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Over 300 disorders
oncology incldes how many disorders?
They lack contact inhibition and adhesion. They dont stick like normal cells most
why are cancer cells more invasive and easily spread?
TMN:
Tumour: characteristics, depth of invasion
Node involvement
metastasis to other organs
most commonly used cancer staging system:
surgery
radiation therapy
interventional radiology
chemotherapy
Common cancer treatments [4]
chemotherapy
The use of medications in the treatment of cancer
Cyber knife
The use of radiation to cut tumours out:
cure: eliminate cancer
control: when disease is not curative
palliation: relieve symptoms when they arise
goals of chemotherapy [3]
Neoadjuvant chemo
Chemo to shrink tumours so they are more easiy resected surgically
Adjuvant chemotherapy
Chemo used in conjection with another treatment modality. For localized diease.
intermittent chemotherapy
Allowing time intercals between chemotherapy treatments
Combination therapy
Administration of two or more chemo agents to treat cancer
Cell kill hypothesis
a certain chemotherapy dosage will kill a constant percentage a cells, rather than a constant number.
Tissues that are continuing to divide
Chemotherapy is more toxic to which kinds of tissues?
chemotherapy. Dosed in milligrams/metre squared
body surface area is used to calculate which drugs?
Based on bbody surface area, height and weight. Could lose weight (N+V) or gain weight (steroids)c
why do chemotherapy drug dosings need to be reevaluated each cycle?
antineoplastic or cytotoxic
targeted therapy
immuno-oncology agents
hormones
classifications of chemotherapy agents: [4]
Antineoplastics/cytotoxicsf
these agents are sub-classified by chemical structure, cell cycle activity, and primary mode of action wihtin the cell
alkylating agents
antimetabolites
anti-tumour antibiotics
vinca (plant) alkaloids
four sub-classifications of antineoplastics/cytotoxics
Alkylating agents
antineoplastic/cytotoxic that does not target a specific place in the cell cycle
“aklyl” group causes breaks in DNA strands, preventing DNA replication and transcription of RNA
Alkylating Agent MOA
Drug resistance is common
Alkylating agents are commonly used in combination chemotherapy regimens. Why?
Cisplatinum
carboplatinum
oxiplatin
“platinum” based alkylating agent therapies [3]
Cyclophosphomide
Nitrogen mustard alkylating agent therapy
Temozolamide
Nitrosoureas alkylating agent therapy that crosses the blood brain barrier (good for brain cancer)
S phase
Antimetabolites target what pase of the cell cycle?
Acts as false metabolites which are incorporated into the DNA strand and prevent DNA and RNA synthesis
Antimetabolite MOA:
•5- Flurouracil (5-Fu) [breast]
•Pemetrexed (Alimta) [lung]
•Methotrexate (MTX) [can be used for autoimmune disorders, anti-rejection]
•Gemcitabine (Gemzar)
•Capecitabine (Xeloda)
Common forms of antimetabolites [5]
Antitumour antibiotics
Natural compounds found in various strainsof streptomyces, a soil fungal organism. Is cell cycle non-specific.
breaks DNA strands
inhibits DNA and RNA synthesis
alters cell membrane
Antitumour antibiotic MOA: there are a variety [3]
►Doxorubincin / Adriamycin
►Epirubicin [bladder cancer]
►Bleomycin
►Mitomycin
Common forms of antitumour antibiotics [4]
Vinca Alkaloids
Plant alkaloid produced from periwinkle plant
Halt cell cycle in M phase by crystallizing microtubules of mitotic spindles, thus inhibiting mitosis
Vinca ALkaloid MOA:
Prevents cells from entering M phase, inhibiting mitosis
Epipodophyllotixin MOA
►Vincristine
►Vinorelbine
Vina alkaloid prototypes: [2]
Etoposide
epipodophyllotixin prototype
vinca alkaloids
epipodophyllotoxins
taxanes
topoisomerase inhibitors
Plant alkaloids: [4]
taxotere.docetaxol
Taxane that is used as a third line treatment, like a last-ditch effort
Taxanes
PLant alkaloid where cells are prematurely thrown into cell division or cell divisiion arrested
Topoisomerase inhibitors
Semi-synthetic extract from the plant Camptotheca Acuminata from asia
Act in S phase to inhibit topoisomerase and cause cell death
Topoisomerase inhibitor MOA:
Camptosar/Irinotecan
Topoisomerase inhibitor prototype
targets specific molecules that cancel cells possess (genes,proteins, antigens.) to halt or interfere with their tumour promoting activity
target therapies MOA
Monoclonal antibodies
Targets one cancer cell antigen on te cancer cell surface
Inhibitors of Her 2 and Her 3 proteins which are over expressed on breast cancer cells.
