CHEMOTHERAPY

Can also be CURE, control palliation

Goal is to destroy malignant tumor cells without excessive destruction of
normal cell
To control tumor growth if cure is no longer possible
Used as adjuvant therapy
A systemic intervention and is appropriate for the following
Disease is widespread
Risk of undetectable disease is high
Tumor cannot be resected and is resistant to radiation therapy

Contraindications

Infection the anti-tumor drugs are immunosuppresives
Recent surgery the drugs may retard healing process
Imapaired renal or hepatic function the drugs are nephrotoxic and
hepatotoxic
Recent radiation therapy also immunosuppresive
Pregnancy the drug may cause congenital defects
Bone marrow depression the drugs may be aggravate the condition. The
WBC levels must be within normal limits

Types of Chemotherapy
1. Adjuvant chemotherapy
2. Neoadjuant chemotherapy
3. Combination chemotherapy

ADJUVANT CHEMOTHERAPY
For clients who are at high risk for recurrence but shows no evidence of
current disease
After initial treatment with either surgery or radiation therapy,
chemotherapeutics drugs are used to eliminate any remaining submicroscopic
cancer cell that are suspected to still present

NEOADJUVANT CHEMOTHERAPY
Refers to pre-op use of chemotherapy to reduce the bulk and lower the
stage of tumor making it amenable to surgery or local therapy


COMBINATION CHEMOTHERAPY
Destroys more malignant cells and produce fewer side-effects because
each drug strikes the cancer cells at a different point in the cell cycle.

Classification Of Chemotherapeutic Agents

ALKYLATING AGENTS
Action
Create defects in tumor DNA. All alkylating agents across link the DNA,
making the two DNA strands bind tightly together. This tight binding prevents
proper DNA and RNA synthesis, inhibiting cell division
Examples
Nitrogen mustard, Cisplatin

TOXICITIES in Alkylating Agents
q Bone Marrow Toxicity
q Mucosal Toxicity
q Neurotoxicity
q Other Male & Female Reproductive System Toxicity

ANTIMETABOLITES
Action
Closely resemble normal metabolites and are counterfeit metabolites that
fool cancer cells into using the anti-metabolites in cellular reaction. Because anti-
metabolites cannot function as proper metabolites, their presence impaires cell
division
Examples methotrexate
5-flouroracil
Toxic effects
nausea, vomiting,
stomatitis, diarrhea, alopecia, leucopenia

ANTITUMOR ANTIBIOTICS
Action
damage the cells DNA and interrupts DNA or ribonucleic acid (RNA)
synthesis
Examples Actinomycin D
Bleomycin

2 APPLE KISS

Toxic effect
damage to cardiac muscle

ANTIMITOTIC AGENTS
Usually made from plant source
Action
Prevent cell division, as a result, the cancer cells either does not divide at all
or divides only once, resulting in two daughter cells that cannot continue divide
Example
vincristine
vinblastine
Toxic effects
affects neurotransmission,
alopecia, bone marrow depression

SAFE HANDLING OF CHEMOTHERAPEUTICS AGENTS
Wear mask, gloves and back closing gown
Skin contact with drugs must be washed immediately with soap and water.
Eyes must be flushed immediately with copious amount of water
Sterile / alcohol-wet cotton pledgets should be used-wrapped around the
neck of the ampule or vial when breaking and withdrawing the drug
Expel air bubbles on wet cotton
Clearly label the IV bottle with ANTINEOPLASTIC CHEMOTHERAPY
Contaminated needles and syringes must be disposed in a clearly marked
special container. leak-proof, puncture proof
Dispose half-empty ampules, vials, IV bottles by putting into plastic bag, seal
and then into another plastic bag or box clearly marked before placing for
removal. Label as hazardous waste
Handwashing should be done before and after removal of gloves
Trained personnel only should be involved in use of drugs