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Final_Cancer Flashcards

(52 cards)

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1
Q

Drivers of Cancer

A

Genetic changes contributing to cancer usually affect 3 cell types:

  1. Proto-oncogenes
  2. Tumor suppressor genes
  3. DNA repair genes
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2
Q

Cancer Incidence

A

■About 1.76 million newly diagnosed individuals each year
■~ 600K men, women + children expected to die
~ 1600 people per day
■2nd leading cause of death in US
- #1 if under age 75
■ 5-year survival is 65%
■ Lifetime risk of dying from cancer is 1 in 4 men, or 1 in 5 women
■ 2nd leading cause of death in children ages 1-14

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3
Q

Why do cancer cells invade?

A
  • No boundaries (Cell does not respect usual cell growth limits)
  • Cells Wander (Less adhesive to one another)
  • Angiogenic (Cells make new blood supply to feed itself)
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4
Q

How is CA staged?

A 
TNM 
Each staged, then combined to form overall stage in roman numerals: the higher the #, more advanced the CA
T: extent + size of tumor
N: # lymph nodes  
M:  metastasized
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5
Q

Staging: M

A

M0: no spread of cancer to distant organs
M1: cancer is found in distant organs

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6
Q

Staging: T

A 
Tis: confined to innermost layer
T1: grown throughout first few layers 
T2: grown into thick muscular layer 
T3: grown thru entire wall
T4: grown thru entire wall + into nearby tissue/organ
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7
Q

Staging: N

A

N0: no spread to lymph nodes
N1: CA found in 1-3 lymph nodes
N2: CA found in 4 or more lymph nodes

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8
Q

External Beam Radiation

A

-Used to treat large surface areas,
-Usually both main tumor & regional lymph nodes
■3D Conformational Radiation Therapy
■Stereotactic radiosurgery (SRS)
■Intraoperative Radiation Therapy (IORT)

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9
Q

3D Conformational Radiation Therapy

A

3D external beam that uses a fitted mold to target CA from different directions

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10
Q

Stereotactic radiosurgery (SRS)

A
  • precise dose of radiation in a small well-defined area, narrow beam radiation
  • Primarily used in the brain
  • higher doses in less frequent treatments
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11
Q

Intraoperative Radiation Therapy (IORT)

A

used inside an open cavity during surgery

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12
Q

Anesthesia Concerns for Radiation

A
  • Provide Rx to reduce patient anxiety + keep immobile
  • May use sedation or GA
  • May be long delays between stimulus + radiation calculations (need to keep pts VS stable + maintain adequate level of anesthesia during stimulus)
  • Usually performed in far + away places (Ensure access to emergency supplies)
  • Radiation exposure to anesthesia personnel (Protective equipment)
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13
Q

Internal radiation therapy

A
  • Brachytherapy
  • High Dose Radiation (HDR)
  • Low Dose Radiation (LDR)
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14
Q

Brachytherapy

A
  • placing radiation inside the body

- high dose radiation seeds, pellets, plaques, or tubes close to the tumor

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15
Q

High Dose Radiation (HDR)

A
  • over a few minutes each time over a period of days or weeks
  • Treatment course + timing of treatments are pre-determined
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16
Q

Low Dose Radiation (LDR)

A
  • Implanted giving a low dose over a period of 1-7 days
  • Patient will usually be on some isolation with minimal interaction with other people -Some may be permanent implants whose radioactivity will diminish overtime
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17
Q

Adverse Radiation Effects

A

■Radiation pneumonitis
■Skin changes
■Decreased salivary gland production: mouth sores, thrush, difficulty swallowing
■Radiation induced heart disease

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18
Q

AEs: Adriamycin (doxyrubicin)/danauorubicin

A

Cardiomyopathy

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19
Q

AEs: Bleomycin

A

pHTN

pulmonary fibrosis

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20
Q

AEs: Vincristine + Vinblastine

A

Neurotoxicity

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21
Q

AEs: Cisplatin

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A

Nephrotoxicity

22
Q

AEs: Cyclophosphamide (cytoxan)

