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Mar: Sem 4 - Principles II > Exam 3: Oncology and Chemotherapy > Flashcards

Exam 3: Oncology and Chemotherapy Flashcards

1
Q

Normal cell process, and cancer cell process

A
  • normal cells grow and divide as needed then perform apoptosis when they are old of damaged
  • Cancer cells survive when they should die or they form when they aren’t needed

S2

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2
Q

What are tissue changes seen in cancer cells?

A
  • Number of cells increases (hyperplasia).
  • Organization changes (dysplasia)

S3

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3
Q

What is the progression from normal cells to cancerous cells?

A

S3

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4
Q

Definition of Cancer

A
  • A collection of related diseases of cells that begin to divide without stopping and can spread into surrounding tissues
    • may form solid tumors or leukemias
  • Caused by genetic changes inherited from parents or mutations to DNA

S4

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5
Q

Characteristics of Cancer Cells

A
  • Less specialized
  • Can ignore pre-programmed apoptosis signals
  • Abnormally influence normal cells (ex. make normal cells form blood vessels which feed a tumor - angiogensis)
  • Can evade the immune system

S5

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6
Q

What are the three “drivers” that increase the proliferation of cancer cells?

A
  • Proto-oncogenes
    Involved in normal cell growth and division
    Become cancer-causing…allow cells to grow and survive
  • Tumor suppressor genes
    Alterations allow genes to divide uncontrollably
  • DNA repair genes
    Incorrect damage repair; cause other mutations

S6

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7
Q

How many types of cancers are there?

A

More than 100

named for organs, tissues, or types of cells that the cancer orginates from

S7

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8
Q

Where do basal cell cancers originate from?

A

Basal layer of the epidermis

S7

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9
Q

Where do squamous cell cancers originate from?

A

Epithelial cells:

  • Beneath skin
  • GI tract
  • lungs
  • Bladder

S7

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10
Q

Where do adenocarcinoma’s originate from?

A
  • Mucous producing cells
  • Gland tissue (breast, prostate)

S7

Attorney General

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11
Q

Where do sarcoma’s originate from?

A

Bone and soft tissue

Ex: osteosarcoma

S7

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12
Q

Where do leukemia’s originate from?

A

Bone marrow

S7

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13
Q

Where do lymphoma’s originate from?

A

Lymphocytes (T or B cells)

These tend to build up on lymph nodes and lymph vessels.

S7

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14
Q

What are some problems in cancer screenings?

A
  • Can cause problems: Colonoscopy perforation
  • Can have false-positives
  • Can have false-negatives

we want a screening that is easy to treat and curable

S9

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15
Q

Screenings are working if statistics show:

A
  • More early-stage cancers found
  • Less late-stage cancers found
  • Less deaths occur

S9

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16
Q

What is absolute risk?

A

Absolute risk

  • How many people get “x” in a certain period.

Ex. If 4 people out of a group of 100,000 get “x” then risk is 4 in 100,000

S10

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17
Q

Explain relative risk.

A

% of people in exposed group that develop cancer

vs.

% of people in unexposed group with diagnosis.

S10

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18
Q

Give an example of a relative risk that is greater than 1.

A

Smoking

Smoking increases risk relative to the rest of the population.
A relative risk >1 there is a positive correlation

S10

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19
Q

Give an example of a relative risk that is less than 1.

A

Exercise

Exercise decreases risk relative to the rest of the population.
A relative risk <1 will be a negative correlation

S10

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20
Q

What cancer screenings are typically standard now?

A
  • Colonoscopy
  • Mammograms
  • Pap Smears

S11

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21
Q

What are the factors measured in tumor staging?

A
  • T: size/extent of primary tumor
  • N: # of nearby lymph nodes which are +
  • M: is there metastasis

S12

The staging is done at diagnosis. No later evaluation.

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22
Q

What are all the measurements for size of the Tumor?

A
  • TX: tumor cannot be measured.
  • T0: tumor cannot be found.

T1-T4 refers to larger and larger size and extent
* T1= least invasive
* T4 = most invasive

S13

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23
Q

What are all the Lymph node measurements?

A
  • NX: cancer in nearby lymph nodes cannot be measured.
  • N0: no cancer in nearby lymph nodes.