▪Trastuzumab/Herceptin (IV therapy)
▪Trastuzumab Emtansine/Kadcyla
▪Pertuzumab/Perjeta
Monoclonal antiodies for breast cancer treatment: [3]
Targets the KRAS oncogene
▪ Panitibumab (Vectibix) – Colorectal Cancer
▪Cetuximab (Erbitux) – Colorectal Cancer
Gene targeted in Colorectal cancer (two targeted therapies)
Immuno-oncology agents
Modifies the host immune system to respnd to cancer. “takes the breaks” off the immune system
stimulates T-cells to target cancer cells and stop proliferation
creates memory cells in immune system that continue to act against cancer after treatment period
stimulates natural killer in immune system
Immuno-oncology agent MOA [3]
Nivolumab (Opdivo ®)
immuno-oncology agent that acts on lung and renal cell
Pembrolizumab (Keytruda®)How
immuno-oncology agent that acts on lung and melanoma:
Used in management of hormone sensitive cancers such as breast and prostate. Changes the hormonal environment of cancer cells by suppressing or eliminating hormonal growth factors
How are hormones used in cancer treatment:
•Tamoxifen, Arimidex, Femara
•Casodex, Eligard, Lupron
•Abiaterone, Xtandi
Common forms of hormones used in cancer treatment [3]
bone marrow
GI tract
hair follicles
Rapily dividing cells are found in: [3]
rapidl dividing cells
healthy and
cancer
Cancer is toxic to:
myelosuppression
Bone marrow suppressoin. Monitored by WBC and differential
leukopenia/neutropenia
decreased white blood cell and neutrophil couunt
Nadir period
Usually the middle of the chemo cycle. All blood values will be the lowest.
An oncolic emergency. Body cannot fight infection, can be fatal.
Fever as cancer side effect is what?
Anemia
decreased hemoglobin
Thrombocytopenia
Decreased platelet count
antibiotics
antigunals
antivirals
medications given for neutropenia [3]
Granulocyte stimulating factors
helps to build WBCs. If they fall below 1.9, have to delay chemo
blood transfusion
Nursing management for severe anemia:
high iron, folate, and B12 diet
Anemia diet
injury and bleeding prevention: avoid activities that can cause cuts or bruises, avoid activities with risk of physical injury
Patient education for thrombodytopenia
Alopecia
Cmplete hair loss or thinning of hair related to the use of specific drugs
Hand foot syndrome (plantar-almar erythrodysthesia)
Skin reaction to palms and soles. Tingling, redness, numbess, swelling, pain, dry, itching, peeling. onset 5-6 weeks after treatment starts
decrease the dose, decrease side effects. But need to give appropriate dose to treat the cancer
treatment for hand foot syndrome
Capectitabine (Xeloda)
may also be seen with high dose 5- Flouracil and many new targeted agents
hand foot syndrome is common with what drug?
Vitamin B6
What may be rpescribed for hand-foot syndrome?
Stomatitis
Inflammation/infection of oral mucous membranes
avoid mouthwashes and specialty toothpaste. Use soft tooth brushbrush, popsicles, ice chips, salt water rinse
Stomatitis prevention:
“magic mouthwash” and prescription preparations (antiseptic)
Treatment for stomatitis:
acute (first 24 hours
delayed
anticipatory (pior to treatment)
Three types of snausea and vomiting
cater to preferences, small frequent meals throughout day, avoid odors with foods & cooking
nutrition for N+V
Neurokinin 1(NK1) Receptor antagonist
anti-emetic that decreases NT involved in emetic response. Normally given for cancer tx
•Fosaprepitant (Emend®)
Neurokinin 1(NK1) Receptor antagonist protoype:
bowel obstruction. Stimulates GI motility
Dopamine antagonists (maxeran) should not be given when?
Phenothiazine derivatives:
Antipsychotic that is also goo at treating cancer N+V
Prochlorperazine (Stemetil®)
Phenothiazine derivative prototype
bananas
rice
applesauce
Tea
BRAT diet for N+V
combined radiation
chemotherapyre
Diarrhea is worsened with…
fluid/ electrolyte imbalance
renal toxicity commonly manifests as
hematuria
bladder toxicity normally manifests as
Mesna
renal protective agent
diuretics
renal protective agents
meds for renal/bladder toxicites [2]