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24 Principles of Anesthesia II > Oncology and Chemotherapy (Exam III) Andy's Cards > Flashcards

Oncology and Chemotherapy (Exam III) Andy's Cards Flashcards

1
Q

What are tissue changes seen in cancer cells?

A
  • Number of cells increases (hyperplasia).
  • Organization changes (dysplasia)
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2
Q

What is the progression from normal cells to cancerous cells?

A
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3
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)
  • Can evade the immune system
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4
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
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5
Q

How many types of cancers are there?

A

More than 100

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6
Q

Where do basal cell cancers originate from?

A

Basal layer of the epidermis

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7
Q

Where do squamous cell cancers originate from?

A

Epithelial cells:

  • Beneath skin
  • GI tract
  • Bladder
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8
Q

Where do adenocarcinoma’s originate from?

A
  • Mucous producing cells
  • Gland tissue (breast, prostate)
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9
Q

Where do sarcoma’s originate from?

A

Bone and soft tissue

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10
Q

Where do leukemia’s originate from?

A

Bone marrow

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11
Q

Where do lymphoma’s originate from?

A

Lymphocytes

These tend to build up on lymph nodes and lymph vessels.

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12
Q

What are some problems in cancer screenings?

A
  • Can cause problems: Colonoscopy perforation
  • Can have false-positives
  • Can have false-negatives
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13
Q

Screenings are working if statistics show:

A
  • More early-stage cancers found
  • Less late-stage cancers found
  • Less deaths occur
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14
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

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15
Q

Explain relative risk.

A

% of people in exposed group that develop cancer

vs.

% of people in unexposed group with diagnosis.

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16
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.

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17
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.

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18
Q

What cancer screenings are typically standard now?

A
  • Colonoscopy
  • Mammograms
  • Pap Smears
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19
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

The staging is done at diagnosis. No later evaluation.

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20
Q

What would a tumor measurement of TX mean?

A
  • TX: tumor cannot be measured.
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21
Q

What would a tumor measurement of T0 mean?

A
  • T0: tumor cannot be found.
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22
Q

What would a tumor measurement of T1 - 4 mean?

A
  • T1= least invasive
  • T4 = most invasive
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23
Q

What does NX mean?

A

NX: cancer in nearby lymph nodes cannot be measured.

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24
Q

What does N0 mean?

A

N0: no cancer in nearby lymph nodes.

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25
Q

What does N 1-3 mean in regards to tumor staging?

A

N1 = limited cancer found in regional lymph nodes
N3 = cancer is all up in these lymph nodes

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26
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.
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27
Q

What are other staging systems?

A
  • 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
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28
Q

For median survival of 6 months or less what two factors are more important that type of cancer?

A
  • Functional status
  • Laboratory values
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29
Q

What factors are associated with a survival rate that is 6 months or less?

A
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30
Q

What type of cancers will frequently radiate to the bone?

A
  • Breast
  • Lungs
  • Kidney
  • Prostate

Osteolytic, osteoblastic or both lesions

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31
Q

What can be helpful in treating cancer metastasis to the bone?

A
  • Radiotherapy/chemotherapy
  • NSAID +/- opioids
  • Vertebroplasty
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32
Q

Hormonal therapy is often helpful for what types of cancer?

A

Breast
Lung
Kidney
Prostate

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33
Q

Why does cancer typically cause pain?

A
  • Invasion of tumor into tissues innervated by afferent neurons
  • Directly invades nerve plexus

Pain is mostly d/t cancer itself not treatment

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34
Q

WHO “Cancer Pain Stepladder”

A
  • Prompt administration
  • On schedule; not prn
  • Add antianxiety drugs as necessary
  • 80-90% effective (simple things can go a long way)
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35
Q

Common nerve blocks used to treat cancer patients

A
  • Celiac plexus for unresectable pancreatic cancer, hepatic cancer, or gastric cancer
  • Intercostal nerves for rib metastasis
  • Lumbar sympathetic ganglion for pelvic tumors
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36
Q

What areas are anesthetized with a celiac plexus block?

A
  • Sympathetic fibers of T5-T12
  • Parasympathetic celiac plexus fibers
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37
Q

For what types of cancer are celiac plexus blocks typically performed?

A

Unresectable:

  • Pancreatic
  • Hepatic
  • Gastric
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38
Q

What injection is used with a neurolytic celiac plexus block?
How long does this typically last?

A

Isopropyl alcohol

Destruction of nerves typically lasts 3-6 months.

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39
Q

What is the principal benefit of continuous infusion via catheters for cancer pain?

A
  • ↓ systemic side effects
  • Technique and equipment very available.
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40
Q

What is the principal benefits of continuous infusion via catheters for cancer pain?