N1-N3 is the number and location of lymph involved
* N1 = limited cancer found in regional lymph nodes
N3 = cancer is all up in these lymph nodes

S13

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24
Q

How is metastasis measured in the tumor staging system?

A
  • MX:cannot be measured.
  • M0: has not spread to other parts of the body.
  • M1: has spread to other parts of the body.

S13

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25
Q

What are other staging systems?

A
  • In situ: abnormal cells are present but have not spread to nearby tissue
  • Localized: limited to place where it started; no sign of spread
  • Regional: has spread to nearby lymph nodes, tissues, or organs
  • Distant: spread to distant parts of body
  • Unknown: not enough information to figure out the stage

S14

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26
Q

For median survival of 6 months or less what two factors are more important that type of cancer?

A
  • Functional status
  • Laboratory values

S15

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27
Q

What factors are associated with a survival rate that is 6 months or less?

A

S15

Serum Calcium will likely indicate bone break-down or kidney involvement

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28
Q

What type of cancers will frequently radiate to the bone?

A
  • Breast
  • Lungs
  • Kidney
  • Prostate

S16

Osteolytic, osteoblastic or both lesions

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29
Q

What can be helpful in treating cancer metastasis to the bone?

A
  • Radiotherapy/chemotherapy
  • NSAID +/- opioids
  • Vertebroplasty (cement that can be injected into the vertabra to stabalize and prevent collapse)

S16

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30
Q

Hormonal therapy is often helpful for what types of cancer?

A

Breast
Lung
Kidney
Prostate

S16

These are the same that radiate to bones

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31
Q

Why does cancer typically cause pain?

A
  • Invasion of tumor into tissues innervated by afferent neurons
  • Directly invades nerve plexus

S17

Pain is mostly d/t cancer itself not treatment

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32
Q

WHO “Cancer Pain Stepladder”

A
  • Prompt administration fo pain meds
  • On schedule; not prn (prophylactic)
  • Add antianxiety drugs as necessary
  • 80-90% effective (simple things can go a long way)

S18

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33
Q

Common nerve blocks used to treat cancer patients

A
  • Celiac plexus
  • Intercostal nerves
  • Lumbar sympathetic

These are used when pharmacologic treatment has failed - hopefully soon we can start using regional as a sooner treatment

S20

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34
Q

What areas are anesthetized with a celiac plexus block?

A
  • Sympathetic fibers of T5-T12
  • Parasympathetic celiac plexus fibers

S20

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35
Q

For what types of cancer are celiac plexus blocks typically performed?

A

Unresectable:

  • Pancreatic
  • Hepatic
  • Gastric

S20

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36
Q

What injection is used with a neurolytic celiac plexus block?
How long does this typically last?

A

Isopropyl alcohol - kills the nerve (but then be aware of sympathectomy)

Destruction of nerves typically lasts 3-6 months.

S20

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37
Q

What is the principal benefit of continuous infusion via catheters for cancer pain?

A
  • ↓ systemic side effects
  • Technique and equipment very available.

S21

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38
Q

What are the drawbacks to continuous catheters for cancer pain?

A
  • limited duration of therapy because of migration, granulomas, lack of homogenous drug distribution, infection rates etc
  • no randomized control trials

S21

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39
Q

What can chemotherapy drugs be used for?

A
  • Kill cancer cells
  • Shrink tumors
  • prepare pts for bone marrow transplant
  • Control overactive immune diseases (SLA and RA)

S23

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40
Q

Chemotherapy target cells in different phases of their ____.

A
  • Cell cycle

Idea is they inhibit growth in different phases

S23

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41
Q

How do alkylating agents work?
Whats an example of an alkylating agent?

A

Cisplatin (Nitrosurea)

  • Damage cell DNA in all phases of the cell cycle, therefore can treat many different cancers.
  • Can cross BBB so its effective at treating brain cancers

S24

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42
Q

What is a severe side effect of alkylating agents?

A

Dose-dependent cause of leukemia 5-10 years after treatment because these agents will damage blood cells.

