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Health Assessment ORAL first half > Cancer > Flashcards

Cancer Flashcards

1
Q

Cancer is the ___ leading cause of death in US

A

Cancer is the __2nd_ leading cause of death in US

Second only to heart disease

Lifetime risk of developing cancer is 1 in 4 for men and 1 in 5 for women.

90% of patients with cancer will require surgery

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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

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

15

A

Can cause

  1. rash/erthyema
  2. fibrosis/sclerosis/telangioectasis
  3. malnutrition/mucositis/nausea
  4. adhesions/fistulas/strictures
  5. conduction defects
  6. perciardial effusion / pericardial fibrosis
  7. pulmonary fibrosis / pneumonitis
  8. tracheal stenosis
  9. Glomerulonephritis
  10. Glomerulosclerosis
  11. Sinusoidal Obstruction syndrome
  12. Hypothyroidism
  13. Panhypopituitarism
  14. Bone marrow suppression
  15. Coagulation necrosis
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4
Q

“Focuses” of preop assessment for Ca patient?

+ anesthetic considerations

A
  1. Malignancy in head/neck
    • airway exam and possible need for trach
    • recurrent laryngeal nerve damage
    • if they have had radiation - be aware of risk for trachel stenosis, sclerosis of joints, fragility of blood vessels
    • maybe consider a smaller ETT
  2. Mediastinal masses obstructing great vessels
    • dyspnea, dysphagia, stridor, wheezing, coughing–> recumbent positon
    • compression of SVC–> JVD, Facial, chest , neck, UE edema
    • be aware that laying down may compress trachea
  • Preop testing: CXR, CT, MRI, EKG, Echo

EKG/ECHO - conduction abnormalities r/t radiation, myopathy r/t chemo agents.

  • Anesthetic concerns
    • airway cart
    • emergency suppy
    • trach
    • spontaneous awake intubation
    • ENT at bedside
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5
Q

What is SVC syndrome?

5

A
  1. Obstruction of superior vena cava caused by spread of Ca into mediastinum or into caval wall
  2. veins above level of heart, particularly with jugular veins and veins in arms, become engorged
  3. edema of face and UE prominent
  4. increased ICP manifests as nausea, sz, decreased LOC
  5. May cause syncope
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6
Q

What is superior mediastinal syndrome?

4

A
  1. combo of SVC syndrome and tracheal compression
  2. Hoarseness, dyspnea and airway obstruciton may be present b/c tracheal compression
  3. txmt consist of radiation therapy or chemo
  4. bronchoscopy/mediastinoscopy to obtain tissue dx can be hazardous
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7
Q

What to look for in airway assessment of Ca patient?

5

A
  1. tracheal deviation or compression
  2. SOB
  3. dificulty breathing
  4. dysphagia
  5. cervical ROM, cervical Xray, ENT consult
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8
Q

What can radiation to head/neck be concerning for?

5

A
  1. permanent tissue fibrosis
  2. carotid artery dx
  3. hypothyroidism
  4. difficult vent
  5. difficult intubation
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9
Q

Special anesthesia preop consideration of head and neck ca?

A
  1. Review imaging studies to determine if alternate airway mgmt plan should be used
  2. question pt regarding dysphagia and difficulty breathing
  3. sx blood loss can be sig T&C, CBC
  4. Lack of accessibility to airway during case
  5. hypercalcemia related to METS
  6. alchol induced liver dx
  7. chornic smoking hx PFT, pulm toilet, inhalers
  8. May need nutritional therapy preop
  9. plan for difficult airway
  10. may need invasive monitorign ie aline
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10
Q

Concerns for geriatrics with ca?

4

A
  1. Greater comorbidities,
  2. fraility,
  3. polypharmacy
  4. risk of delirium
    • chemobrain- chemo induced cognitive dysfunction
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11
Q

Education and prevention around sx with ca patient?

2

A
  1. management of comorbidities
  2. exercise routine prior to sx- improves surgical recovery and overall survivorship
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12
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
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13
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)
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14
Q

Considerations for respiratory system assessment for Ca pt?

A
  • Baseline and serial PFT
  • Chest radiography
  • pleural effusion
  • bleomycin?
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15
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
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16
Q

Which cancers are known for secreting ADH?

A
  • Duodenal
  • lung (small cell)
  • lymphoma
  • pancreatic
  • prostate
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17
Q

Which cancers can secrete human chorionic gonadotropin?

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

causes gynecomastia, galactorrhea, precocious puberty

18
Q

Which Ca can secrete adrenocorticotropic hormone?

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

manifestation: cushing syndrome

19
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
20
Q

How many days after chemo does nadir happen?

A

7-14 days

21
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
22
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
23
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
24
Q

What is the multiple hit hypothesis for cancer deconditioning?

A
  • Chemo
  • radiotherapy
  • sx
  • cancer
  • age
  • medical comorbidities
  • sedentary lifestyle
  • cancer fatigue
25
Q

What are some preoperative considerations to optimize patient for sx?

