Ap1 Anesthesia, Cancer Review

Front 1

6 properties of a cancer cell?

Back 1

1. Growth signal autonomy
2. evasion of apoptosis
3. Evasion of Growth inhibition
4. Angiogenesis
5. invasion & metastasis
6. unlimited replicatiion

Front 2

Characteristics of benign tumors?

Back 2

1. Slow growth.
2. encapsulated
3. noninvasive
4. Well- differentiated (look like othe tissue cells)
5. low mitotic index(rarely divide)
6. Do not metastasize

Front 3

Characteristics of Malignant?

Back 3

1. Rapid growth
2. Not encapsulated
3. Invade local tissue
4. Poorly differentiated
5. High mitotic rate(many cells dividing)
6. Metastisizes (lymph and blood vessels help)

Front 4

What are proto-oncogenes?

Back 4

Genes that normally direct synthesis of proteins that regulate (accelerate) proliferation.
-ex: Growth factor, etc

Front 5

What is an Oncogene?

Back 5

Mutant Proto-oncogenes that accelerate abnormal cell growth and cancers.

Front 6

What is a tumor suppressor gene?

Back 6

Genes that encode proteins that in their normal state negatively regulate cell proliferation.

Front 7

What is the"mechanics",? "accelerators"? the"brakes" in cancer growth?

Back 7

DNA Repair Genes{Mechanics)
Oncogenes (accelerators)
Tumor-suppressor genes(Brakes)

Front 8

Stages of Cancer Formation

Back 8

Initiation
Promotion
Proliferation
Progression
Mutation
Invasion & Spread

Front 9

What is Apoptosis?

Back 9

Programmed "self-destruction" cell death

Front 10

What are some of the promoters of Cancer?

Back 10

Tobacco use
Diet
sexual behavior
alcohol use
sunlight exposure
ionizing radiation exposure
Occupational hazards
environmental agents (radon, smoke, air pollution)

Front 11

What is epidemiology?

Back 11

Study of disease and statistics in populations.

Front 12

What is incidence?

Back 12

The number of NEW cases of a disease in a population in a given time

Front 13

What is prevalence?

Back 13

All Cases of a disease, in a population per unit of time and per 100,000.

Front 14

Name 6 current Cancer Therapies?

Back 14

-Surgery
-Radiation
-Chemotherapy
-Combination therapy
-Alternative therapy
-Supplements

Front 15

What are the goals of cancer therapy?

Back 15

1. Cure
2. Control
3. Palliation

Front 16

3 Surgical Innovations in Cancer Care?

Back 16

1. Microsurgical/ Robotic Technique
2. Peri- or Intraoperative Chemo
3. Sentinal Node Surger/biopsy.

Front 17

What is a sentinol Node?

Back 17

The first lymph node to receive lymph drainage--Tumor cells migrate here first. Part of the tumor staging process,

Front 18

Advantages of Sentinol node biopsy?

Back 18

Allows targeted node removal instead of all nodes.
Less nerve damage.
Less lymph dysfunction.

Front 19

Advantages of Hyperthermic Chemoperfusion?

Back 19

-Targets lesions that don't respond to systemic chemo.
-Heat injures tumor cells directly.
-Heat enhances chemo penetration.
-Systemic absorption is limited.

Front 20

Anesthetic concerns of Intraop Hyperthermic chemoperfusion

Back 20

- massive fluid shifting.
Monitoring needs
--Aline, CVP, PA/TEE, Hourly labs
Warming/Cooling devices
Antiemetics (10x increase in PONV)
-Special chemo protective gear

Front 21

Anesthesia concerns for head and neck Radiation?

Back 21

Airway: Edema, friabilit, fibrosis,
CNS: vascular and tissue changes
CV: Vascular atrophy, pericarditis, MI, accelerated atherosclerosis.

Front 22

What is Tumor Lysis Syndrome?

Back 22

hyperkalemia,
hyperphosphatemia,
hypocalcemia
hyperuricemia
hyperuricosuria

Front 23

What are the Cadiac Toxic Chemo-agents?

Back 23

Adriamycin(doxorubicin)
Daunomycin
5-FU

Front 24

What are the Pulmonary Toxic Chemo-agents?

