Surgical Considerations in the Cancer Patient
There are special considerations when planning operative procedures on cancer patients beyond the normal planning done for the same operation on a nononcologic patient (Table 4.4).
TABLE 4.4. Special considerations in the cancer patient.
Oncologic factors
Potential associated problems
Tumor-specific factors:
Gastrointestinal
Head and neck/mediastinal Cerebral tumors/brain metastasis Paraneoplastic syndromes
Cancer factors:
Cachexia/malnutrion
Hypercoagulability Bone metastasis
Treatment-specific factors:
Steroids
Radiation therapy Tamoxifen
Obstruction and aspiration risk; gastrointestinal bleeding; bowel perforation
Reduced oral intake; superior vena cava obstruction; airway compromise; difficulty with ventilation or intubation
Decreased mental status; syndrome of inappropriate secretion of antidiuretic hormone; increased intracerebral pressures
Syndrome of inappropriate secretion of antidiuretic hormone; hypercalcemia
Increased infection; fluid and electrolyte management; wound healing
Venous thrombosis; superior vena cava syndrome; pulmonary embolism
Hypercalcemia; increased fracture risk; potential for cord compression; potential for difficulty with intubation
Gastritis and gastrointestinal bleeding; diabetes; adrenal insufficiency; difficulties with wound healing
Neutropenia and anemia; pulmonary fibrosis; cardiac dysfunction; stomatitis; alteration in mucosal integrity of the gastrointestinal tract; constipation; bowel perforation; nausea; vomiting; diarrhea; hypercoagulability Pulmonary fibrosis; difficulty with wound healing Hypercoagulability
These considerations include cancer syndromes affecting nutrition, debilitated performance status, hypercoagulability, paraneoplastic syndromes, tumor-specific effects, and effects of chemotherapy or radiation therapy.

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