A
  • ↓ systemic side effects
  • Technique and equipment very available.
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41
Q

Chemotherapy target cells in different phases of their ________.

A
  • Cell cycle
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42
Q

How do alkylating agents work?
Whats an example of an alkylating agent?

A

Cisplatin (Nitrosurea)

  • Damage cell DNA in all phases of the cell cycle.
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43
Q

What is a severe side effect of alkylating agents?

A

Dose-dependent cause of leukemia 5-10 years after treatment.

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44
Q

What types of cancers do antimetabolites treat?

A
  • Breast
  • Ovary
  • Intestines
  • Leukemias
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45
Q

How do antimetabolites work?

A

Interfere with DNA and RNA

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46
Q

What are two examples of antimetabolites?

A
  • Methotrexate
  • 5-Fluorouracil
47
Q

How do Anti-tumor antibiotics treat cancer?

A
  • Interfere with DNA copying enzymes
48
Q

What are examples of anti-tumor antibiotics?

A

-cins

Doxorubicin, bleomycin, etc

49
Q

What type of cancer drugs have life-time dosing limits?
Why is this?

A

Anti-tumor antibiotics because they permanently damage cardiac tissue in large doses.

50
Q

Which chemotherapy increases the risk of a second cancer developing?

A

Topoisomerase Inhibitors

51
Q

Which chemotherapeutic agent damages cells in all phases through the prevention of protein synthesis?

A

Mitotic Inhibitors

52
Q

Which chemotherapeutic class may cause peripheral neuropathy?

A

Mitotic inhibitors

(-Taxels and vincristine, vinblastine, etc.)

53
Q

What cells are most likely to be damaged due to chemotherapy?

A
  • Bone marrow
  • Hair follicles
  • GI tract (including mouth)
  • Reproductive systems
54
Q

What drug can inhibit hormonal contraceptives?

And thus result in unexpected baby’s.

A

Aprepitant (neurokinin 1 antagonist)

55
Q

How does marijuana treat nausea/vomiting?

A

Depresses CNS vomiting center

56
Q

What is radiation’s effects on the peripheral vascular system?

A

Coagulopathy

6x increase!

57
Q

What is radiation’s effects on tissues afflicted by head and neck cancers?

A
  • ↓ Thyroid function
  • Carotid artery disease
  • Possible airway issues
58
Q

What is radiation’s effects on the chest wall and/or breasts?

A
  • Pericarditis
  • Cardiomyopathy
  • Valvulopathies
  • Dysrhythmias
59
Q

What is the possible effect of radiation on the lungs??

A

Radiation pneumonitis

60
Q

What chemotherapeutic agent is known to cause cardiomyopathy?

A

Adriamycin

61
Q

What chemotherapeutic agent is known to cause pulmonary toxicity?

A

Bleomycin

62
Q

What chemotherapeutic agents are known to cause peripheral neuropathy?

A
  • Cisplatin
  • Vincristine (mitotic inhibitor)
63
Q

What preoperative abnormalities might be seen in a cancer patient?

A
  • ↓ RBCs
  • ↓ WBCs
  • ↓ PLTs
  • ↑ Ca⁺⁺
64
Q

Why is hypercalcemia common in cancer?

A

Many drugs are toxic to bone marrow thus causing breakdown and releasing Ca⁺⁺ into the bloodstream.

65
Q

What test is useful for testing for adrenal insufficiency?

A

ACTH stimulation test

66
Q

Why is adrenal insufficiency often seen in cancer patients?

A

Steroid treatments

67
Q

Why is tumor resection a risk factor for tumor recurrence?

A
  • Tumor cells can spread into blood stream
  • Residue remains behind
  • Localized spread via lymphatics
68
Q

Why is inflammation and surgical stress bad for cancer patients?

A

Surgical stress → elevation COX expression → PG’s and thromboxanes → promoted cell survival and cancer cell growth

69
Q

How long can inflammation and stress last post surgery?

A

weeks

70
Q

β adrenergic receptors at the sites of tumor growth will upregulate cancer cell active via nerve fiber delivery of _______.

A

norepinephrine

71
Q

What drug class directly stimulates cancer cell proliferation and invasion, inhibits leukocyte migration, and inhibits NK cell activity?

A

Opioids

72
Q

How do volatiles adversely effect cancer patients?

A
  • Induce chemo resistance
  • Inhibit NK cells
73
Q

What effects does propofol have on cancer cells?

A
  • Decreases migration
  • Promotes apoptosis

Propofol on top as always.

74
Q

Long term administration of NSAIDS _______ proliferation of cancer cells.

A

decreases

75
Q

Cancer types diagram

Flip Card

A
76
Q

What is the major cause of lung cancer?

A

Tobacco smoke

3 decade lag time in cancer occurrence

77
Q

What substances cause lung cancer other than tobacco?

