Modalities

Cure

Control
palliation

Goals of Cancer Treatment

Surgery

Used for  Diagnosis 

Staging of more than 90 % of all cancers 

Primary treatment of more than 60% of cancers.

Prophylaxis

• To remove tissue or organs for prevention of the disease that have high potential or incidence of occurrence.

Diagnostic Surgery

biopsy, endoscopy, laparoscopy, and open surgical exploration 

____

Aims to ensure histologic diagnosis and staging of cancer thru _________,_____,_____,_____

Treatment

• To remove entire tumor and involved surrounding lymph nodes 

Reconstruction and Palliation

• Allow the involved organs to  function as long as possible, 

• to relieve pain  

• and provide comfort or bypass an obstruction.

Salvage

• Use of an extensive surgical approach to treat a local disease recurrence 

• mastectomy after lumpectomy with radiation therapy for breast cancer.

mastectomy after lumpectomy, with radiation therapy for breast cancer

Example of Salvage

Primary Treatment

Removal of malignant tissue and having disease-free normal tissue margin. 

Adjuvant Treatment

Reduces for incidence, progression or recurrence of cancer.

Electrosurgery

Cryosurgery

Chemosurgery

Laser

Photodynamic

Video-assissted Thorascoscopy

Intraoperative Electron Beam Radiation Therapy

Give some “Selected Surgical Techniques”

Electrosurgery

• Eliminates cancer by using cutting and coagulation effects of high frequency electrical current applied by needles, blades or electrodes.

Cryosurgery

• Cryoprobe

______

• Application of liquid nitrogen thru _____ inserted into a tumor for in situ destruction by deep-freezing the intracellular and extracellular structure. 

Chemosurgery

• Use of layer by layer surgical resection of tissue and topical application of chemotherapeutic medication.

Laser

• Destroy cancer cells by intense thermal energy therapy.

Photodynamic therapy

• Hematoporphyrin derivative HpD

• laser light , 24 to 48 hours

________

• Involves intravenous injection of photosensitizing drug (________ with uptake by cancer cells, followed by exposure to _______within _______ of injection.  

Video-assisted Thoracoscopy

• Rigid telescopes and cameras are introduced through first incision and endoscopic surgical instrument is introduced into remaining incision. 

Intraoperative Electron Beam Radiation Therapy 

• Image: the tumor is visible through the applicator, & the docking process 

Intraoperative Electron Beam Radiation Therapy 

• Tumoricidal doses of radiation are delivered to tumors at the time of surgery while the dose to adjacent healthy tissue is minimized.

Chemotherapy

Use of cytotoxic medications to cure some cancers.

Cure

Control
palliation

Myeloblative

Chemoprevention agent

Goals of Chemotherapy (5)

Cure

 cure the disease or effect a complete remission of at least 5 years.

Control

provide extension to patient’s survival.

Palliation

improve quality of life and increase comfort by reducing tumor burden or relieving obstruction, pain or other symptoms.

Myeloblative

provide disease free bone marrow, create space in marrow and suppress host immune system in preparation for blood/stem cell transplantation.

Chemoprevention Agents

used varied drugs or nutrients that block the initiation of carcinogenesis or halt the progression of premalignant cells.

1. Adjuvant

2. Neoadjuvant

3. Primary

4. Induction

5. Intensification/ Consolidation

6. maintenance

7. Salvage

8. Combination Chemotherapy

Uses of Chemotherapy

Adjuvant

used in conjunction  with another treatment. 

To treat remaining cancer cells or macrometastasis prevent local or distant relapse of the disease

neoadjuvant

to shrink the tumor before it is removed surgically or treated with radiation therapy.

primary

Treatment to patients with localized disease.

Induction

initial chemotherapy to achieve significant cell death and complete remission of the disease.

Intensification/Consolidation

Second course of chemotherapy with different or same drugs or dose to achieve disease remission. 

Maintenance

 therapy given over 1, 2 or 5 years. 

Maintenance

Prevent the disease from recurring. 

Salvage

used to control the cancer disease or to provide palliation for patients when other treatments were not successful.

Combination Therapy

multiple drugs given in different doses, routes or schedule enhance the drug(s) effect on tumor cell death. 

Cell Generation Cycle

Cell Kill Hypothesis

PRINCIPLES

Cell Generation Cycle

disruption of cell cycle effective in targeting cancer cells for increased cell death.

Cell Kill Hypothesis

• every tumor cell must be killed to cure cancer.

