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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
Lung CA surgery preop labs/testing
Pulm function tests DLCO VO2 max CXR ABGs baseline O2 sat cardiac stress test H/H, type and cross blood
26
Head and Neck CA surgery considerations
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
Breast CA surgery considerations
poor IV access limb at risk of lymphedema think about a PICC line
28
Colon/GI CA surgery considerations
possible aspiration risk - give prophylactic meds (no Reglan) possible dehydration from GI obstructions - give preop fluids
29
Prostate CA surgery
associated with increased bleeding
30
Cancer treatment types
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
Doxorubicin & Daunorubicin adverse effects
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
Fluorouracil adverse effects
pericarditis angina coronary artery vasospasm ischemia related ECG changes conduction defects
33
Bevacizumab, trastuzumab, sorafenib adverse effects
targeted therapy HTN vascular thromboembolic complications bleeding - must stop 4-8 weeks before surgery!
34
Radiation to chest cardiac adverse effects
myocardial fibrosis pericarditis valvular fibrosis conduction abnormalities get EKG, CXR, stress test, ECHO, vital signs, BNP level
35
Bleomycin adverse effects
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
Methotrexate adverse effects
antimetabolite - toxicity 8% immunosuppressant drug (RA, Chron's) and chemo drug fulminant non-cardiogenic pulmonary edema progressive inflammation with infiltrates, effusions
37
radiation to chest pulmonary adverse effects
interstitial pneumonitis, pulmonary fibrosis tracheal stenosis get pre op O2sat, CXR, PFT, ABG
38
Cisplatin adverse effects
alkaline chemo agent - dose limiting effect decreased GFR within 3-5 days renal insufficiency, hypomagnesemia ATN - acute renal failure requiring hemodialysis peripheral neuropathy
39
Cyclophosphamide adverse effects
SIADH syndrome hemorrhagic cystitis (bladder bleeding) plasma cholinesterase inhibitor - succs will be prolonged
40
Ifosfamide adverse effects
tubule dysfunction proteinuria, glucosuria
41
High dose radiation renal effects
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
Ca treatment hepatic adverse effects
Methotrexate - associated with acute liver dysfunction Radiation - associated with sinusoidal obstruction syndrome (severe liver dysfunction) get liver function test, albumin levels
43
Ca treatment airway/oral cavity issues
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
Ca treatment GI/Endocrine adverse effects
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
Ca treatment hematologic system adverse effects
chemo: myelosuppression thrombocytopenia/platelet dysfunction tumors releasing procoagulants radiation: coagulation necrosis of vascular endothelium post radiation bleeding get CBC, PT/PTT, INR
46
Ca treatment nervous system adverse effects of: Cyclophosphamide Methotrexate Vinca Alkaloids Cisplatin Alkylating agents
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
CA Nausea/Vomiting management
metoclopramide, droperidol, zofran provide reassurance that measures will be taken to control n/v
48
CA pain management
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
Specific electrolytes to double check pre op
Na, K, Mg, and Ca if metastasis to bone
50
Full list of pre op lab values and studies to check for CA patient
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
What are you looking for in a CXR
tracheal deviation/compression masses aortic aneurysm cardiomegaly pulmonary edema pneumonia atelectasis chronic diseases
52
What are you looking for in an EKG
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
Primary location/Metastasis/treatment side effects
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
CA patient airway evaluation
tracheal deviation/compression SOB dyspnea dysphagia colon obstruction? (aspiration risk) will they need one lung ventilation?
55
CA patient physical exam
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
Pre op correction of abnormalities
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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