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Flashcards in Cancer Deck (43)
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1

Cancer is the ___ leading cause of death in US

second

2

Most common cancer types among genders?

Male

  • prostate
  • lung
  • colon

Female

  • breast
  • lung
  • colon

3

What can bleomycin cause?

  • Pulmonary hypertension
  • pulmonary fibrosis

4

What can cisplatin cause?

  • Dysrhythmia
  • magnesium wasting
  • mucositis
  • ototoxicity
  • peripheral neuroapthy
  • SIADH
  • Renal tubular necrosis
  • thromboembolism

5

What can cyclophosphamide (cytoxan) do?

  • Encephalopathy/delirium
  • hemorrhagic cystitis
  • myelosuppression
  • pericarditis
  • pericardial effusion
  • SIADH
  • pulmonary fibrosis

6

What can doxorubicin cause?

  • CMP
  • myelosuppression

7

What can fluorouracil cause (5FU?)

  • Acute cerebellar ataxia
  • ischemic and nonischemic EKG changes
  • CP
  • Gastritis
  • myelosuppression

8

What can methotrexate cause?

  • Encephalopathy
  • hepatic dysfunction
  • mucositis
  • plt dysfunction
  • hypersensitivity pneumonitis
  • renal failure
  • myelosuppression

9

What can tamoxifen cause?

thromboembolism

10

What can vincristine cause?

  • Autonomic dysfuction
  • MI
  • peripheral neuropathy
  • bronchospasm
  • SIADH

11

What was the picture to remember common chemo toxicities?

  • C= Cisplatin (aklyating agent)- acoustic n injury + nephrotoxicity
  • V= vincristine and vinblastine (tubulin binding drug_= peripheral neuropathy
  • B: bleomycin (antitumor antibiotic)= pulmonary fibrosis FIO2 <30%
  • D= doxorubicin(antitumoe antibiotic)= cardiotoxic
  • 5= 5FU (antimetabolite)- bone marrow suppression
  • M= Methotrexate (antimetabolite)= bone marrow suppression

12

Common adverse effects of radiation therapy? (Skin, GI, cardiac, resp, renal, hepatic, endocrine, hematologic)

13

Focuses of preop assessment for Ca patient?

  • Malignancy in head/neck
    • airway exam and possible need for trach
    • recurrent laryngeal n damage
  • Mediastinal masses obstructing great vessels
    • dyspnea, dysphagia, stridor, wheezing, coughing--> recumbent positon
    • compression of SVC--< JVD, Facial, chest , neck, UE edema
  • Preop testing: CXR, CT, MRI, EKG, Echo
  • Anesthetic concerns
    • airway cart
    • emergency suppy
    • trach
    • spontaneous awake intubation
    • ENT at bedside

14

What is SVC syndrome?

  • Obstruction of superior vena cava caused by spread of Ca into mediastinum or into caval wall
  • veins above level of heart, particularly with jugular veins and veins in arms, become engorged
  • edema of face and UE prominent
  • increased ICP manifests as nausea, sz, decreased LOC
  • May cause syncope

15

What is superior mediastinal syndrome?

combo of SVC syndrome and tracheal compression

  • HOrseness, dyspnea and airway obstruciton may be present b/c tracheal compression
  • txmt consist of radiation therapy or chemo
  • bronchoscopy/mediastinoscopy to obtain tissue dx can be hazardous

16

What to look for in airway assessment of Ca patient?

  • tracheal deviation or compression
  • SOB
  • dificulty breathing
  • dysphagia
  • cervical ROM, cervical Xray, ENT consult

17

What can radiation to head neck be concerning for?

permanent tissue fibrosis

  • carotid artery dx
  • hypothyroidism
  • difficult vent
  • difficult intubation

18

Special anesthesia preop consideration of head and neck ca?

  • Review imaging studies to determine if alternate airway mgmt plan should b eused
  • question pt regarding dysphagia and difficulty breathing
  • sx blood loss can be sig T&C, CBC
  • Lack of accessibility to airway during case
  • hypercalcemia related to METS
  • alchol induced liver dx
  • chornic smoking hx PFT, pulm toilet, inhalers
  • May need nutritional therapy preop
  • plan for difficult airway
  • may need invasive monitorign ie aline

19

Concerns for geriatrics with ca?

  • Greater comorbidities, fraility, polypharmacy
  • risk of delirium
    • chemobrain- chemo induced cognitive dysfunction

20

Education and prevention around sx with ca patient?

  • management of comorbidities
  • exercise routine prior to sx- improves surgical recovery and overall survivorship

21

What is important question to ask Ca patient's (regarding meds)?

  • Prior ca treatments and dates
    • long term s/e
    • acute s/e

22

Concerns during assessment of CV system in Ca patient?

  • HR, pulse, carotid arteries
  • if bruits present-> ask patient to stop breathing 15 sec
    • if severe stenosis and large intraop fluid shifts are expected, revascularization is considered
    • mild stenosis= pharm therapy
  • sig fatigue and loss of functional status
    • echo ordered and result WNL may not mean much under stress of sx
  • Cardiac stress testing might be considered?
  • maybe BNP

23

What is one drug that strongly affects CV system?

doxorubicin (adriamycin)

  • Acute/chronic
  • QT prolongation
  • dysrhythmia
  • ischemia-related EKG changes
  • HTN (monoclonal antibodies and tyrosine kinase inhibitors)

24

Considerations for respiratoyr system assessment for Ca pt?

  • Baseline and serial PFT
  • Chest radiography
  • pleural effusion
  • bleomycin?

25

What are some complications with adenocarcinoma? large cell lung Ca? small cell lung Ca?

  • Adenocarcinoma (30-50%)- blood clots
  • large cell- gynecomastia
  • small cell- muscle weakeness, paraneoplastic syndromes

26

Which cancers are known for secreting ADH?

  • Duodenal
  • lung (small cell)
  • lymphoma
  • pancreatic
  • prostate

27

Which cancers can secrete human chorionic gonadotropin?

  • Adrenal
  • breast
  • lung (large cell)
  • ovarian
  • testicular

causes gynecomastia, galactorrhea, precocious puberty

28

Which Ca can secrete adrenocorticotropic hormone?

  • Carcinoid
  • lun g(small cell)
  • thymoma
  • thyroid

manifestation: cushing syndrome

29

How can the renal system be impacted with cisplatin and cyclophosphamide?

  • Cisplatin (and methotrexate)
    • renal insuff-- usually resolve with cessation of drug
  • Cyclophosphamide
    • SIADH
    • cystitis
    • medication concern: mivacurium, succinylcholine
    • renal labs
  • tumor cell lysis
    • uric acid crystal buildup

30

How many days after chemo does nadir happen?

7-14 days