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Health Assessment > Cancer Assessment > Flashcards

Cancer Assessment 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 therapyectopic 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,

ook 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

TNMT -

tumor size 1-4N -

lymph node involvement 0-3M -

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 endothelial damage (looks like pneumonia, type 1&2 alveolar necrosis - pulmonary fibrosis - no Rx

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

37
Q

radiation to chest pulmonary adverse effects

A

interstitial pneumonitis,

pulmonary fibrosis

tracheal stenosis

get pre op 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 - permanent injury marked by 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 of:

Cyclophosphamide

Methotrexate

Vinca Alkaloids

Cisplatin

Alkylating agents

A

high dose Cyclophosphamide - acute delirium, encephalopathy, ataxia

Methotrexate - dementia

Vinca 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, recentPE,

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

Health Assessment (14 decks)

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