S24

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43
Q

Other side effects and interactions

A
  • SE: peripheral neuropathy
  • SE: Acute renal failure if taken with NSAIDs

S24 and S54 (Neuropathy was S36)

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44
Q

What types of cancers do antimetabolites treat?

A
  • Breast
  • Ovary
  • Intestines
  • Leukemias

S25

A BOIL

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45
Q

How do antimetabolites work?

A

Interfere with DNA and RNA - act as subsitute for normal building blocks

S25

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46
Q

What are two examples of antimetabolites?

A
  • Methotrexate
  • 5-Fluorouracil

S25

Its 5 AM somewhere

47
Q

How do Anti-tumor antibiotics treat cancer?

A
  • Interfere with DNA copying enzymes

Used for a large variety of cancers

S26

48
Q

What are examples of anti-tumor antibiotics?

A

-cins

Doxorubicin, bleomycin, Mitomycin-C etc

S26

49
Q

What type of cancer drugs have life-time dosing limits?
Why is this?

A

Anti-tumor antibiotics because they permanently damage cardiac tissue in large doses.

S26

50
Q

Anesthesia Implication of Bleomycin

A

Increases risk of Pulmonary O2 toxicity with high FiO2

S26

51
Q

Which chemotherapy increases the risk of a second cancer developing?

A

Topoisomerase Inhibitors

S27

52
Q

MOA for Topoisomerase inhibitors and what cancers do they treat?

A
  • Plant alkaloids: prevent strands of DNA from being separated to copy
  • Treat: Leukemias, Lung, ovarian, GI, Colorectal and pancreatic

DNA is PLANTED together
PC - LLOG

S27

53
Q

Which chemotherapeutic agent damages cells in all phases through the prevention of protein synthesis?

A

Mitotic Inhibitors

S28

54
Q

Which other chemotherapeutic class may cause peripheral neuropathy?

A

Mitotic inhibitors

(-Taxels and vincristine, vinblastine, etc.)

S28

55
Q

What agents are the plant alkaloids?

A
  • Topoisomerase inhibitors
  • Mitotic inhibitors

S27 and 28

56
Q

What other types of treament are there for cancer?

A
  • Targeted Therapy (newer drugs): specific proteins or receptors on cancer cells
  • Hormone therapy: prevent body from making specific hormones (slower growth of hormonal tumors)
  • Immunotherapy: boost immune system to better recognize cancer cells

S29

57
Q

What cells are most likely to be damaged due to chemotherapy?

A
  • Bone marrow (neutrophenia)
  • Hair follicles
  • GI tract (including mouth)
  • Reproductive systems

S30

58
Q

What drug can inhibit hormonal contraceptives by 28 days?

And thus result in unexpected baby’s.

A

Aprepitant (neurokinin 1 antagonist)

S31

59
Q

How does marijuana treat nausea/vomiting?

A
  • Depresses CNS vomiting center
  • more effective than phenothiazines
  • decreases anesthetic requirements 15-30%

S31

60
Q

What is radiation’s effects on the peripheral vascular system?

A

Coagulopathy

6x increase!

S34

61
Q

What is radiation’s effects on tissues afflicted by head and neck cancers?

A
  • ↓ Thyroid function
  • Carotid artery disease
  • Possible airway issues (stiff tissues (kahoot) have rescue airway devices available)

S34

62
Q

What is radiation’s effects on the chest wall and/or breasts?

A
  • Pericarditis
  • Cardiomyopathy
  • Valvulopathies
  • Dysrhythmias/conduction abnormalities

S35

63
Q

What is the possible effect of radiation on the lungs??

A

Radiation pneumonitis

can also be prone to esophageal errosion

S35

64
Q

What chemotherapeutic agent is known to cause cardiomyopathy?

A

Doxyrubicen (Adriamycin)

S36

65
Q

What chemotherapeutic agent is known to cause pulmonary toxicity?

A

Bleomycin

S36

66
Q

What chemotherapeutic agents are known to cause peripheral neuropathy?

A
  • Cisplatin
  • Vincristine (mitotic inhibitor)

S36

67
Q

What preoperative abnormalities might be seen in a cancer patient?

