Exam 3: Oncology and Chemotherapy Flashcards
(114 cards)
1
Q
Normal cell process, and cancer cell process
A
- normal cells grow and divide as needed then perform apoptosis when they are old of damaged
- Cancer cells survive when they should die or they form when they aren’t needed
S2
2
Q
What are tissue changes seen in cancer cells?
A
- Number of cells increases (hyperplasia).
- Organization changes (dysplasia)
S3
3
Q
What is the progression from normal cells to cancerous cells?
A
S3
4
Q
Definition of Cancer
A
- A collection of related diseases of cells that begin to divide without stopping and can spread into surrounding tissues
- may form solid tumors or leukemias
- Caused by genetic changes inherited from parents or mutations to DNA
S4
5
Q
Characteristics of Cancer Cells
A
- Less specialized
- Can ignore pre-programmed apoptosis signals
- Abnormally influence normal cells (ex. make normal cells form blood vessels which feed a tumor - angiogensis)
- Can evade the immune system
S5
6
Q
What are the three “drivers” that increase the proliferation of cancer cells?
A
-
Proto-oncogenes
Involved in normal cell growth and division
Become cancer-causing…allow cells to grow and survive -
Tumor suppressor genes
Alterations allow genes to divide uncontrollably -
DNA repair genes
Incorrect damage repair; cause other mutations
S6
7
Q
How many types of cancers are there?
A
More than 100
named for organs, tissues, or types of cells that the cancer orginates from
S7
8
Q
Where do basal cell cancers originate from?
A
Basal layer of the epidermis
S7
9
Q
Where do squamous cell cancers originate from?
A
Epithelial cells:
- Beneath skin
- GI tract
- lungs
- Bladder
S7
10
Q
Where do adenocarcinoma’s originate from?
A
- Mucous producing cells
- Gland tissue (breast, prostate)
S7
Attorney General
11
Q
Where do sarcoma’s originate from?
A
Bone and soft tissue
Ex: osteosarcoma
S7
12
Q
Where do leukemia’s originate from?
A
Bone marrow
S7
13
Q
Where do lymphoma’s originate from?
A
Lymphocytes (T or B cells)
These tend to build up on lymph nodes and lymph vessels.
S7
14
Q
What are some problems in cancer screenings?
A
- Can cause problems: Colonoscopy perforation
- Can have false-positives
- Can have false-negatives
we want a screening that is easy to treat and curable
S9
15
Q
Screenings are working if statistics show:
A
- More early-stage cancers found
- Less late-stage cancers found
- Less deaths occur
S9
16
Q
What is absolute risk?
A
Absolute risk
- How many people get “x” in a certain period.
Ex. If 4 people out of a group of 100,000 get “x” then risk is 4 in 100,000
S10
17
Q
Explain relative risk.
A
% of people in exposed group that develop cancer
vs.
% of people in unexposed group with diagnosis.
S10
18
Q
Give an example of a relative risk that is greater than 1.
A
Smoking
Smoking increases risk relative to the rest of the population.
A relative risk >1 there is a positive correlation
S10
19
Q
Give an example of a relative risk that is less than 1.
A
Exercise
Exercise decreases risk relative to the rest of the population.
A relative risk <1 will be a negative correlation
S10
20
Q
What cancer screenings are typically standard now?
A
- Colonoscopy
- Mammograms
- Pap Smears
S11
21
Q
What are the factors measured in tumor staging?
A
- T: size/extent of primary tumor
- N: # of nearby lymph nodes which are +
- M: is there metastasis
S12
The staging is done at diagnosis. No later evaluation.
22
Q
What are all the measurements for size of the Tumor?
A
- TX: tumor cannot be measured.
- T0: tumor cannot be found.
T1-T4 refers to larger and larger size and extent
* T1= least invasive
* T4 = most invasive
S13
23
Q
What are all the Lymph node measurements?
A
- NX: cancer in nearby lymph nodes cannot be measured.
- N0: no cancer in nearby lymph nodes.
N1-N3 is the number and location of lymph involved
* N1 = limited cancer found in regional lymph nodes
N3 = cancer is all up in these lymph nodes
S13
24
Q
How is metastasis measured in the tumor staging system?
A
- MX:cannot be measured.
- M0: has not spread to other parts of the body.
- M1: has spread to other parts of the body.
S13
25
What are other staging systems?
- In situ: abnormal cells are present but have not spread to nearby tissue
- Localized: limited to place where it started; no sign of spread
- Regional: has spread to nearby lymph nodes, tissues, or organs
- Distant: spread to distant parts of body
- Unknown: not enough information to figure out the stage
| S14
26
For median survival of 6 months or less what two factors are more important that type of cancer?
- Functional status
- Laboratory values
| S15
27
What factors are associated with a survival rate that is 6 months or less?
| S15
## Footnote
Serum Calcium will likely indicate bone break-down or kidney involvement
28
What type of cancers will frequently radiate to the bone?
