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Anesthesia & Coexisting Disease > Final_Cancer > Flashcards

Final_Cancer Flashcards

1
Q

Drivers of Cancer

A

Genetic changes contributing to cancer usually affect 3 cell types:

  1. Proto-oncogenes
  2. Tumor suppressor genes
  3. DNA repair genes
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2
Q

Cancer Incidence

A

■About 1.76 million newly diagnosed individuals each year
■~ 600K men, women + children expected to die
~ 1600 people per day
■2nd leading cause of death in US
- #1 if under age 75
■ 5-year survival is 65%
■ Lifetime risk of dying from cancer is 1 in 4 men, or 1 in 5 women
■ 2nd leading cause of death in children ages 1-14

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3
Q

Why do cancer cells invade?

A
  • No boundaries (Cell does not respect usual cell growth limits)
  • Cells Wander (Less adhesive to one another)
  • Angiogenic (Cells make new blood supply to feed itself)
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4
Q

How is CA staged?

A 
TNM 
Each staged, then combined to form overall stage in roman numerals: the higher the #, more advanced the CA
T: extent + size of tumor
N: # lymph nodes  
M:  metastasized
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5
Q

Staging: M

A

M0: no spread of cancer to distant organs
M1: cancer is found in distant organs

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6
Q

Staging: T

A 
Tis: confined to innermost layer
T1: grown throughout first few layers 
T2: grown into thick muscular layer 
T3: grown thru entire wall
T4: grown thru entire wall + into nearby tissue/organ
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7
Q

Staging: N

A

N0: no spread to lymph nodes
N1: CA found in 1-3 lymph nodes
N2: CA found in 4 or more lymph nodes

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8
Q

External Beam Radiation

A

-Used to treat large surface areas,
-Usually both main tumor & regional lymph nodes
■3D Conformational Radiation Therapy
■Stereotactic radiosurgery (SRS)
■Intraoperative Radiation Therapy (IORT)

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9
Q

3D Conformational Radiation Therapy

A

3D external beam that uses a fitted mold to target CA from different directions

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10
Q

Stereotactic radiosurgery (SRS)

A
  • precise dose of radiation in a small well-defined area, narrow beam radiation
  • Primarily used in the brain
  • higher doses in less frequent treatments
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11
Q

Intraoperative Radiation Therapy (IORT)

A

used inside an open cavity during surgery

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12
Q

Anesthesia Concerns for Radiation

A
  • Provide Rx to reduce patient anxiety + keep immobile
  • May use sedation or GA
  • May be long delays between stimulus + radiation calculations (need to keep pts VS stable + maintain adequate level of anesthesia during stimulus)
  • Usually performed in far + away places (Ensure access to emergency supplies)
  • Radiation exposure to anesthesia personnel (Protective equipment)
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13
Q

Internal radiation therapy

A
  • Brachytherapy
  • High Dose Radiation (HDR)
  • Low Dose Radiation (LDR)
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14
Q

Brachytherapy

A
  • placing radiation inside the body

- high dose radiation seeds, pellets, plaques, or tubes close to the tumor

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15
Q

High Dose Radiation (HDR)

A
  • over a few minutes each time over a period of days or weeks
  • Treatment course + timing of treatments are pre-determined
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16
Q

Low Dose Radiation (LDR)

A
  • Implanted giving a low dose over a period of 1-7 days
  • Patient will usually be on some isolation with minimal interaction with other people -Some may be permanent implants whose radioactivity will diminish overtime
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17
Q

Adverse Radiation Effects

A

■Radiation pneumonitis
■Skin changes
■Decreased salivary gland production: mouth sores, thrush, difficulty swallowing
■Radiation induced heart disease

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18
Q

AEs: Adriamycin (doxyrubicin)/danauorubicin

A

Cardiomyopathy

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19
Q

AEs: Bleomycin

A

pHTN

pulmonary fibrosis

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20
Q

AEs: Vincristine + Vinblastine

A

Neurotoxicity

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21
Q

AEs: Cisplatin

A

Nephrotoxicity

22
Q

AEs: Cyclophosphamide (cytoxan)

A

bone marrow suppression

23
Q

AEs: Methotrexate

A

Hepatic toxicity

24
Q

AEs: L-asperigenase

A

hepatic failure

25
Q

AE: CVS effects most often associated with

A

Anthracycline agents

26
Q

AEs: Acute Cardiac Changes from Chemo

A
  • ST-T wave changes, PVCs, PACs, sinus tachycardia
  • Changes are unrelated to dose + usually revert to baseline 1-2m after tx
  • Decreased R wave amplitude may be a precursor of later cardiomyopathy
27
Q

Bleomycin - clinical symptoms

A 
*occurs 4-10 weeks after therapy
Pulmonary toxicity: 
-Pleuretic chest pain
-Fever
-CXR: bilateral basal peripheral infiltrates with fibrosis
-Cough
-DOE
-Rails
28
Q

Targeted therapy

A

■Targets proteins that control how cancer cells grow, divide, + spread
■The foundation of precision medicine
■Types: Small molecule, Monoclonal antibodies

29
Q

How does targeted therapy work?

