Anti-Cancer: Cytotoxic, Hormonal & Radiation Therapies

What is the primary goal of chemotherapy?

To inhibit cell proliferation and tumor multiplication.

Why is chemotherapy problematic for healthy cells?

It damages rapidly dividing healthy cells, leading to significant side effects.

Name the three main classes of cytotoxic agents.

Alkylating agents, antimetabolites, and anti-tumour antibiotics.

How do alkylating agents work?

They inhibit DNA replication and transcription by cross-linking DNA strands.

What is the pharmacodynamic action of antimetabolites?

They inhibit DNA replication by mimicking normal metabolites.

How do anti-tumour antibiotics exert their effect?

They inhibit both RNA and DNA synthesis in cancer cells.

List four factors that influence the choice of a cytotoxic agent for a patient.

Cancer type, cancer stage, client age, comorbidities/past treatments, and client preference.

Which patient tissues are most susceptible to cytotoxic-agent side effects and why?

Hair follicles, bone marrow, skin, and GI lining because they contain rapidly dividing cells.

Which lab tests are essential before each chemotherapy treatment and why?

Renal and liver function tests to ensure safe dosing and drug clearance.

What two medications are commonly given as pre-medications to prevent infusion hypersensitivity reactions?

Diphenhydramine (Benadryl) and methylprednisone.

Which supportive medications can cause steroid-induced mania, insomnia, or anxiety during chemotherapy?

Steroids and other anti-emetics used for chemotherapy-induced nausea and vomiting.

For how long should patients avoid pregnancy or insemination after completing cytotoxic chemotherapy?

For one year after the final treatment.

For how long are cytotoxic drugs excreted in body fluids after a treatment session?

Up to 48 hours.

Give two key instructions for handling bodily fluids at home after chemotherapy.

Close the toilet lid and flush twice; launder contaminated linens separately.

List at least four common symptoms nurses should monitor and manage as part of chemotherapy supportive care.

Nausea/vomiting, diarrhea, alopecia, signs of infection or sepsis, fatigue, and mental-health concerns.

Name three categories of hormone-therapy drugs used in cancer treatment.

Aromatase inhibitors, androgen deprivation therapy, and selective estrogen receptor modulators (SERMs).

What surgical procedures can serve as hormone therapy by removing hormone-producing organs?

Orchiectomy (testicle removal) and oophorectomy (ovary removal).

How can radiation therapy be used as a form of hormone therapy?

It destroys or shrinks hormone-producing tissues to stop hormone production.

State the three ways hormone-therapy drugs work in the body.

Blocking hormone production, blocking hormone receptors on cancer cells, or interfering with hormone action.

Which three cancers are most commonly treated with hormone therapy?

Prostate, breast, and endometrial cancers.

List five common side effects of hormone therapy.

Fatigue, hot flashes, erectile dysfunction or vaginal dryness, weight gain, bone loss/fractures, and mood changes.

What key fertility-related teaching should nurses provide when starting hormone therapy?

Discuss potential infertility or medical menopause and offer fertility-preservation counseling.

Medication math: How many Tamoxifen 20 mg tablets are needed to administer a 40 mg ordered dose?

2 tablets.

A 110-lb patient receives Cyclophosphamide 200 mg. What is the safe dosage range (1–5 mg/kg)?

50–250 mg; the 200 mg dose is within the safe range.

If Cyclophosphamide tablets are 25 mg each and 200 mg is ordered, how many tablets should the nurse give?

8 tablets.

A patient weighing 80 kg is prescribed 4 mg Leukeran daily. With a safe range of 0.03–0.1 mg/kg, is the dose safe?

Yes; safe range is 2.4–8 mg. The nurse would administer 2 tablets of 2 mg.

IV flow-rate calculation: 100 mL over 30 minutes equals how many mL/hr?

200 mL/hr.

An IV chemotherapy infusion runs at 22 mL/hr for 10 hours. What total volume is delivered?

220 mL.

What are the three major forms of radiation therapy discussed?

External radiation, internal implant brachytherapy, and systemic radiopharmaceutical therapy.

How does external beam radiation destroy cancer cells?

High-energy photon beams damage DNA so cells can no longer divide.

List four common side effects of external radiation therapy.

Radiation burn, fatigue, nausea/vomiting, and headache.

What is brachytherapy?

Placement of a sealed radioactive source (implant) inside or near the cancer for a short time.

Describe MammoSite therapy in breast cancer care.

A 5-day balloon catheter brachytherapy that delivers high-dose radioactive seeds to the surgical cavity.

Define radiopharmaceuticals.

Radioactive drugs administered orally or IV that target cancer cells and emit cell-damaging radiation.

What are the two types of radiopharmaceutical therapies?

Radioimmunotherapy and peptide receptor radionuclide therapy (PRRT).

Where are radiopharmaceuticals typically administered?

In the hospital’s nuclear medicine department with nuclear physicians, technicians, and nurses.

List two common side effects of radiopharmaceutical therapy.

Mild diarrhea and a general feeling of being unwell; it may also lower WBCs and hemoglobin.

What excreta-related education should be given after radiopharmaceutical therapy?

Sit to urinate, wear gloves, flush twice, wash soiled linens separately, and practice good hand hygiene.

What is the purpose of topical antimicrobial dressings in oncology or burn wound care?

To inhibit bacterial growth in a localized wound area.

Give three examples of silver-containing topical agents.

Silver sulfadiazine, silver nitrate, and nanocrystalline silver.

Why is silver sulfadiazine contraindicated near the eyes and in certain populations?

It is oculotoxic and contraindicated in pregnant or breastfeeding women and infants under two months.

What key property distinguishes nanocrystalline silver dressings?

They provide a stronger, longer-lasting antimicrobial effect but require frequent moistening.

Why is bismuth-impregnated petroleum gauze advantageous for children with fresh skin grafts?

It is applied only once, reducing pain from frequent dressing changes.

What serious adverse effects can mafenide acetate cause?

Metabolic acidosis, allergic reactions, and respiratory complications such as tachypnea and low arterial PCO₂.

For what wound type is chlorhexidine gluconate recommended?

Superficial partial-thickness burns, because it does not interfere with epithelialization.