by gnomey

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3 classes of TNM system
T-tumor size
N-lymph node involement
M- distant metastasis
Stages of cancer
0- carcinoma in situ (noninvasive)
1- larger tumor (invasive) and no lymph node involvement
2- tumor spread beyond organ of original site (remains in anatomical area of orgin)
3-lymph node involement
4- cancer spread to another organ
What are the 5 life-threating emergencies r/t paraneoplastic syndrome?
1. SVC obstruction
2. increased ICP
3. pericardial tamponade
4. renal failure
5. hypercalcemia
cause of fever in paraneoplastic syndrome?
1. rapidly proliferating tumor cells
2. tumor necrosis
3. inflammation
4. toxic cancer cell products
5. lactic acidosis
MOA of chemotherapy?
Interupts DNA synthesis in rapidly dividing cells
SE of cyclophosphamide?
chemotherapy agent that causes seizures

pulmonary toxicity and pulmonary fibrosis
SE of methotrexate
1. chemotherapy agent that causes acute delirium and encephalopathy,
progressive dementia with prolonged administration
2. renal toxicity
3. hepatic dysfunction
SE of Vincristine
chemotherapy agent that affects microtubules causing sensorimotor peripheral neuropathies
SE of Cisplatin
chemotherapy agent that causes damage to dorsal root ganglion causing large fiber neuropathy

renal toxicity->hypocalcemia, hypomagnesemia, hypophosphatemia
What is the concern of administering regional anesthesia if a patient is on vincristine or cisplatin?
These chemotherapy drugs affect nerve fibers and regional blocks can cause long-term/permanent neuropathies
What are the SE of danorubicin, doxorubicin, anthracycline, and cyclopshophamide?
chemotherapy agent that causes cardiomyopathy, cardiac failure, and cardiac tamponade
S&S of cardiac damage d/t chemotherapy drugs
danurubicin, doxorubicin, anthracycline, and cylcophosphamide cause:
URI symptoms (non-productive cough)
cardiomegaly or pleural effusion
Decrease QRS voltage
ST-T wave changes
What type of fluids are best to use if there is CV damage r/t chemotherapy drugs? drugs?
colloids are to be used to avoid pulmonary edema caused by crystalloid hydration

Epi and vasopressin to increase CO and BP
SE of bleomycin?
interstitial pneumonitis/fibrosis that is irreversible
What are anesthetic consideration when treating patient with interstitial pneumonitis or alveloar fibrosis?
1. Watch fluids- impaired lymph drainage leading to pulm edema
2. Monitor abg/spO2
3. avoid 100% FiO2, d/t toxicity d/t free radicals
4. SpO2>90% on O2<30%
5. corticosteroid treatment
6. avoid presedation
What is the cause of renal damage in pt on chemotherapy?
There is lysis of cells that cause release of uric acid. uric acid crystals form in renal tubules causing nephropathy
WHat are anesthetic considerations in pt with hyperuricemic nephropathy?
1. watch fluids (have dec GFR)
2. keep urine alkalinized (give fluids)
3. Sch prolonged in renal impairement
4. percutaneous nephrostomy
what is nephrotic syndrome?
deposition of tumor antigen-antibody complexes (uric acid) in glomerular membrane->Decrease GFR
What are hematologic system effects r/t chemotherapy?
-decrease ability of marrow to produce cells
-anemia d/t decrease RBX
-thrombocytopenia d/t decrease platelets
-neutroenia d/t decrease WBC
MOA of angiogenesis inhibitors
prevents the creation of new blood vessels so tumors lose their blood supply
MOA of alkylating chemotherapy drugs? examples
MOA: interferes with normal function of DNA by alkylation and cross-linking strands of DNA thereby destroying cancer cells
Drugs: cyclophosphamide
MOA of antimetabolite chemotherapy drugs? names?
MOA: nucleic acid synthesis inhibitors; interferes with cell reproduction by switching specific metabolites necessary for specific steps in cellular reproduction. Used for slow growing tumor
Drugs: methotrexate
MOA of vinca/plant alkaloids? names?
MOA: disrupts the normal function of microtubules in cancer cells leading to cell death by preventing normal mitosis
Drugs: Vinblastine, vincristine
MOA of antibiotic chemotherapy drugs? names?
MOA: interferes by inhibiting DNA and RNA synthesis
Drugs: doxorubicin, daunorubicin, and bleomycin
MOA of platinating drugs? names?
MOA: intereferes with DNA replication
Drugs: Cisplatin
WHat is the major consideration if a patient has been treated with bleomycin?
Risk for interstitial pulmonary edema d/t impaired lymph drainage r/t pulm fibrosis
-careful titration of IV fluids
-lowest FiO2 to keep SpO2 >90%
IF a patient has been treated with daunorubicin, doxorubicin what are consideration of anesthetic management?
Avoid use of anesthetic  drugs that are myocardial depressants, these pt may have some degree of HF
What is the first sign of corticosteroid-induced neuromuscular toxicity? dosage
Difficulty rising from sitting position and weakness of neck flexors
-this SE resolves after drug is discontinued
Prednisone (or equivalent) 60-100mg/day
What type of antidepressant is useful as an adjunct to opioids?
tricyclic antidepressants
What effect can alkylating chemotherapeutic drugs have on NMBD? example
Alkylating drugs can possibly prolong the response to Succinylcholine

