer patient?
- 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
Why are steroids used during Ca txmt?
- 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
What is the multiple hit hypothesis for cancer deconditioning?
- Chemo
- radiotherapy
- sx
- cancer
- age
- medical comorbidities
- sedentary lifestyle
- cancer fatigue
What are some preoperative considerations to optimize patient for sx?
- Nutrient deficiencies
- electrolyte abnormalities
- anemia
- coags
- steroid replacement
Common sites of mets for breast ca? prostate ca? lung ca? colon ca?
- Breast ca–> bone
- prostate ca–> bone
- lung ca (Esp small cell)–> brain
- colon ca–> liver
What are you looking for on CXR for Ca patient?
- Tracheal deviation or compression
- masses
- aortic aneurysm
- fractures (ribs, clavicle, vertebrae)
- cardiomegaly
- pulmonary edema
- PNA
- atelectasis
- chronic dx
Spinal cord compresion in Ca?
- urinary or bowerl incontinence
- peripheral neuropathies
- gait distubrances
Cardiac tamponade s/s?
- muffle heart tones
- elevated JVD
- distended neck veins
- progressiv edyspnea
Neutropenia sepsis s/s?
- Low grade fever or none
- cough
- arthralgia
CNS metastasis s/s?
- HA
- visual disturbance
- balance and gait disturbance
- confusion
- n/v
Tumor lysis syndrome s/s?
- Elevated uric acid, K, phos level
- often seen 12-72 hours post chemo tx for hematologic malignancy
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