A

–Help immune system destroy cancer cells
–Stop cancer cells from growing
–Stop signals that help to form blood vessels
–Deliver cell-killing substances to cancer cells
–Cause cancer cell death
–Starve hormones needed for cancer cell proliferation

30
Q

stem cell therapy is used for

A

cancers of the blood and lymphatic system

  • Lymphoma, myeloma
  • Leukemia
31
Q

Types of stem cell therapy

A
  1. Autologous - Cells are harvested from bone marrow before chemo
  2. Allogenic- Stem cells from a donor
    * Best match is usually a first degree relative
32
Q

carcinoid syndrome

A
  • GI tumors
  • Arise from fore/mid + hind gut
  • Mid-gut tumors = most common; < 25% of tumors in this area produce carcinoid syndrome
  • Symptoms presented are proportional to amount of secreting tumor present
33
Q

carcinoid syndrome could secrete

A
  • Serotonin
  • Bradykinins
  • Histamines
  • Prostaglandins
34
Q

Anesthetic considerations for Carcinoid syndrome

A
  • invasive monitoring for BP
  • freq. electrolyte samples
  • Pretreat with: Octreotide (or paltreotide-somatostatin analogs)
  • steroids
  • H1, H2 antagonists
  • consider in pts with gastric, lung, colorectal tumors
35
Q

Management of CA pain

A

Neuroablative techniques:
-Interrupt pain transmission fibers
-Cordotomy, rhizotomy, myelotomy, dorsal root entry zone lesion
Neurostimulatory techniques:
-Implanted electrodes
Neuropharmacological:
-Epidural pumps, intrathecal administration, intraventricular spaces

36
Q

Transcutaneous Electronic Nerve Stimulator (TENS)

A
  • Peripheral nerve stimulation
  • SubQ nerve stimulation
  • Localized pain in a specific dermatomal or focal region
  • Regional dermatomal + visceral nerve endings
  • Pt will need anesthesia for placement of subQ units
  • Staged process: pocket creation, testing + insertion, battery change
37
Q

Neuroablative Technique: Cordotomy

A

-Destroys pain-conducting tracts of the spinal cord
-Percutaneous approach at level of C1-C2
(fluoroscopic or CT guided, MAC w/ LA)
-Open approaches at other spinal levels (GA)

38
Q

Neuroablative Technique: Cordotomy - post procedure side effects

A
  • Dysesthesia
  • urinary retention
  • Ataxia
  • Paresis
  • sympathetic dysfunction (hypotension, Horner’s syndrome and bladder dysfunction)
  • Sexual sensitivity impaired or lost
  • Acquired central hypoventilation syndrome
39
Q

SVC Syndrome

A

Compression of the thin walled superior vena cava by an expanding mediastinal mass
(Obstruction of venous drainage from upper thorax )

40
Q

SVC Syndrome S/S

A
  • head, neck, upper extremity edema, H/A, vertigo
  • Hoarseness, chest pain, difficulty swallowing
  • Horner’s syndrome
41
Q

Horners Syndrome

A

constricted pupils, sagging eyelid, lack of sweating

42
Q

Preparation for Cancer Surgery

A

Key = PREPARE

  • Review preop consult notes/scans available
  • Speak with surgeon
  • For large masses especially of bone or near vascular beds prepare with large IVs, possible central access, arterial line, rapid infuser, have blood products on hand
43
Q

Diagnostic procedures - CA require

A
  • very cooperative, immobile patient

- know the location, biopsies near major vessels, lung, liver, kidney may have greater complications

44
Q

Spinal cord perfusion pressure

A

Arterial pressure - spinal cord venous pressure (or CSF)

45
Q

Leukemia

A

CA of blood

-forms in tissues in bone marrow + lymphatic system

46
Q

Lymphoma

A

group of blood cancers that develop in lymphatic system

47
Q

Lymphotic leukemias begin in

A

lymph

48
Q

Myeloid leukemias begin in

A

bone marrow

49
Q

GVHD

A

life threatening complication of bone marrow transplant

-donor cells attack antigens on recipients cells

50
Q

GVHD presentation

A
  • soughing of skin
  • oral/GI ulcerations
  • abd pain, rash, pain
51
Q

GVHD tx

A

Prevent: Tacro/cyclosporine
Tx: Glucocorticoids

52
Q

Chronic GVHD

A
  • major cause of late non-relapse death in older pts at high risk
  • pericarditis + restrictive lung disease
  • nephrotic syndrome, jaundice

Anesthesia & Coexisting Disease (23 decks)

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