**13. Approaches to oncological patients**

Systematic evaluation of oncologic patients is important. Patients are questioned about whether they have received chemotherapy (RT) or radiotherapy (RT). In these patients, impaired health status and blood vessel changes due to bone marrow suppression may be seen.

Alkylating agents such as cyclophosphamide may cause prolongation of the neuromuscular block.

It should be kept in mind that oxygen therapy at high concentration increases interstitial pneumonia and interstitial fibrosis due to bleomycin.

Skin reactions related to RT and KT should be noted. Vascular access may be problematic. Most cancer patients are malnourished due to their illnesses and side effects of treatment. Loss of appetite, cachexia, hyperproteinemia and hypoalbuminemia are common. Preoperative nutritional support should be given. Immunonutrition is thought to be useful to reduce immunosuppression. Lung metastases may be found to impair respiratory functions. The cardiotoxic effects of KT and RT may extend to cardiomyopathy, pericardial effusion, pericarditis and congestive heart failure.

In the hepatobiliary system, hepatomegaly, deterioration in liver function tests and even cirrhosis can be seen. Decrease in coagulation factors and coagulopathy can be seen.

In the urinary system, radiation nephropathy can be seen.

In the hematopoietic system, immune system impairment may be seen.

Multidisciplinary examination of cancer patients should be done. After their clinical and laboratory values are improved, the patients should be given to surgery.