• CA dose kills only fraction, thus continuous and repeated chemotherapy should be done to kill all cancer cells. 

Cell Cycle Phase: Specific: effective specific phase

Cell Cycle phase: Nonspecific : efffetive in all phases

Classification of Chemotherapy Drugs

Cell Cylce Phase: Specific

effective specific phase in cell cycle to prevent cell replication by damaging cellular DNA and blocking production of protein necessary for DNA and RNA synthesis.

Antimetabolites

Vinca Plant Alkaloids /Mitotic Inhibitors

Miscellaneous Agents

Enumerate the Cell Cylce Phase: Specific

Antimetabolites

•  blocks essential enzymes for DNA synthesis.

Toxic Effect: rapidly proliferating cells (GIT, Hair, Skin, WBC)

Side effects:

1. Nause and Vomiting

2. Stomatitis

3. Diarrhea

4. Alopecia

5. Leukopenia

Antimetabolites:

Toxic Effects

Side Effects:

Vinca Plant Alkaloids / Mitotic Inhibitors

• Exerts a cytotoxic action by binding to tubular proteins during the M phase (metaphase stage) causing  mitotic arrest with the cell losing its ability to divide and resulting in cell death.

Miscellaneous Agents

• inhibiting protein synthesis, cell proliferation, (acts at different phases in the cell cycle.

Cell Cycle Phase: NonSpecific

effective in all phases of cell cycle including the resting phase and are usually administered through bolus dosing;

Alkylating Agents

Antitumor Antibiotics

Nitrosoureas

Hormononal Agents

Antihormonal Agents

Corticosteroids

Cell Cycle Phase: NonSpecific (enumerate)

Alkylating Agents

• inhibit DNA, RNA and protein synthesis. 

Antitumor Antibiotics

• disrupt DNA transcription and RNA synthesis, create free radicals, which generate breaks in DNA and interfere with DNA repair

Nitrosoureas

• inhibit synthesis and replication of DNA and RNA. Have the capacity to cross the brain barrier.

Hormonal Agents

• alter the environment of the cell by affecting the membrane’s permeability.

Antihormonal Agents

• provide ability to neutralize the effect of or inhibit the production of natural hormones used by hormone dependent tumors.

Corticosteroid

• exert anti-inflammatory effect on the body tissues increase appetite and promote a feeling of well-being.

Corticosteroids

• phase specific (G1) act by binding to specific intracellular receptors, repressing transcription of mRNA and thereby altering cellular function and growth.  

1. patient’s elligibility for chemotherapy

2. cancer cell histology type

3. rate of drug absorption

4. Tumor location

5. Tumor Burden

6. Tumor Resistance to chemotherapy

Factors considered in chemotherapy drug selection

Patient’s eligibility for chemotherapy

confirmed diagnosis, previous therapies, age, bone marrow, cardiac, hepatic, respiratory, renal and nutritional status.

Rate of Drug Absorption

treatment interval, dosages and route.

Tumor Location

many drugs may not cross blood-brain barrier. 

Tumor Burden

larger tumors are generally less responsive to chemotheraphy.

Oral

Subcutaneous and IM
intravenous (bolus; continuous or intermittent)

Intraaerterial

Intraperitoneal

Intrapleural

intrathecal

Intravesicular

Intracavity

Routes of Chemotherapy Administration

Intrapleural

 infused thru chest tubes

Intrathecal

 thru ommaya reservoir, lumbar puncture access or both.

Intravesicular

skin testing technique to check hypersensitivity.

Intracavity

bladder thru catheters.

1. Carcinogenecity

2. genetoxicity

3. Teratogenecity

4. Organ Toxicity

5. Accidental Exposure

Potential Health Risks Associated with Chemotherapy Drugs.

   Conditions associated with exposure to chemotherapeutic 

wash hands before and after handling

LImit access to preparation areas

Keep labeled drug spill kit

wear latex gloves, long sleeve gown with cuff, goggles,

Prepare drugs using aseptic technique

use Luer-lock equipment and prime IV tubings inside zip-lock bags

Safe Handling Guidelines

DRUG PREPARATION

• Wear Protective equipment

• administer in a safe unhurried environment

• plastic-backed absorbent pad under infusion tubing and syringe to minimize spills

• Do not dispose of any used supplies in a patient care area.