ex. cyclophosphamide
What are the 2 most frequent complications that occur during a mediastinoscopy?
Hemorrhage and pneumothorax
What may occur during a mediastinoscopy in relation to cardiovascular/neurological system?
1. Right innominate artery compression causing loss of distal pulse
2. Bradycardia due to stretching of the vagus nerve or trachea compression by mediastinoscope
Compresion of right carotid artery off right innominate artery manifest as a postoperatve neuro deficit
Does chronic large bowel obstruction require RSI?
No, there is not an increase risk of aspiration during induction
When is a radical prostatectomy recommended?
prostate ca with lymph node involevement (stage III)
What kind of therapy will a patietn with metastatic prostate cancer be on?
Will be on hormone therapy. Maybe on high dose prednisone for short periods if there is incapacitating bone pain
What are the risk factors for breast cancer?
Principal: older than 50 and family history (1st degree relative diagnosed before age 50)

other: early menarche, late menopause, late first pregnancy, and nulliparity
What is the benefit of sentinel lymph node mapping?
Sentinel node is the first lymph node in the axillary chain. if the sentinel node is tumor free the remaining nodes are also likely to be tumor free and no further axillary surgery is needed
What is an anesthetic consideration if isosulfan blue dye is used in sentinel mapping?
there may be a transient decrease in SpO2 of 3%
What are 2 anesthetic considerations if a patient has a cardiac myxoma?
1. low CO
2. Arterial hypoxemia

bothdue to obstruction at mitral or tricuspid valve
What dysrhythmia may occur after removal of atrial myxoma?
supraventricular cardiac dysrhthmias
Why is adequate fluid management crucial in pt with an orthopedic cancer?
Hypercalcemia occurs when pt is dehydrated
What is the cause of peripheral neuropathy in multiple myeloma?
peripheral neuropathy is caused by amyloidosis. usually uncommon in myeloma
What is released from tumor cells when they are killed by chemotherapy drugs? manifestations?
Uric acid is released. Pt develops urate nephropathy and/or gouty arthritis
What inhalation anesthetic is avoided in pt with leukemia?
N2O, because of potential bone marrow depression
What is the diffence between nociceptive and neuropathic pain?
Nociceptive pain is due to peripheral stimulation of nociceptros in somatic and visceral structures

Neuropathic pain involves peripheral or central afferent neural pathways
Describe the location and sensation of somatic pain
Location: tumor involvement of muscles or bones

Sensation: aching, stabbing, or throbbing
Describe the location and sensation of visceral pain?
Location: lesions of hollow or solid viscus

Hollow viscus: diffuse, gnawing, or crampy

Solid viscus: aching or sharp
Treatment options for nociceptive pain?
nonopioids and opioids
Describe sensation of neuropathic pain
burning or lancinating pain
What is the benefit of using gabapentin with mastectomy?
reduce analgesic requirements in acute postop pain, but not for chronic postop pain
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