* Breast
* Lungs
* Kidney
* Prostate
| S16
## Footnote
Osteolytic, osteoblastic or both lesions
29
What can be helpful in treating cancer metastasis to the bone?
- Radiotherapy/chemotherapy
* NSAID +/- opioids
* Vertebroplasty (cement that can be injected into the vertabra to stabalize and prevent collapse)
| S16
30
Hormonal therapy is often helpful for what types of cancer?
Breast
Lung
Kidney
Prostate
| S16
## Footnote
These are the same that radiate to bones
31
Why does cancer typically cause pain?
* Invasion of tumor into tissues innervated by afferent neurons
* Directly invades nerve plexus
| S17
## Footnote
Pain is mostly d/t cancer itself not treatment
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WHO “Cancer Pain Stepladder”
* Prompt administration fo pain meds
* On schedule; not prn (prophylactic)
* Add antianxiety drugs as necessary
* 80-90% effective (simple things can go a long way)
| S18
33
Common nerve blocks used to treat cancer patients
* Celiac plexus
* Intercostal nerves
* Lumbar sympathetic
*These are used when pharmacologic treatment has failed - hopefully soon we can start using regional as a sooner treatment*
| S20
34
What areas are anesthetized with a celiac plexus block?
- Sympathetic fibers of T5-T12
- Parasympathetic celiac plexus fibers
| S20
35
For what types of cancer are celiac plexus blocks typically performed?
Unresectable:
- Pancreatic
- Hepatic
- Gastric
| S20
36
What injection is used with a neurolytic celiac plexus block?
How long does this typically last?
Isopropyl alcohol - kills the nerve (but then be aware of sympathectomy)
*Destruction of nerves typically lasts 3-6 months*.
| S20
37
What is the principal benefit of continuous infusion via catheters for cancer pain?
- ↓ systemic side effects
- Technique and equipment very available.
| S21
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What are the drawbacks to continuous catheters for cancer pain?
- limited duration of therapy because of migration, granulomas, lack of homogenous drug distribution, infection rates etc
- no randomized control trials
| S21
39
What can chemotherapy drugs be used for?
* Kill cancer cells
* Shrink tumors
* prepare pts for bone marrow transplant
* Control overactive immune diseases (SLA and RA)
| S23
40
Chemotherapy target cells in different phases of their ____.
* Cell cycle
*Idea is they inhibit growth in different phases*
| S23
41
How do alkylating agents work?
Whats an example of an alkylating agent?
Cisplatin (Nitrosurea)
- Damage cell DNA in all phases of the cell cycle, therefore can treat many different cancers.
- Can cross BBB so its effective at treating brain cancers
| S24
42
What is a severe side effect of alkylating agents?
Dose-dependent cause of leukemia 5-10 years after treatment because these agents will damage blood cells.
| S24
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Other side effects and interactions
- SE: peripheral neuropathy
- SE: Acute renal failure if taken with NSAIDs
| S24 and S54 (Neuropathy was S36)
44
What types of cancers do antimetabolites treat?
- Breast
- Ovary
- Intestines
- Leukemias
| S25
## Footnote
A BOIL
45
How do antimetabolites work?
Interfere with DNA and RNA - act as subsitute for normal building blocks
| S25
46
What are two examples of antimetabolites?
- Methotrexate
- 5-Fluorouracil
| S25
## Footnote
Its **5 AM** somewhere
47
How do Anti-tumor antibiotics treat cancer?
- Interfere with DNA copying enzymes
*Used for a large variety of cancers*
| S26
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What are examples of anti-tumor antibiotics?
-cins
*Doxorubicin, bleomycin, Mitomycin-C etc*
| S26
49
What type of cancer drugs have life-time dosing limits?
Why is this?
Anti-tumor antibiotics because they permanently damage cardiac tissue in large doses.
| S26
50
Anesthesia Implication of Bleomycin
Increases risk of Pulmonary O2 toxicity with high FiO2
| S26
51
Which chemotherapy increases the risk of a second cancer developing?
Topoisomerase Inhibitors
| S27
52
MOA for Topoisomerase inhibitors and what cancers do they treat?
- Plant alkaloids: prevent strands of DNA from being separated to copy
- Treat: Leukemias, Lung, ovarian, GI, Colorectal and pancreatic
DNA is PLANTED together
PC - LLOG
| S27
53
Which chemotherapeutic agent damages cells in all phases through the prevention of protein synthesis?
Mitotic Inhibitors
| S28
54
Which other chemotherapeutic class may cause peripheral neuropathy?
Mitotic inhibitors
(-Taxels and vincristine, vinblastine, etc.)
| S28
55
What agents are the plant alkaloids?
