Basics of cancer and chemotherapy

It covers basic information about cancer and chemotherapy drugs.

1. Shashikanthraddy
Patil
M.Sc. Nursing
BASICS OF CANCER &
CHEMOTHERAPY
07/05/17

2. What is cancer?
Cancer is a general term used to refer to a condition where the 
body's cells begin to grow and reproduce in an uncontrollable 
way. 
These cells can then invade and destroy healthy tissue, including 
organs. 
Cancer sometimes begins in one part of the body before 
spreading to other parts.
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3. Epidemiology
•One of the commonest cause of death in adults
•Found at all ages, incidence increases as age 
advances
•~10% are hereditary- breast, ovary, colon, brain
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Types of cancers
1.Carcinoma
2.Sarcoma
3.Lymphoma
4.Leukemia
5.Melanoma

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7. Pathophysiology
•Normal cells contain
Proto-oncogenes that control cell growth/division & apoptosis
Tumor suppressor genes controlling DNA/cell replication.
•Cancer is a multistep process
•Requires-
Activation of proto-oncogenes- dominant mutation                                  
   
Suppression of tumor suppression genes- recessive mutation                 
                
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8. Symptoms- early/warning
•Non-healing oral or skin ulcer
•Lump/swelling in breast, neck, limbs
•Dysphagia 
•Hoarseness 
•Hemoptysis
•Painless hematuria
•Post-menopausal bleeding
•Unexplained weight loss or anemia
•Change in a mole- size, color, ulceration
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9. Diagnosis
•A review of health history
•Physical examination
•Laboratory tests (blood, urine, etc.)
•Biopsy & FNAC
•Imaging tests (X-ray, PET/CT, MRI, ultrasound, etc.)
•Nuclear medicine scans (bone scans, etc.)
•Endoscopy
•Genetic tests
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10. Cancer staging
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11. Modalities of treatment
1. local therapy:
•Surgery.
•Radiation therapy.
2. Systemic treatment:
•Chemotherapy.
•Hormonal therapy.
•Monoclonal antibodies.
•Radioactive material.
3. Supportive care.
4. Non-conventional therapy.
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12. CHEMOTHERAPY
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13. Introduction
•Chemotherapy (also called chemo) is a type of cancer
treatment that uses drugs to destroy cancer cells.
•Chemotherapy works by stopping or slowing the
growth of cancer cells, which grow and divide quickly.
• But it can also harm healthy cells that divide quickly,
such as those that line your mouth and intestines or
cause your hair to grow.
•Damage to healthy cells may cause side effects.
Often, side effects get better or go away after
chemotherapy is over.07/05/17

14. Principles of Chemotherapy
•Induce cell differentiation.
•Induce cell death or apoptosis.
•Suppress cancer cells for variable periods without
inducing cell death.
•Chemotherapy drugs are more toxic to sensitive malignant
cells than normal cells.
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16. Mechanisms of chemotherapy
•Damage the DNA of the affected cancer cells. It is not always
possible to be selective, but selectivity is the ultimate goal of
any drug. e.g., cisplatin (Platinol®), doxorubicin
(Adriamycin®)
•Inhibit the synthesis of new DNA strands to stop the cell
from replicating, because the replication of the cell is what
allows the tumor to grow. e.g., methotrexate (Abitrexate®)
•Stop the mitotic processes of a cell. Stopping mitosis stops
cell division (replication) of the cancer and may ultimately
halt the progression of the cancer. e.g., Vinblastine
(Velban®), Vincristine (Oncovin®)
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18. Modes of chemotherapy
•PRIMARY CHEMOTHERAPY
It is used as the sole anti-cancer treatment in a highly
sensitive tumor types
•Example – CHOP for Non- Hodgkin's lymphoma
•ADJUVANT CHEMOTHERAPY
Treatment is given after surgery to “mop up”
microscopic residual disease
•Example – Adriamycin, cyclophosphamide for
breast cancer
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19. Modes contnd..
•NEOADJUVANT CHEMOTHERAPY
Treatment is given before surgery to shrink tumor and
increase chance of successful resection
•Example – Adriamycin, ifosfamide for
osteosarcoma
•CONCURRENT CHEMOTHERAPY
Treatment is given simultaneous to radiation to
increase sensitivity of cancer cells to radiation
•Example – Cisplatin, 5-fluourouracil, XRT for head
and neck tumors
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20. Combination therapy
•Reduces resistance to drugs
•Increased effectiveness
•Access to sanctuary sites e.g. lungs, CSF
•Combinations selected to avoid
overlapping toxicity
•Causes spectrum of adverse effects but
minimises risk of lethal effects.
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21. Aim of combination therapy
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Different mechanisms of action Compatible side effects

Different mechanisms of resistance
ACTIVITYACTIVITY SAFETYSAFETY
INCREASED EFFICACYINCREASED EFFICACY

22. Targeted therapy
•Definition
New technology and drugs that allow the cancer treatment to
“target” a certain cancer cell by interfering with the natural
functions of tumor growth
•How they work
They “target” specific parts of a cancer cell or its actions
•Potentially fewer side effects
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23. Palliative therapy
•Symptom Control when previous therapy has failed or
disease has relapsed.
•AIM is to improve survival and improve Quality of life
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24. There is a wide variation in sensitivity of
various cancers to chemotherapy
HIGH INTERMEDIATE
LOW
Lymphoma Breast Head and Neck
Leukemia Colon Prostate
Small cell lung cancerSmall cell lung cancerGastric
Testicular cancer Pancreatic
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25. Classification cytotoxic drugs
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26. Chemotherapy major classes
•Alkylating agents
•Antimetabolites
•Antitumor antibiotic
•Plant alkaloids
•Hormonal agent
•Immunotherapy
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27. Chemotherapy – routes of administration
•Oral
•IV
•IM
•SC
•Intrathecal
•Intraperitoneal
•Intravitreal
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28. Side effects of chemotherapy
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29. Nursing care
•Explain the procedure of administration, oral , iv, s/c
•Explain side effects in particular risk of infection and mouth
care
•Assess venous access if IV route of administration.
•Administration of anti-emetics
•Assess anti-emetic regimen - is it effective?
•Nutritional intake
•Fluid intake / balance
•Signs of infection e.g. Hickman line site
•Psychological care
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30. Thank you