Cancer Assessment Flashcards
Your patient has cancer and has received radiation to the head and neck. What are some physical assessment findings that could be found on this type of patient?
Tracheal deviation/compression
SOB
Difficulty breathing (sign of airway obstruction)
Dysphagia
Cervical ROM
What are some special anesthetic preop considerations for a patient with head and neck cancer?
- Review imaging studies → determine if alternate AW plan is needed
- Plan for Diff AW
- Lack of accessibility to AW in case: special equipment
- Chronic smoking hx: PFTs/pulm toilet/inhalers
- Ask about dysphagia/difficulty breathing (signs of AW obstruction)
- Obtain T&C/CBC → BL high risk
- Ca r/t METS: check Ca level
- Alcohol induced liver disease: LFTs
- Nutritional therapy preop?
- Invasive monitoring? A-line
What are some complications from Doxorubicin (Adriamycin) treatment?
- Cardiotoxicity (acute or chronic)
- QT prolongation
- Cardiomyopathy
- Dysrhythmias
- Ischemia-related EKG changes
- Myelosuppression
Your patient has cancer in the mediastinum. What are some consequences of radiation to this area?
- Conduction abnormalities (arrythmias)
- Valvular fibrosis
- Accelerated CAD
Your patient presents with a mediastinal mass. What are some PHYSICAL EXAM findings of this malignancy?
- SVC syndrome: “compression of SVC”
- JVD
- Facial, chest, neck, and upper extremity edema
- Flushed face
- Superior mediastinal syndrome: Tracheal compression AND SVC syndrome
- Dyspnea
- Dysphagia
- Stridor
- Wheezing
- Coughing
- RECUMBENT position WORSE (lying down)
Your patient has cancer and has received radiation to the head and neck. What are the consequences of radiation to these areas?
- Permanent tissue fibrosis***
- Difficult ventilation
- Difficult intubation
- Carotid artery disease (carotid stenosis)
- Hypothyroidism
Your patient has a history of taking Bleomycin for their cancer. What are some preoperative ROS questions you should ask the patient?
SOB?
Any functional limitations?
Exercise intolerance?
Any pulmonary function tests done?
When did you take Bleomycin? How long?
List some renal assessment considerations for a patient with cancer.
- Drugs toxic to renal system:
- Cisplatin- renal tubular necrosis
- Methotrexate- renal failure
- cyclophosphamide
- SIADH
- & inhibit pseudocholinesterase! (mivacurium, succs)
- concern for any meds metabolized by pseudocholinesterase
- Check BUN, Cr, GFR
- Tumor cell lysis: from radiation or chemo → destroys tumor cells rapidly → releases uric acid, phos, K
- Uric acid builds up in kidneys → renal failure
Hematologic system assessment on cancer patient?
- *Myelosuppresion
- Nadair (bottom blood counts) → happens 7-14 days after chemo administered
- CA produces hypercoagulable states → thromboembolitic events increase 6 x in CA pts
- Questions:
- Bruising or bleeding?
- Last time had chemo/radiation?
- Every have a blood clot?
- Blood transfusion hx?
- Anemia hx?
- Prone to infections?
- Questions:
What are the components of tumor staging?
- T- tumor size
- Tx: cannot be measured
- T0- cannot be found
- T1-4: extent/size of tumor
- N- # lymph nodes nearby that have CA
- Nx: cant be measured
- N0- no lymph
- N1-4: # and location of lymph nodes w/ CA
- M- metastasized (CA spread from primary tumor to other parts of body)
- Mx: no measure
- M0: no spread
- M1: CA spread to other parts
What are some consequences of having radiation to the abdomen?
Stenotic lesions throughout the GI tract
Sinusoidal obstruction syndrome
Reactivation of hepatitis B
What are the GI consequences on a patients with chemo and radiation?
- mucousitis - predispose to AW bleeding, impaired wound healing
- N/V- increase aspiration risk
- diarrhea
- electrolyte imbalances, dehydration, malnutrition
- radiation
- stenotic lesions throughout GI tract
- Sinusodal obstructive syndrome
- reactivation of Hep B
Types of lung cancer and associated concerns
-
Adenocarcinoma (form of large cell)
- 30-50% of lung cancers
- → increase platelets (blood clots)
- Ask for history of blood clots
- Large cell –gynecomastia
-
Small cell -muscle weakness (paraneoplastic syndromes)
- Autoimmune, effects antibodies
- Eaton-Lambert and MG→ NMBD can be prolonged in these patients
- May have joint pain, muscle weakness
- Pain in hands, fingers, knees, ankles?
How can you optimize your cancer patient before taking for surgery?
- Correction of:
- Nutrient deficiencies
- Electrolyte abnormalities
- Anemia
- Coagulopathies
- Steroid replacement
- Education and prevention
- Exercise routine before surgery- improves surgical recovery/improves overall survivorship (“prehab”)
- tabacco cessation
What neurological history questions would be important to ask a patient with cancer and what processes are associated to these concerns?
Questions:
- Numbness or tingling?
- What agents have you been on in the past?
- Ever been diagnosed with MG or Eaton-Lambert?
- Any muscle weakness?
Neurological Altering Processes
- Vincristine—virtually all patients experience paresthesia
- peripheral neuropathy
- encephalopathy
- Corticosteroid-induced neuromuscular toxicity (prednisone 60-100mg/day) → stopped, goes away
- s/s limp, muscle weakness (wont ask)
- Lots of chemo meds supplemented with steroids
- Radiation + methotrexate –> irreversible dementia