* Topoisomerase inhibitors
* Mitotic inhibitors
| S27 and 28
56
What other types of treament are there for cancer?
- Targeted Therapy (newer drugs): specific proteins or receptors on cancer cells
- Hormone therapy: prevent body from making specific hormones (slower growth of hormonal tumors)
- Immunotherapy: boost immune system to better recognize cancer cells
| S29
57
What cells are most likely to be damaged due to chemotherapy?
- Bone marrow (neutrophenia)
- Hair follicles
- GI tract (including mouth)
- Reproductive systems
| S30
58
What drug can inhibit hormonal contraceptives by 28 days?
*And thus result in unexpected baby's*.
Aprepitant (neurokinin 1 antagonist)
| S31
59
How does marijuana treat nausea/vomiting?
* Depresses CNS vomiting center
* more effective than phenothiazines
* decreases anesthetic requirements 15-30%
| S31
60
What is radiation's effects on the peripheral vascular system?
**Coagulopathy**
6x increase!
| S34
61
What is radiation's effects on tissues afflicted by head and neck cancers?
- ↓ Thyroid function
- Carotid artery disease
- Possible airway issues (**stiff tissues** (kahoot) have rescue airway devices available)
| S34
62
What is radiation's effects on the chest wall and/or breasts?
- Pericarditis
- Cardiomyopathy
- Valvulopathies
- Dysrhythmias/conduction abnormalities
| S35
63
What is the possible effect of radiation on the lungs??
Radiation pneumonitis
*can also be prone to esophageal errosion*
| S35
64
What chemotherapeutic agent is known to cause cardiomyopathy?
Doxyrubicen (Adriamycin)
| S36
65
What chemotherapeutic agent is known to cause pulmonary toxicity?
Bleomycin
| S36
66
What chemotherapeutic agents are known to cause peripheral neuropathy?
- Cisplatin
- Vincristine (mitotic inhibitor)
| S36
67
What preoperative abnormalities might be seen in a cancer patient?
- ↓ RBCs (anemia)
- ↓ WBCs (neutropenia)
- ↓ PLTs (thrombocytopenia)
- ↑ Ca⁺⁺ (hypercalcemia)
- Adrenal insfficiency related to steriods
| S37
68
Why is hypercalcemia common in cancer?
Many drugs are toxic to bone marrow, liver and kidneys thus causing breakdown and releasing Ca⁺⁺ into the bloodstream.
| S37
69
What test is useful for testing for adrenal insufficiency?
ACTH stimulation test
| S37
70
Why is tumor resection a risk factor for tumor recurrence?
- Tumor cells can spread into blood stream
- Residue remains behind
- Localized spread via lymphatics
| S38
71
Why is inflammation and surgical stress bad for cancer patients?
Surgical stress → elevation COX expression → PG's and thromboxanes catalyzed → promote cell survival and cancer cell growth
* inflammation and stress may suppress NK cells
| S39
72
How long can inflammation and stress last post surgery?
weeks
| S39
73
β adrenergic receptors at the sites of tumor growth will upregulate cancer cell activity via nerve fiber delivery of ____.
norepinephrine (catecholamine surge)
| S39
74
How do Opioids effect cancer cells?
Opioids directly:
* stimulate cancer cell proliferation and invasion
* inhibits leukocyte migration
* inhibits NK cell activity
| S40
75
How do volatiles adversely effect cancer patients?
- Increase migration and invasion of cancer cells by affecting platelets
- Induce chemo resistance
- Inhibit NK cells
| S40
76
What effects does propofol have on cancer cells?
- Decreases migration by down regulating signaling pathways
- Promotes apoptosis by increasing cytotoxicity of NK cells
*Propofol on top as always*.
| S40
77
Long term administration of NSAIDS ____ proliferation of cancer cells.
decreases
| S40
78
Cancer types diagram
*Flip Card*
| S44
79
What is the major cause of lung cancer?
Tobacco smoke (90%)
3 decade lag time in cancer occurrence
| S45
80
What substances cause lung cancer other than tobacco?
- Asbestos
- Radon gas
| S45
81
What are the types of lung cancer?
- Small cell
- Non-small cell (75-80%)
- Carcinoid
- Mesothelioma
| S46
82
What are the subtypes of non-small-cell lung cancer?
NSMC Lung cancer:
- Squamous
- Adenocarcinoma
- Large cell
| S46
83
What is the typical origin of small cell lung cancer?
Neuroendocrine
*Thus the cancer is typically metastatic on presentation*
| S47
84
What lung cancer always recurs and is resistant to further treatment?
Small cell lung cancer
| S47
85
What are possible large side effects of small cell lung cancer?
- ↓ Na⁺ (SIADH)
- Hypercortisolism (Cushings presentations)
- Lambert-Eaton Syndrome
| S48
86
Lambert-Eaton syndrome involves symptoms that ____ with exercise/movement.
improve
| S48
87
Myasthenia Gravis involves symptoms that ____ with exercise/movement.
deteriorate
| S48
88
How does Lambert-Eaton Syndrome react with some of our anesthesia drugs?
