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1a. 675 - Coexisting Diseases > Week 9 - Cancer > Flashcards

Week 9 - Cancer Flashcards

1
Q

What % of pts with cancer require surgery?

A

90%

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2
Q

What % of pts diagnosed w/ cancer survive for at least 5 years?

A

65%

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3
Q

What carcinogen accounts for more cases of cancer than all known carcinogens combined?

A

Tuh- baccuh

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4
Q

What cancer amongst males has the highest and second highest incidence?

A
  1. Prostate
  2. Lung/Bronchus
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5
Q

What cancer amongst females has the highest and second highest incidence?

A
  1. Breast
  2. Lung/Bronchus
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6
Q

2 main cancer mechanisms?

A
  1. Proto-oncogene → exposure to cancer promoting agent → Oncogene → Cancerous Cell
  2. Inactivation of Tumor suppressing gene → uncontrolled cell division
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7
Q

Your Pt has an ↑ CEA test, what kind of cancer might they have?

A

↑ CEA alone does not always indicate Cancer
Investigate further

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8
Q

What kind of chemotherapeutic is Cyclophosphamide?

A

Alkylating Agent

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9
Q

What kind of cancer is Cyclophosphamide used to tx?

8

A
  • Lymphoma
  • Multiple Myeloma
  • Leukemia
  • Ovarian CA
  • Breast CA
  • Small Cell Lung CA
  • Neuroblastoma
  • Sarcoma
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10
Q

Anesthetic consideration in a pt treated w/ Cyclophosphamide?

A

Irreversible inhibition of pseudocholinesterase
* Prolongation of Succinylcholine DoA

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11
Q

What is the purpose of radiation therapy in the treatment of cancer?

A

Targets cancerous cells by damaging DNA → Cellular apoptosis (Death)

apoptosis sounds neat

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12
Q

What are the presentations (and their causes) of tumor lysis syndrome?

3

A
  • Acute Renal failure (due to ↑ uric acidemia)
  • Cardiac Arrhythmias ( ↑ K+ release)
  • Muscular Tetany (↑ phosphate release → hyperphosphatemia → hypocalcemia)
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13
Q

What is released due to tumor lysis syndrome?

3

A
  • ↑ Uric Acid
  • ↑ K+
  • ↑ Phosphate
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14
Q

Doxorubicin is toxic to which body system, and what are the anesthetic considerations?

A

Cardiac
* Pre-op EKG & ECHO
* Check K+ levels

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15
Q

Bleomycin is toxic to which body system, and what are the anesthetic considerations?

3

A

Pulmonary Toxicity
* Do NOT use 100% O2, < 30% is fine
* Pre-op CXR

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16
Q

Methotrexate is toxic to which body systems?

A
  • Acute Hepatic Dysfunction
  • Bone Marrow (Myelosuppression)
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17
Q

Concern for a pt receiving Tamoxifen?

A

VTE (Thromboembolism)

18
Q

Anthracyclines are what kind of medications?

A

Antibiotic that comes from Streptomyces bacteria

19
Q

What are a couple of Anthracyclines and what is their suffix?

5ish

A

-rubicins
* Doxorubicin (Adriamycin aka. da red Devil)
* Daunorubicin
* Epirubicin
* Idarubicin

20
Q

What are chemotherapeutic cardiotoxicity risk factors?

A
  • Large cumulative dose (>300 or > 500 mg/m2 of doxorubicin)
  • hx of High BOLUS dose
  • hx of cocomitant radiation therapy
21
Q

How may the cardiotoxicity of doxorubicin be decreased?

3

A

Free radical scavengers
* Dexrazoxane
* Liposomal preparations

22
Q

When and how does chemotherapeutic Acute Cardiotoxicity present?

4

A

Early in treatment
* Dysrhythmias
* QT prolongation
* Cardiomyopathy

23
Q

How is acute cardiotoxicity from chemotherapy treated?

A

Acute toxicity reverses w/ d/c of therapy

24
Q

What specific chemotherapeutic drugs cause HTN in 30-40% of pts?

4…. and I’m sorry

A
  • Bevacizumab
  • Tratuzumab
  • Sorafenib
  • Sunitinib
25
Q

What are some disease states we are concerned for in pts who have received Mediastinal radiation?

5

A
  • Myocardial fibrosis
  • Pericarditis
  • Valvular fibrosis
  • Conduction abnormalities
  • ↑ development of CAD
26
Q

What medication should be avoided in bone marrow donors, and why?

A

N2O
* May cause bone marrow suppression

27
Q

Anesthetic considerations for pts on chemotherapy?

5

A
  • Use Regional Anesthesia (unless CI)
  • ↓ use of VA
  • Propofol induction/infusion (TIVA)
  • Avoid Etomidate (cancer migration?)
  • Maintain asceptic technique
28
Q

Volatile anesthetic effects on immune system?

A
  • ↓ cytotoxicity of NK cells
  • ↑ apoptosis of T-cells
  • ↑ tumorigenic growth factos
  • ↓ apoptosis of Cancer cells
  • ↑ angiogenesis (↑ tumor blood supply)
29
Q

Which VA causes the most suppression of the immune system?

A

Isoflurane (can cause cancer cell migration)

30
Q

What combination of anesthetics causes the lowest amount of immunosuppression?

A
  • Propofol
  • COX inhibitors
  • Regional Anesthesia
31
Q

What regional anesthesia technique can be used for Mastectomy?

A

PEC I & II block

32
Q

What complication of regional anesthesia for a mastectomy would you be concerned for?

A

Pneumothorax

33
Q

What are some Anesthetic considerations for Radical Prostatectomy?

5

A
  • Long Surgical Time
  • Lithotomy position
  • ↑ Blood loss
  • Open vs. Robotic
  • Radiation beads
34
Q

What gene inactivation is an early step in the development of many types of cancer?

A

p53 (Tumor-suppressing gene)

35
Q

DVT/VTE prophylaxis is continued for how long after a high-risk cancer pt undergoes major surgery?

A

4 weeks

36
Q

Which anesthetic drugs have cytotoxic effects on cancer cells?

A

Amide LAs
* Lidocaine
* Bupivacaine
* Ropivacaine

37
Q

You’re in pre-op w/ a pt who has a hx of chemo & radiation, besides airway, what considerations are you concerned of?

5

A
  • Cardio/Pulmonary/Renal toxicity
  • Neuropathies
  • N/V -> hypokalemic metabolic alkalosis
  • ↑ Bleeding risk (impaired platelets)
  • Avoid DVL -> Use Glidescope/C-mac
38
Q

What gene most likely triggers cancer when exposed to sunlight or tobacco smoke?

A

Oncogene

39
Q

Your pt is on Doxorubacin (Anthracycline) what kind of pre-operative test(s) would you want to get?

A
  • Echocardiogram
  • EKG
40
Q

Pt on chemotherapy, are they more likely to experience HoTN or HTN?

A

HTN, especially with targeted therapies

41
Q

What type of heart dysfunction occurs with chemotherapies?

A

LV Dysfunction

1a. 675 - Coexisting Diseases (12 decks)

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