Oncology pt3 Flashcards
What is the major cause of lung cancer?
Tobacco smoke (90%)
3 decade lag time in cancer occurrence
What substances commonly cause lung cancer other than tobacco? (2)
- Asbestos
- Radon gas
What are the types of lung cancer? (4) Which is most prevalent?
- Small cell
- Non-small cell (75-80%)
- Carcinoid
- Mesothelioma
What are the subtypes of non-small-cell lung cancer? (3)
NSCLC Lung cancer:
- Squamous
- Adenocarcinoma
- Large cell
What type of lung cancer makes up 75-80% of cases?
Non-small cell
What is the typical origin of small cell lung cancer?
Neuroendocrine
Thus the cancer is typically metastatic on presentation
What lung cancer always recurs and is resistant to further treatment?
Small cell lung cancer
What are possible large side effects of small cell lung cancer? (3)
- ↓ Na⁺ [SIADH]
- Hypercortisolism [Cushings]
- Lambert-Eaton Syndrome
What is the name for the disease called hypercortisolism?
Cushing’s Disease
Lambert-Eaton syndrome involves weakness/fatiguability symptoms that ________ as the day goes on and with exercise.
improves with exercise
Myasthenia Gravis involves weakness/fatiguability symptoms that ________ as the day goes on.
worsen with exercise and throughout the day
Lack of improvement with acetylcholinesterase inhibitors and extreme sensitivity to non-depolarizing neuromuscular blockers are characteristics of what disease?
Lambert-Eaton Syndrome (LEMS)
What tumor type is mostly benign and has great (>90%) 5 year survival rates?
carcinoid tumors
Carcinoid syndrome usually results from tumor originating from where?
GI tract
What are characteristics of Carcinoid Syndrome? (3)
- Tumor secretion of serotonin, histamine, PG’s, tachykinins, kallikrein
- Hemodynamic collapse unresponsive to pressors
- Coronary artery spasm
How is carcinoid syndrome treated? What do these drugs do?
Octreotide & Somatostatin
These inhibit tumor growth, angiogenesis, and the hormones secreted from the tumor.
What type of lung cancer has a 5-year survival rate that greatly improves with surgery?
Non-small cell lung cancer (NSCLC)
- 10% w/o surgery
- 40% w/ surgery
Squamous cell lung cancers grow to a large size but _______ late.
metastasize late
What are possible consequences of squamous cancer’s large growth (mass effect)? (3)
Mass Effect:
- Hemoptysis
- Obstructive PNA
- Superior Vena Cava syndrome
What is the most common subtype of non-small cell lung cancers?
Adenocarcinomas
Adenocarcinomas will typically metastasize ______.
metastasize early
What two hormones are often secreted by adenocarcinomas? (2)
- Growth Hormone
- ACTH
⇶ cushings symptoms
What is the least common non-small cell lung cancer subtype?
What should be known about its metastatic characteristics?
- Large cell
- Metastasizes rapidly
NSAIDs can induce acute respiratory failure when combined with what chemotherapeutic?
Cisplatin
What factors can help predict one lung desaturation? (3)
- High % of Ventilation or perfusion to operative lung on the preoperative V/Q scan.
- Poor PaO₂ during two lung ventilation
- Right sided thoracotomy
What is the formula for predicted post-operative FEV₁ ?
PreopFEV1 x (1-(%resection/100))
If 70% FEV1 preop and resecting RLL
- RLL = 12/42 = 29% resection
- 70 x (1-(29/100))
- ppoFEV1=49.7%
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 ?
ppoFEV₁ = 60 x (1 - 23.8/100)
ppoFEV₁ = 45.72%
How many dermatomes are typically covered via a paravertebral block?
4-6 dermatomes
What are contraindications for paravertebral blocks? (4)
- Site infection
- Empyema
- Paravertebral tumor
- Kyphoscoliosis
A paravertebral block at ___ is necessary for a sternotomy.
T4
A paravertebral block at ___ is necessary for a thoracotomy.
T6
A paravertebral block at ___ is necessary for abdominal procedures.
T10
What is required for intercostal nerve block?
Blockade 2 dermatomes above and 2 dermatomes below incision.
What are indications for intercostal nerve block? (3)
- Thorax surgery
- Upper abdomen surgery
- Mastectomy
What are disadvantages associated with intercostal nerve block? (2)
- Pneumothorax risk
- LA toxicity (especially if multiple levels are blocked).
Flip for intercostal nerve block pictures.
What is the leading cause of cancer deaths in both genders?
Lung cancer
What are 3 subtypes of non-small cell lung cancer?
- squamous cell
- adenocarcinoma
- large-cell
What are the 4 M’s of assessment for patients with lung cancer?
- Mass effect
- Metabolic abnormalities
- Metastases
- Medications
