Preoperative evaluation and management of patients with cancer
- Ellen F Manzullo, MD, FACP
Ellen F Manzullo, MD, FACP
- Professor of Medicine
- University of Texas
- MD Anderson Cancer Center
- Sunil K Sahai, MD, FAAP, FACP
Sunil K Sahai, MD, FAAP, FACP
- Associate Professor of Medicine
- Department of General Internal Medicine
- MD Anderson Cancer Center
- Harrison G Weed, MS, MD, FACP
Harrison G Weed, MS, MD, FACP
- Professor of Internal Medicine
- The Ohio State University College of Medicine
The preoperative management of the patient with cancer can be complex. While patients with cancer are similar in many ways to those without cancer, the direct and indirect (systemic) effects of the cancer and the side effects of cancer therapy can influence perioperative evaluation and management. Here we will provide an overview of issues that are relevant to patients with current or past cancer. General preoperative evaluation and estimation of cardiac risk from surgery are discussed elsewhere. (See "Preoperative medical evaluation of the adult healthy patient" and "Evaluation of cardiac risk prior to noncardiac surgery".)
The preoperative medical evaluation of cancer patients should include an assessment of nutritional status, functional status, and symptom control (particularly regarding cancer-related pain) in addition to an assessment of general medical issues. The natural history of the cancer and effects of any prior chemotherapy or radiation therapy should also be considered. The short- and long-term outcomes of cancer surgery in older patients can be equivalent to those in younger patients. Treatment considerations should be based on functional status, not on chronological age . (See "Comprehensive geriatric assessment for patients with cancer".)
The timing and purpose of the cancer surgery can affect perioperative evaluation. While rarely emergent, cancer surgery is usually not elective, and therefore the amount of time available to medically optimize a patient may be limited.
In addition to managing coexisting medical conditions, the internist may also play an important role in coordinating the many complex levels of care provided by surgeons, medical oncologists, radiation oncologists, and others.
Patients with cancer may become significantly malnourished for a variety of reasons. Eating and drinking can be impaired by pain, nausea, stomatitis, or tumors involving the oropharynx or gastrointestinal tract. Furthermore, metabolic aberrations may induce anorexia and weight loss. (See "Pathogenesis, clinical features, and assessment of cancer cachexia".)
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- CARDIOVASCULAR STATUS
- Cardiac assessment
- Pericardial disease
- Coronary, electrical, and valvular heart disease
- Carotid artery disease
- Cardiac toxicity from chemotherapy
- Medication management
- CARDIOPULMONARY MASS EFFECTS
- PULMONARY ISSUES
- Treatment-related pulmonary toxicity
- Pleural effusions
- ENDOCRINE AND ELECTROLYTE STATUS
- Adrenal insufficiency
- Carcinoid crisis
- Pheochromocytoma/paraganglioma surgery
- HEMATOLOGIC STATUS
- Neutropenia and lymphopenia
- NEUROLOGIC STATUS
- Paraneoplastic syndromes
- Screening for brain metastases
- Stroke risk in patients undergoing neck irradiation
- OTHER EFFECTS OF CHEMOTHERAPY
- Wound healing
- IMMUNIZATIONS PRIOR TO SPLENECTOMY