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Flashcards in Cancer Assessment Deck (56)
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1

Most common cancers

Lung (#2 in men, increasing in women)

Breast (#1 in women)

Colon/GI (#2 cause of death overall)

Prostate (#1 in men)

Head & Neck

Metastatic tumors - brain, liver, spinal cord, superior vena cava compression

2

Pathological changes in hematologic system

Anemia: bone marrow suppression, GI ulcerations and anemia due to invasion

Neutropenia

Thrombocytopenia

Hypercoagulable state: risk of thromboembolic event

3

What hematologic questions to ask pt?

have you been anemic

infections

do you bruise/bleed easily

blood clots

4

Neuromuscular system pathologic changes

myofascial pain,

peripheral neuropathies

spinal cord compression

5

What neuromuscular questions to ask pt?

do you have numbness/tingling

can you move all extremities

do you have good strength

are you in pain

6

Pulmonary system pathological changes

pulm edema/CHF

recurrent pleural effusions (metastasis)

pneumonitis

pulmonary osteoarthropathy

7

Pulmonary osteoarthropathy definition

condition that affects some lung CA pts:

clubbing

spoon-shaped nails

inflammation/swelling/pain of hands, fingers, knees, ankles

8

Squamous cell lung CA incidence and effect

25-40%

hypercalcemia

9

Adenocarcinoma lung CA incidence and effect

30-50%

hypercoagulable

osteoarthritis

10

Large cell lung CA incidence and effect

10%

gynecomastia

11

Small cell lung CA incidence and effect

15-24%

inappropriate ADH secretion

ectopic corticotropin secretion

Eaton-Lambert syndrome (myasthenia syndrome)

12

Various pathological changes

anorexia/weight loss - hyperalimentation (artificial nutrients, typically IV)

electrolyte abnormalities - hypercalcemia from bone metastasis Na & K changes from N/V/diarrhea

adrenal insufficiency - tumors or corticosteroid therapyectopic hormone production - from syndromes that release extra hormones (ADH)

13

Cardiac system pathological changes

malignant involvement of the pericardium (pericardiual effusions)

electric alternans or paroxysmal A-fib/flutter

pericardial tamponade (most common in lung CA)

drug induced cardiomyopathy

impairment of LVF for 3 years after therapy has stopped

SVC obstruction - metastatic to mediastinum. venous engorgement above waist: dyspnea, airway obstruction (especially when lying down)facial/neck edema, JVD

14

What cardiac questions to ask pt?

ask about exercise intolerance

SOB

recent echo

manually feel pulse,

ook for JVD

ask about masses

15

Renal pathological changes

decreased clearance

drug induced nephrotoxicity/nephrotic syndrome

ureteral obstruction - hydronephrosis, hyperuricemia

16

Hepatic pathological changes

hepatocyte damage

coagulopathies (hypercoagulable state in general)

DIC common with hepatic metastasis

17

metabolic changes in CA pts

catabolic state:diarrhea

poor nutritional status (check albumin, will affect protein bound drugs)

volume depleted state - hypotension

18

Paraneoplastic syndrome incidence rate

8% of CA patients

19

Paraneoplastic neurologic changes

limbic encephalitis

cerebellar degeneration

myasthenia syndrome and gravis

20

Paraneoplastic endocrine changes

SIADH (headache, nausea, ataxia, lethargy, seizures)

hypercalcemia

Cushing's syndrome

hypoglycemia

21

Paraneoplastic renal changes

nephritis

amyloidosis

22

Paraneoplastic other changes

fever

cachexia

dermatologic changes

rheumatologic changes

hematologic changes

23

Cancer staging

TNMT -

tumor size 1-4N -

lymph node involvement 0-3M -

metastasis 0-no, 1-yes

stage 1 best prognosis

stage 4 worst prognosis

24

Lung CA surgery considerations

associated CAD, pulmonary insufficiency after tissue resection

potential for massive blood loss

special equipment (double lumen ETT)

25

Lung CA surgery preop labs/testing

Pulm function tests

DLCO

VO2 max

CXR

ABGs

baseline O2 sat

cardiac stress test

H/H, type and cross blood

26

Head and Neck CA surgery considerations

review imaging to assess airway needs

ask about dysphagia, difficulty breathing

potential for significant blood loss (H/H, type and cross)

lack of accessible airway, get special equipment

hypercalcemia related to metastasis

often heavy drinkers, get liver function test

27

Breast CA surgery considerations

poor IV access

limb at risk of lymphedema

think about a PICC line

28

Colon/GI CA surgery considerations

possible aspiration risk - give prophylactic meds (no Reglan)

possible dehydration from GI obstructions - give preop fluids

29

Prostate CA surgery

associated with increased bleeding

30

Cancer treatment types

traditional - when you can't differentiate between cancer and normal cells, increased cell death

targeted - given for specific cell division process

radiation - external beam, pellet/implant

Ablation - thermo, microwave, cold, electric field therapy