A
  • Nutrient deficiencies
  • electrolyte abnormalities
  • anemia
  • coags
  • steroid replacement
26
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
27
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
28
Q

Spinal cord compresion in Ca?

A
  • urinary or bowerl incontinence
  • peripheral neuropathies
  • gait distubrances
29
Q

Cardiac tamponade s/s?

A
  • muffle heart tones
  • elevated JVD
  • distended neck veins
  • progressiv edyspnea
30
Q

Neutropenia sepsis s/s?

A
  • Low grade fever or none
  • cough
  • arthralgia
31
Q

CNS metastasis s/s?

A
  • HA
  • visual disturbance
  • balance and gait disturbance
  • confusion
  • n/v
32
Q

Tumor lysis syndrome s/s?

A
  • Elevated uric acid, K, phos level
  • often seen 12-72 hours post chemo tx for hematologic malignancy
    *
33
Q
A
34
Q

What to consider with cancer to head/neck -4

and

Radiation to Head and Neck -6

These patients need an airway assesment that also includes -5

A

WHAT TO CONSIDER WITH CANCER TO HEAD/NECK:

  1. airway exam, evaluate for possible need for tracheostomy
  2. assess for recurrent larygneal nerve damage - affect ability to open vocal cords
  3. mediastinal masses! Can obstruct great vessels, lead to JVD, face, neck, UE edema.
  4. mediastinal masses- can also lead to dyspnea, dysphagia, stridor, wheezing, coughing, can be worse when laying down and lead to tracheal compression

RADIATION TO HEAD/NECK

  1. possibility of permanent tissue fibrosis
  2. carotid artery ds (assess for bruits, could be stenosis of carotid artery, vascular consult)
  3. hypothyroidism (can lead to goiter affecting airway)
  4. Tracheal stenosis
  5. difficult ventilation
  6. difficult intubation

WHEN DOING AN AIRWAY ASSESMENT;

  1. look for tracheal deviation or compression
  2. SOB
  3. Dyspnea/difficulty breathing
  4. dysphagia
  5. CERVICAL ROM, consider cervical XRAY

CXR, CT, MRI, echo? EKG?

35
Q

Cancer Surgery for Head and Neck cancer - what to consider

6

A
  1. Review imaging studies to determine if alternate airway management plan should be used, i.e. assess for r/f tracheal compression
  2. Assess for dysphagia, diffilculty breathing, signs of airway obstruction
  3. Be aware surgical blood closs can be significant, consider type and cross, CBC
  4. May not have accessiblity to airway during case, may need special equipment
  5. Plan for difficult airway
  6. May need invasive monitoring
36
Q

Perioperative assessment of Cancer pt - CV system

5

EFFECT OF RADIATION ON CV SYSTEM

A
  1. Assessment of HR, pulse, carotid arteries
  2. if bruits are present, 70% occlusion already, depending on surgery, if large fluid shifts are expected - may need to do revasc first.
  3. significant fatigue and loss of functional status - ECHO, results WNL - cardiac stress testing if high risk surgery, check BNP
  4. EKG - QT prolongation, cardiomyopathy, dysrthymias, ischemia related EKG changes
  5. HTN may be from monoclonal antibodies

EFFECT OF RADIATION ON CV SYSTEM:

acceleated CAD, valvular fibrosis, conduction abnormalities, need perioidc ECHO.

if doxorubicin - perioidic ECHOs

37
Q

Lung Cancers:

Adenocarcinoa

Large Cell Carcinoma

Small cell carcinoma

A

Adenocarcinoma:

  • peripheral location
  • hypercoaguable state
  • arthritis

Large Cell Carcinoma

  • Peripheral location
  • gynecomastia r/t tumor secreting HCG

Small Cell Carcinoma:

  • SIADH - ADH secreting
  • Cushingoid symptoms- inc. cortisol
  • Eaton Lambert - muscle weakness
  • PTH secreting tumor - hyper Ca++
  • central origin
38
Q

Effect of Chemo/radiation on GI system

8+

A
  1. Mucositis
  2. N/V
  3. diarrhea
  4. electrolyte imblanaces
  5. dehydration
  6. malnutrition
  7. radiation -> stenotic lesions throughout the GI tract,
  8. sinusoidal obstruction syndrome -TBI
  9. ?reactivation of HEP b?
39
Q

What to consider with cancer pts - endocrine system

A
  1. steroids are frequently used for tx, reduce inflammation, reduce N/V, stimulate appetite
  2. could cause HPA , may need stress dose in surgery
  3. might lead to DM or make DM harder to tx
  4. radiation to neck may lead to hypothyroidism, which may ultimately cause goiter
40
Q

For cancer patients, we want pre-operative correction of

5

A
  1. Nutrient deficiencies
  2. Electrolyte Abnormalities
  3. Anemia
  4. Coagulopathies
  5. Steroid Replacement
41
Q

what metastasizes where

A

breast -> bone

prostate -> bone

lung cancer -> brain

colon cancer -> liver

Health Assessment ORAL first half (7 decks)

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