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

Chemotherapy

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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