A
  • ↓ RBCs (anemia)
  • ↓ WBCs (neutropenia)
  • ↓ PLTs (thrombocytopenia)
  • ↑ Ca⁺⁺ (hypercalcemia)
  • Adrenal insfficiency related to steriods

S37

68
Q

Why is hypercalcemia common in cancer?

A

Many drugs are toxic to bone marrow, liver and kidneys thus causing breakdown and releasing Ca⁺⁺ into the bloodstream.

S37

69
Q

What test is useful for testing for adrenal insufficiency?

A

ACTH stimulation test

S37

70
Q

Why is tumor resection a risk factor for tumor recurrence?

A
  • Tumor cells can spread into blood stream
  • Residue remains behind
  • Localized spread via lymphatics

S38

71
Q

Why is inflammation and surgical stress bad for cancer patients?

A

Surgical stress → elevation COX expression → PG’s and thromboxanes catalyzed → promote cell survival and cancer cell growth

  • inflammation and stress may suppress NK cells

S39

72
Q

How long can inflammation and stress last post surgery?

A

weeks

S39

73
Q

β adrenergic receptors at the sites of tumor growth will upregulate cancer cell activity via nerve fiber delivery of ____.

A

norepinephrine (catecholamine surge)

S39

74
Q

How do Opioids effect cancer cells?

A

Opioids directly:
* stimulate cancer cell proliferation and invasion
* inhibits leukocyte migration
* inhibits NK cell activity

S40

75
Q

How do volatiles adversely effect cancer patients?

A
  • Increase migration and invasion of cancer cells by affecting platelets
  • Induce chemo resistance
  • Inhibit NK cells

S40

76
Q

What effects does propofol have on cancer cells?

A
  • Decreases migration by down regulating signaling pathways
  • Promotes apoptosis by increasing cytotoxicity of NK cells

Propofol on top as always.

S40

77
Q

Long term administration of NSAIDS ____ proliferation of cancer cells.

A

decreases

S40

78
Q

Cancer types diagram

Flip Card

A

S44

79
Q

What is the major cause of lung cancer?

A

Tobacco smoke (90%)

3 decade lag time in cancer occurrence

S45

80
Q

What substances cause lung cancer other than tobacco?

A
  • Asbestos
  • Radon gas

S45

81
Q

What are the types of lung cancer?

A
  • Small cell
  • Non-small cell (75-80%)
  • Carcinoid
  • Mesothelioma

S46

82
Q

What are the subtypes of non-small-cell lung cancer?

A

NSMC Lung cancer:

  • Squamous
  • Adenocarcinoma
  • Large cell

S46

83
Q

What is the typical origin of small cell lung cancer?

A

Neuroendocrine

Thus the cancer is typically metastatic on presentation

S47

84
Q

What lung cancer always recurs and is resistant to further treatment?

A

Small cell lung cancer

S47

85
Q

What are possible large side effects of small cell lung cancer?

A
  • ↓ Na⁺ (SIADH)
  • Hypercortisolism (Cushings presentations)
  • Lambert-Eaton Syndrome

S48

86
Q

Lambert-Eaton syndrome involves symptoms that ____ with exercise/movement.

A

improve

S48

87
Q

Myasthenia Gravis involves symptoms that ____ with exercise/movement.

A

deteriorate

S48

88
Q

How does Lambert-Eaton Syndrome react with some of our anesthesia drugs?

A
  • Lack of improvement with acetylcholinesterase inhibitors (Myesthenia gravis improves with these)
  • extreme sensitivity to non-depolarizing neuromuscular blockers

S48

89
Q

(Carcinoid tumors)

What tumor type is mostly benign and has great (>90%) 5 year survival rates?

A

Neuroendocrine tumors

S49

90
Q

Carcinoid syndrome usually results from tumor originating from where?

A

GI tract

S49

91
Q

What are characteristics of Carcinoid Syndrome?

A
  • Tumor secretion of serotonin, histamine, PG’s, tachykinins, kallikrein
  • Unresponsive to pressors (hemodynamic collapse)
  • Coronary artery spasm

TUC
T= His Sloppy Pigs Kill Turtles

S49

92
Q

How is carcinoid syndrome treated?

A

Octreotide & Somatostatin

These inhibit tumor growth, angiogenesis, and the hormones secreted from the tumor.