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A

bone marrow suppression

23
Q

AEs: Methotrexate

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A

Hepatic toxicity

24
Q

AEs: L-asperigenase

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A

hepatic failure

25
AE: CVS effects most often associated with
Anthracycline agents
26
AEs: Acute Cardiac Changes from Chemo
- ST-T wave changes, PVCs, PACs, sinus tachycardia - Changes are unrelated to dose + usually revert to baseline 1-2m after tx - Decreased R wave amplitude may be a precursor of later cardiomyopathy
27
Bleomycin - clinical symptoms
``` *occurs 4-10 weeks after therapy Pulmonary toxicity: -Pleuretic chest pain -Fever -CXR: bilateral basal peripheral infiltrates with fibrosis -Cough -DOE -Rails ```
28
Targeted therapy
■Targets proteins that control how cancer cells grow, divide, + spread ■The foundation of precision medicine ■Types: Small molecule, Monoclonal antibodies
29
How does targeted therapy work?
–Help immune system destroy cancer cells –Stop cancer cells from growing –Stop signals that help to form blood vessels –Deliver cell-killing substances to cancer cells –Cause cancer cell death –Starve hormones needed for cancer cell proliferation
30
stem cell therapy is used for
cancers of the blood and lymphatic system - Lymphoma, myeloma - Leukemia
31
Types of stem cell therapy
1. Autologous - Cells are harvested from bone marrow before chemo 2. Allogenic- Stem cells from a donor * Best match is usually a first degree relative
32
carcinoid syndrome
- GI tumors - Arise from fore/mid + hind gut - Mid-gut tumors = most common; < 25% of tumors in this area produce carcinoid syndrome - Symptoms presented are proportional to amount of secreting tumor present
33
carcinoid syndrome could secrete
- Serotonin - Bradykinins - Histamines - Prostaglandins
34
Anesthetic considerations for Carcinoid syndrome
- invasive monitoring for BP - freq. electrolyte samples - Pretreat with: Octreotide (or paltreotide-somatostatin analogs) - steroids - H1, H2 antagonists - consider in pts with gastric, lung, colorectal tumors
35
Management of CA pain
Neuroablative techniques: -Interrupt pain transmission fibers -Cordotomy, rhizotomy, myelotomy, dorsal root entry zone lesion Neurostimulatory techniques: -Implanted electrodes Neuropharmacological: -Epidural pumps, intrathecal administration, intraventricular spaces
36
Transcutaneous Electronic Nerve Stimulator (TENS)
- Peripheral nerve stimulation - SubQ nerve stimulation - Localized pain in a specific dermatomal or focal region - Regional dermatomal + visceral nerve endings - Pt will need anesthesia for placement of subQ units - Staged process: pocket creation, testing + insertion, battery change
37
Neuroablative Technique: Cordotomy
-Destroys pain-conducting tracts of the spinal cord -Percutaneous approach at level of C1-C2 (fluoroscopic or CT guided, MAC w/ LA) -Open approaches at other spinal levels (GA)
38
Neuroablative Technique: Cordotomy - post procedure side effects
- Dysesthesia - urinary retention - Ataxia - Paresis - sympathetic dysfunction (hypotension, Horner’s syndrome and bladder dysfunction) - Sexual sensitivity impaired or lost - Acquired central hypoventilation syndrome
39
SVC Syndrome
Compression of the thin walled superior vena cava by an expanding mediastinal mass (Obstruction of venous drainage from upper thorax )
40
SVC Syndrome S/S
- head, neck, upper extremity edema, H/A, vertigo - Hoarseness, chest pain, difficulty swallowing - Horner’s syndrome
41
Horners Syndrome
constricted pupils, sagging eyelid, lack of sweating
42
Preparation for Cancer Surgery
Key = PREPARE - Review preop consult notes/scans available - Speak with surgeon - For large masses especially of bone or near vascular beds prepare with large IVs, possible central access, arterial line, rapid infuser, have blood products on hand
43
Diagnostic procedures - CA require
- very cooperative, immobile patient | - know the location, biopsies near major vessels, lung, liver, kidney may have greater complications
44
Spinal cord perfusion pressure
Arterial pressure - spinal cord venous pressure (or CSF)
45
Leukemia
CA of blood | -forms in tissues in bone marrow + lymphatic system
46
Lymphoma
group of blood cancers that develop in lymphatic system
47
Lymphotic leukemias begin in
lymph
48
Myeloid leukemias begin in
bone marrow
49
GVHD
life threatening complication of bone marrow transplant | -donor cells attack antigens on recipients cells
50
GVHD presentation
- soughing of skin - oral/GI ulcerations - abd pain, rash, pain
51
GVHD tx
Prevent: Tacro/cyclosporine Tx: Glucocorticoids
52
Chronic GVHD
- major cause of late non-relapse death in older pts at high risk - pericarditis + restrictive lung disease - nephrotic syndrome, jaundice

Anesthesia & Coexisting Disease (23 decks)

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