- Lack of improvement with acetylcholinesterase inhibitors (Myesthenia gravis improves with these)
- extreme sensitivity to non-depolarizing neuromuscular blockers
| S48
89
# (Carcinoid tumors)
What tumor type is mostly benign and has great (>90%) 5 year survival rates?
Neuroendocrine tumors
| S49
90
Carcinoid syndrome usually results from tumor originating from where?
GI tract
| S49
91
What are characteristics of Carcinoid Syndrome?
- Tumor secretion of serotonin, histamine, PG's, tachykinins, kallikrein
- Unresponsive to pressors (hemodynamic collapse)
- Coronary artery spasm
TUC
T= His Sloppy Pigs Kill Turtles
| S49
92
How is carcinoid syndrome treated?
Octreotide & Somatostatin
*These inhibit tumor growth, angiogenesis, and the hormones secreted from the tumor.*
| S49
## Footnote
These help GI symptoms and octreotide helps with GI bleeds.
93
What type of lung cancer has a 5-year survival rate that greatly improves with surgery?
Non-small cell lung cancer
- 10% w/o surgery
- 40% w/ surgery
| S50
94
Squamous cell lung cancers grow to a large size but ____ late.
metastasize
| S50
95
What are possible consequences of squamous cancer's large growth?
Mass Effect:
- Hemoptysis
- Obstructive PNA
- Superior Vena Cava syndrome
- Endobronchial tumor
| S51
96
What is the most common subtype of non-small cell lung cancers?
Adenocarcinomas (these metastasize early)
| S52
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Where are Adenocarcinomas commonly found?
* Brain
* Bone
* Liver
* Adrenal glands
* Chest wall
* Diaphragm
* Pericardium
Brian Breaks Little CRNAs And Dirty Pimps
| S52
98
What two hormones are typically secreted by adenocarcinomas?
- Growth Hormone
- ACTH (Cushings presentation)
| S52
99
What is the least common non-small cell lung cancer subtype?
What should be known about its metastatic characteristics?
- Large cell
- Metastasizes rapidly and usually are large cavitating tumors
| S53
100
4 M's assessment of pts with lung cancer
1. Mass effect: is it compromising other structures
2. Metabolic abnormalities: hypercalcemia, hyponatremia, hyperglycemia (Cushings)
3. Metastases
4. Medications and what do we need to keep in mind with the meds (bleomycin, cisplatin etc)
| S54
101
What factors can help predict one lung desaturation?
- High % of with ventilation or perfusion to operative lung on the preoperative V/Q scan.
- Poor PaO₂ during two lung ventilation (especially in lateral position)
- Right sided thoracotomy (pt will be in L decubitus)
| S57
## Footnote
This is a VQ scan - the dark is perfusion
102
What is the formula for predicted post-operative FEV₁ ?
| S59
103
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 ?
RUL + RML = 6 + 4 = 10 lung segments
10 segments/42 total = 23.8% of the lung resected
ppoFEV₁ = 60 x (1 - 23.8/100)
ppoFEV₁ = 45.72%
| S59
## Footnote
Please look at this.... I think the equation is technically wrong. Same result, but wrong way of using the forumla. There is 10 lung segments missing so I think this should read ppoFEV₁ = 60 x (1 - **10**/100). Maybe this is your way of doing it, which is cool too.
104
What anticoagulative drug class requires discontinuation 7 days prior to surgery?
- -grel drugs ( P2Y12 Inhibitors)
- Ticagrelor
*Clopidogrel, prasugrel, etc*
| S62
105
*Flip card to see anticoagulative medication hold times.*
| S62
106
How many dermatomes are typically covered via a paravertebral block?
4-6 dermatomes for 1 shot
| S63
107
What are contraindications for paravertebral blocks?
- Site infection
- Empyema
- Paravertebral tumor
- Kyphoscoliosis
| S63
108
A paravertebral block at ___ is necessary for a sternotomy.
T4
| S64
109
A paravertebral block at ___ is necessary for a thoracotomy.
T6
| S64
110
A paravertebral block at ___ is necessary for abdominal procedures.
T10
| S64
111
What is required for intercostal nerve block?
Blockade 2 dermatomes above and 2 dermatomes below incision.
(innervates musculature of chest and abd wall)
| S65
112
What are indications for intercostal nerve block?
- Thorax surgery
- Upper abdomen surgery
- Mastectomy
| S65
113
What are disadvantages associated with intercostal nerve block?
- Pneumothorax
- Bleeding
- LA toxicity (especially if multiple levels are blocked bc this is a very vascular area).
| S65
114
*Flip for intercostal nerve block pictures*.
| S66