• Inform patients that chemo drugs are harmful to healthy cells and that protective emasure used by stadd to minimize exposure

Safe Handling Guidelines

DRUG ADMINISTRATION

placed all supply and unused drug in puncture proof, leak proof labeled container

disposal in accordance with proper waste

all hazardous containers should be labeled

Safe Handling Guidelines

DISPOSE SUPPLIES AND USED DRUGS

1. Mucous membrane – mouth, tongue, esophagus, stomach, intestine and rectum.

   1. anorexia, loss of taste, aversion of food, erythema, painful ulceration in GIT, nausea and vomiting.

2. Hair Cells – alopecia

3. Bone marrow depression – affects granulocytes, lymphocytes, thrombocytes    and erythrocytes.

4. Organs, such as heart, lungs, bladder and kidneys (cardiac toxicity with doxorubicin)

5. Reproductive organ – impaired reproductive ability or altered fetal development.  

Effects of Chemotherapy Drug

• Alert the nurse to the onset of toxicity.

• Teach how to take care of access sites and dispose of used equipment and excretion safely.

• increase fluid intake to flush out the drugs.  Get extra rest.

• WBC count is low – limit exposure to others, especially children or those with infection.

• Help identify and manage toxic effects or side effects of drugs and provide psychological effects.

• Careful assessment and monitoring of client’s signs and symptoms including appropriate laboratory tests.

MANAGEMENT OF CLIENT RECEIVING CHEMOTHERAPY

Radiation Therapy

Is localized  treatment that is used alone or in conjunction with other treatment such as chemotherapy and surgery.

Radiation Therapy

Consist of delivering ionizing radiation of gamma and x-rays in one of two ways.

1. Teletherapy (External Radiation)

2. Brachytherapy (internal, Interstitial, or intracavitary radiation)

Two ways of Radiation Therapy

TELETHERAPY (External radiation)

delivery of radiation from a source of some distance from the client.

BRACHYTHERAPY (internal, interstitial or intracavitary radiation)

a radioactive material is placed directly into or adjacent to the tumor, a technique that delivers a high dose to the tumor and low dose to the normal tissues.

Lethal injury to DNA

 primary mechanism by which radiation kills cells in faster growing tumors and tissues.

Curative

Control

Palliation
Prevention
Myeloablative

Goals of Radiation Therapy

Curative

 eradicate the disease and allow the individual to live a normal life. 

Control

control the growth and spread of the disease. 

Prevention

prevent microscopic disease

Palliation

improve the quality of life by relieving or diminishing symptoms.

Myeoablative

used to reduce the tumor cell volume and provide immune suppression to prevent rejection of the blood/stem cell graft.

• Maintain greatest possible distance from the source

• Spend minimum amount of time close to radiation source

• Shield yourself from radiation with lead gloves and aprons

• If pregnant, avoid contact with radiation sources

• if you work near radiation, wear monitoring device

• avoid direct exposure to radioisotope containers

• patient with implanted radioisotopes kept in a private room

• handle bed linen and clothing with care

• long handled forceps

Give the 11 SAFETY PRINCIPLES in Radiation Therapy (Ket mga lima lang)

Biotherapy

• Modifies the biologic processes that result in malignant cells, primarily through enhancing the person’s own immune responses.

Immunotherapy

• is the development of monoclonal antibodies that enhance the immune system’s ability to fight the cancer.

(Phototherapy, photoradiation, and photochemotherapy)

Photodynamic Therapy is also known as?

Photodynamic Therapy

Is a method of treating of certain kinds of superficial tumors.

Photodynamic Therapy

• photofrin

_________ Given intravenous dose of photosensitizing compound, _______ retained in higher concentration in malignant tissues.

Photodynamic Therapy

3 days

3 days

________ Activated by laser treatment in _____after the drug injection and administered for ____

Photodynamic THerapy

Drug interacts with oxygen molecules in the tissue to produce cytotoxic oxygen molecules

Bone Marrow and peripheral Stem Cell Transplantation

Stimulate a non-functioning marrow or to replace marrow.

Bone Marrow and peripheral Stem Cell Transplantation

Given as an intravenous infusion of bone marrow cells from donor to client.

Bone Marrow and peripheral Stem Cell Transplantation

Common in leukemia

Apharesis

Harvesting Stem Cells from peripheral Blood

Apharesis

• Process of removing circulating stem cells from peripheral blood through apheresis and returning these cells to the patient after dose-intensive chemotherapy.

BEND MSM

• Botanical agents

• Energy healing

• Nutritional supplements

• Dietary regimens

• Mind-body modalities

Spiritual approaches

• Miscellaneous therapies

COMPLEMENTARY THERAPIES

Complementary Therapies

Refers to therapies that clients choose as a compliment to medical treatment.