A
  • Asbestos
  • Radon gas
78
Q

What are the types of lung cancer?

A
  • Small cell
  • Non-small cell
  • Carcinoid
  • Mesothelioma
79
Q

What are the subtypes of non-small-cell lung cancer?

A

NSMC Lung cancer:

  • Squamous
  • Adenocarcinoma
  • Large cell
80
Q

What type of lung cancer makes up 75-80% of cases?

A

Non-small cell

81
Q

What is the typically origin of small cell lung cancer?

A

Neuroendocrine

Thus the cancer is typically metastatic on presentation

82
Q

What lung cancer always recurs and is resistant to further treatment?

A

Small cell lung cancer

83
Q

What are possible large side effects of small cell lung cancer?

A
  • ↓ Na⁺
  • Hypercortisolism
  • Lambert-Eaton Syndrome
84
Q

What is the name for the disease called hypercortisolism?

A

Cushing’s Disease

85
Q

Lambert-Eaton syndrome involves symptoms that ________ as the day goes on.

A

improve

86
Q

Myasthenia Gravis involves symptoms that ________ as the day goes on.

A

deteriorate

87
Q

Lack of improvement with acetylcholinesterase inhibitors and extreme sensitivity to non-depolarizing neuromuscular blockers are characteristics of what disease?

A

Lambert-Eaton Syndrome

88
Q

What tumor type is mostly benign and has great (>90%) 5 year survival rates?

A

Neuroendocrine tumors

89
Q

Carcinoid syndrome usually results from tumor originating from where?

A

GI tract

90
Q

What are characteristics of Carcinoid Syndrome?

A
  • Tumor secretion of serotonin, histamine, PG’s, tachykinins, kallikrein
  • Hemodynamic collapse unresponsive to pressors
  • Coronary artery spasm
91
Q

How is carcinoid syndrome treated?

A

Octreotide & Somatostatin

These inhibit tumor growth, angiogenesis, and the hormones secreted from the tumor.

92
Q

What type of lung cancer has a 5-year survival rate that greatly improves with surgery?

A

Non-small cell lung cancer

  • 10% w/o surgery
  • 40% w/ surgery
93
Q

Squamous cell lung cancers grow to a large size but _______ late.

A

metastasize

94
Q

What are possible consequences of squamous cancer’s large growth?

A

Mass Effect:

  • Hemoptysis
  • Obstructive PNA
  • Superior Vena Cava syndrome
95
Q

What is the most common subtype of non-small cell lung cancers?

A

Adenocarcinomas

96
Q

Adenocarcinomas will typically metastasize ______.

A

earlier

97
Q

What two hormones are typically secreted by adenocarcinomas?

A
  • Growth Hormone
  • ACTH
98
Q

What is the least common non-small cell lung cancer subtype?
What should be known about its metastatic characteristics?

A
  • Large cell
  • Metastasizes rapidly
99
Q

NSAIDs can induce acute respiratory failure when combined with what chemotherapeutic?

A

Cisplatin

100
Q

What factors can help predict one lung desaturation?

A
  • High % of V/Q to operative lung on the preoperative V/Q scan.
  • Poor PaO₂ during two lung ventilation
  • Right sided thoracotomy
101
Q

What is the formula for predicted post-operative FEV₁ ?

A
102
Q

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 ?

A

ppoFEV₁ = 60 x (1 - 23.8/100)

ppoFEV₁ = 45.72%

103
Q

What anticoagulative drug class requires discontinuation 7 days prior to surgery?

A
  • -grel drugs ( P2Y12 Inhibitors)
  • Ticagrelor

Clopidogrel, prasugrel, etc

104
Q

Flip card to see anticoagulative medication hold times.

A
105
Q

How many dermatomes are typically covered via a paravertebral block?

A

4-6 dermatomes

106
Q

What are contraindications for paravertebral blocks?

A
  • Site infection
  • Empyema
  • Paravertebral tumor
  • Kyphoscoliosis
107
Q

A paravertebral block at ___ is necessary for a sternotomy.

A

T4

108
Q

A paravertebral block at ___ is necessary for a thoracotomy.

A

T6

109
Q

A paravertebral block at ___ is necessary for abdominal procedures.

A

T10

110
Q

What is required for intercostal nerve block?

A

Blockade 2 dermatomes above and 2 dermatomes below incision.

111
Q

What are indications for intercostal nerve block?

A
  • Thorax surgery
  • Upper abdomen surgery
  • Mastectomy
112
Q

What are disadvantages associated with intercostal nerve block?

A
  • Pneumothorax
  • LA toxicity (especially if multiple levels are blocked).
113
Q

Flip for intercostal nerve block pictures.

A

24 Principles of Anesthesia II (23 decks)

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