S49

These help GI symptoms and octreotide helps with GI bleeds.

93
Q

What type of lung cancer has a 5-year survival rate that greatly improves with surgery?

A

Non-small cell lung cancer

  • 10% w/o surgery
  • 40% w/ surgery

S50

94
Q

Squamous cell lung cancers grow to a large size but ____ late.

A

metastasize

S50

95
Q

What are possible consequences of squamous cancer’s large growth?

A

Mass Effect:

  • Hemoptysis
  • Obstructive PNA
  • Superior Vena Cava syndrome
  • Endobronchial tumor

S51

96
Q

What is the most common subtype of non-small cell lung cancers?

A

Adenocarcinomas (these metastasize early)

S52

97
Q

Where are Adenocarcinomas commonly found?

A
  • Brain
  • Bone
  • Liver
  • Adrenal glands
  • Chest wall
  • Diaphragm
  • Pericardium

Brian Breaks Little CRNAs And Dirty Pimps

S52

98
Q

What two hormones are typically secreted by adenocarcinomas?

A
  • Growth Hormone
  • ACTH (Cushings presentation)

S52

99
Q

What is the least common non-small cell lung cancer subtype?
What should be known about its metastatic characteristics?

A
  • Large cell
  • Metastasizes rapidly and usually are large cavitating tumors

S53

100
Q

4 M’s assessment of pts with lung cancer

A
  1. Mass effect: is it compromising other structures
  2. Metabolic abnormalities: hypercalcemia, hyponatremia, hyperglycemia (Cushings)
  3. Metastases
  4. Medications and what do we need to keep in mind with the meds (bleomycin, cisplatin etc)

S54

101
Q

What factors can help predict one lung desaturation?

A
  • High % of with ventilation or perfusion to operative lung on the preoperative V/Q scan.
  • Poor PaO₂ during two lung ventilation (especially in lateral position)
  • Right sided thoracotomy (pt will be in L decubitus)

S57

This is a VQ scan - the dark is perfusion

102
Q

What is the formula for predicted post-operative FEV₁ ?

A

S59

103
Q

A patient has had a right upper and right middle lobectomy done. The patients preoperative FEV₁ was 60%. What is the predicted post-operative FEV₁ ?

A

RUL + RML = 6 + 4 = 10 lung segments
10 segments/42 total = 23.8% of the lung resected

ppoFEV₁ = 60 x (1 - 23.8/100)

ppoFEV₁ = 45.72%

S59

Please look at this…. I think the equation is technically wrong. Same result, but wrong way of using the forumla. There is 10 lung segments missing so I think this should read ppoFEV₁ = 60 x (1 - 10/100). Maybe this is your way of doing it, which is cool too.

104
Q

What anticoagulative drug class requires discontinuation 7 days prior to surgery?

A
  • -grel drugs ( P2Y12 Inhibitors)
  • Ticagrelor

Clopidogrel, prasugrel, etc

S62

105
Q

Flip card to see anticoagulative medication hold times.

A

S62

106
Q

How many dermatomes are typically covered via a paravertebral block?

A

4-6 dermatomes for 1 shot

S63

107
Q

What are contraindications for paravertebral blocks?

A
  • Site infection
  • Empyema
  • Paravertebral tumor
  • Kyphoscoliosis

S63

108
Q

A paravertebral block at ___ is necessary for a sternotomy.

A

T4

S64

109
Q

A paravertebral block at ___ is necessary for a thoracotomy.

A

T6

S64

110
Q

A paravertebral block at ___ is necessary for abdominal procedures.

A

T10

S64

111
Q

What is required for intercostal nerve block?

A

Blockade 2 dermatomes above and 2 dermatomes below incision.
(innervates musculature of chest and abd wall)

S65

112
Q

What are indications for intercostal nerve block?

A
  • Thorax surgery
  • Upper abdomen surgery
  • Mastectomy

S65

113
Q

What are disadvantages associated with intercostal nerve block?

A
  • Pneumothorax
  • Bleeding
  • LA toxicity (especially if multiple levels are blocked bc this is a very vascular area).

S65

114
Q

Flip for intercostal nerve block pictures.

A

S66

Mar: Sem 4 - Principles II (27 decks)

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