Back 24

Bleomycin
Cytoxan
Carmustine
Busulfan
Methotrexate
Mitomycin

Front 25

What are the Neuro toxic Chemo-agents

Back 25

Vinca Alkaloids: Vincristine & vinblastin
Methotrexate
L-asparaginase
Cisplatin-peripheral neuropathy
Taxanes- periheral neuropathy

Front 26

What are the Renal Toxic Chemo-agents?

Back 26

Cisplatin
Mitomycin
Methotrexate (high doses)

Front 27

What chemo-agent is toxic to plasma cholinesterase?

Back 27

Cytoxan

Front 28

What is the number one agent responsible for secondary tumors?

Back 28

DNA Alkylating Drugs

Front 29

What is the primary dose limiting factor in the usse of alkylating drugs(esp busulfan)?

Back 29

Bone marrow suppression
(Myleosuppression)

Front 30

What is the Nadir for RBC's? WBCs? Platelets?

Back 30

RBC's 2 Weeks
WBCs 1 week
Platelets 10 days

Front 31

What are the Alkylating Drugs used in Chemotherapy?

Back 31

Nitrogen Mustards
Alkyl Sulfonates
Nitrosoureas
Ethylenimine
Triazene

Front 32

What is the most versatile and frequently used Nitrogen Mustard(Alkylating Group)?

Back 32

Cytoxan
(used for lymphomas, leukemias, lung ca, breast, ovarian, cervical, testicular)

Front 33

What are the most common side effects of Cytoxan?

Back 33

-inhibits plasma cholinesterase
-Myleosuppression
-SIADH: water intoxication
-Cystitis
-interstitial pulm fibrosis

Front 34

What is a common side effect of the Nitrosoureas: Carmustine?

Back 34

Profound Myleosuppression

Front 35

What is a common side effect of the Alkyl Sulfonate: Busulfan?

Back 35

Interstitial Pulmonary fibrosis. (and myleosuppression)

Front 36

What are the common side effects of the folate antagonist: Methotrexate?

Back 36

Renal failure
Allergic pneumonitis
Liver fibrosis

Front 37

What is the concern for patients on 5-FU (used for breast cancer)?

Back 37

Safety- patients will be unstable with Severe cerebellar ataxia lasting 1-6 weeks.

Front 38

What is usually the first sign of Vinca alkaloid Toxicity?

Back 38

Neurotoxicity--
CN X (Vagus Palsy)...
RLN Palsy
Loss of Deep tendon reflexes
Sensory impairment
-

Front 39

What is a frequent complaint with Taxol? (Taxane chemo used in Breast, ovary, neck head cancers)

Back 39

Peripheral neuropathy, severe hypersensitivity in 1-2%, and myelosuppression

Front 40

What Anthracycline Antibiotic is cardio toxic?

Back 40

Adriamycin
--can cause dose related permanent cardiomopathy (59%)
**(TOXIC DOSE: 550 mg/m2)

Front 41

What is the toxic cardiac dose of Adriamycin?

Back 41

550 mg/m2

Front 42

What cardiac protective drug is often prescribed for women who have taken Adriamycin(doxorubicin) for breast cancer?

Back 42

Dexrazpxane (Zinecard)
--usually given after an accumulative dose of 300mg/m2 of doxorubicin has been given and require more.

Front 43

What is the main concern with Bleomycin?

Back 43

Pulmonary toxicity (w/ doses >400 mg)

Front 44

What anesthesia concerns with Bleomycin?

Back 44

Treat as restrictive lung disease--
-use pressure controlled ventilation,
lower volumes, higher rates, lower O2

Watch fluid administration

Front 45

What Pulm function test result would you expect with Bleomycin pulmonary toxicity?

Back 45

Fev1/Fvc: normal,
Fev1: low,
FVC: low

Front 46

What are concerns with "ASE: Enzyme Chemo agents?
(L-Asparginase

Back 46

Hypersensitivity reactions
(Have epi handy)

Front 47

What is the dose limiting toxic effect of Cisplatin?

Back 47

Renal toxicity.
(keep hydrated!)
....also Ototoxicity, peripheral neuropathies, cardiac arrhythmias and seizures

Front 48

What are two main common side effects with most chemo agents?

Back 48

Nausea
Myelosuppression

Front 49

What are some of the new targeted cancer therapies?

Back 49

Monoclonal antibodies
-- attack growth factor receptors on tumors
Angiogenesis inhibitors
--target growth factors in blood vessels