Endocrine/Cancer Flashcards
Common CA surgeries for men
Prostate (#1)
Lung (#2)
Colon/GI
Most common CA surgery for women
Breast
Common sites of metastases for resection
Brain, liver, spinal cord
Considerations for lung CA surgery
1) Potential for massive bleeding during surgery (make sure to type and cross and set up blood warmer)
2) Pulmonary insufficiency after lung tissue resection (will remain intubated after surgery, get a-line to check ABGs)
3) May have associated CAD
Considerations for bronchial and neck CA surgery
1) Look at imaging to determine airway management
2) Ask if they have dysphagia or trouble breathing (checking for airway obstruction)
3) We will lack close accessibility to the airway during the case d/t surgical location
4) Expect significant blood loss
Considerations for those on chemo/radiation
CBC
Check for peripheral neuropathies (chemo can cause these)
Affect of CA and treatment on the heme system
1) Anemia (d/t bone marrow suppression or GI ulceration/bleeding)
2) Neutropenia and thrombocytopenia
Recurrent venous thrombus can occur with ___ CA
pancreatic
Types of lung cancers and their effects on the body
1) Squamous (25-40% incidence)
- hypercalcemia
2) Adenocarcinoma (35-50%)
- hypercoagulability & osteoarthritis
3) Large cell (10%)
- gynecomastia
4) Small cell (15-24%)
- Ectopic corticotropin secretion
- Excess ADH secretion
- Eaton-Lambert Syndrome (similar disease process to MG–> will affect the type of NMB we use)
When may adrenal insufficiency occur?
Adrenal tumor
Corticosteroid therapy
What can happen if TPN is abruptly stopped?
Hypoglycemia
Effects of malignant involvement of the pericardium
1) Pericardial tamponade (often happens as a result of lung CA)
- Electrical alternans (alternation of QRS complex amplitude or axis between beats- the heart essentially wobbles in the fluid filled pericardium)
- Paroxysmal a-fib or a-flutter
Chemo can cause this effect on the heart
Drug induced cardiomyopathy
- LV function may be impaired for up to 3 years post therapy
Invasion of the mediastinum can cause
SVC obstruction
- causes venous engorgement above the waist
Dyspnea and airway obstruction
Chemo meds that are cardiac toxic
Doxorubicin and Daunorubicin
- Causes CHF in <3%
- Acute cardiomyopathy in 10% (benign, and symptoms resolve in 1-2 months)
- SEVERE cardiomyopathy in 2% (mortality rate of 60% in 3 weeks, and unresponsive to mechanical/drug therapy)
- These meds enhance the myocardial depression caused by anesthetics (acute LV failure can occur with GA up to 2 months post treatment)
Chemo meds that are pulm toxic
1) Methotrexate (8% toxicity)
- sudden pulmonary edema (non-cardiogenic)
- progressive inflammation with infiltrates and effusions
2) Bleomycin (dose-related toxicity– rare if below 150mg/m2)
- Pulm endothelial damage (treat with corticosteroids) –> can result in type I and II cell necrosis and pulm fibrosis (no tx)
- Increased A-a gradient
- Hyperoxic pulmonary injury (Do not give 100% O2*****)–> try to keep sats over 90% with less than 30% FiO2
Effects of 5-fluorouracil
Immunosuppression
Leukopenia
Megaloblastic anemia
Chemo meds that are renal toxic
Cisplatin (dose dependent)
- Decreased GFR within 3-5 days
- ATN -> ARF -> hemodialysis
How to treat??
- Hydration and mannitol diuresis (may help to protect against the advancement of renal toxicity)
Chemo meds that cause encephalopathy
1) High-dose cyclophosphamide (acute delerium)
2) Methotrexate (reversible, but can cause dementia with prolonged use)
These meds can cause neuropathies
1) Vinca alkaloids
- peripheral neuropathies
- Autonomic neuropathy (usually reversible)
2) Cisplatin
- dose-dependent damage to the doral root gangia –> large fiber neuropathy
What is autonomic neuropathy?
ANS dysfunction d/t DM
- 20-40% of all diabetics have it
- Most affects the CV and GI systems
Causes:
- Ortho hypotension
- Resting tachycardia
- Impotence
- Peripheral neuropathy
- Loss of HR variability
- Gastroparesis
- Cardiac dysrrhythmia
- Altered breathing regulation
- Sudden death syndrome
These chemo meds can cause plasma cholinesterase inhibition
Alkylating agents (Cytoxan) --it will prolong the effect of sux!!
Bleomycin/Busulfan/BCNU can cause
Interstitial pneumonitis and fibrosis (3-6%)
- appears as cough, dyspnea, and basilar rales
Treatment:
- Corticosteroids
- Avoid high FiO2
- Use colloids rather than crystalloids
Cardiac complications due to doxorubicin/daunorubicin may first appear as
an upper respiratory infection, but with rapidly progress to CHF. Evaluate ventricular function.
Severe cardiomyopathy can occur if 550mg/m2
If a CA patient has N/V, you should always treat them as if they have
a full stomach
These meds are commonly used to treat N/V in the CA population
Reglan
Zofran
Droperidol
Type of pain scale we should use with CA patients
VAS (visual analogue scale)
CA airway evaluation
Tracheal compression or deviation?
Dysphagia or difficulty breathing (airway obstruction)
Trach?
One-lung ventilation?
CA and IV access
Prior mastectomy?
Remember that if on chemo, they may have poor vasculature/access
- Allow adequate time to get enough access
- Pt will often know where their best access sites are
What are we most concerned about with DM?
Making sure they don’t become hypoglycemic**