LU 3.2 Medical Management of Cancer

What is chemotherapy ?

• a form of cancer treatment that uses chemical substances, particularly cytotoxic drugs, to destroy cancer cells

What are the goals of chemotherapy ?

• for curative

• to control the growth and spread of cancer

• as adjuvant therapy

• as neoadjuvant therapy

• palliative care to relieve symptoms

What are the pre chemotherapy assessment ?

• physical assessment

• previous concurrent medical/ surgical illness

• presence of prior cancer therapy toxicities (radiation and chemotherapy)

• laboratory parameter (complete blood cell count)

• clinical parameter (ECG and Chest xray to exclude any cardiac or lung problems)

• psychosocial assessment of patient and family members

What are the classification of chemotherapy drugs ?

• Alkylating agents

• Nitrosoureas

• Antimetabolites

• Anti-tumor antibiotics

• Plan alkaloids

• Topoisomerase inhibitors

• Miscellaneous agents

What is the calculation of chemotherapy dosage ?

Briefly describe alkylating agents in terms of

• function

• side effect

• drug example

• to treat which cancer

• function : damage the DNA by preventing from replicate

• side effect : bone marrow suppression, nausea, vomiting

• example : Carboplatin, Busulfan, Cisplatin

• to treat hematology cancer, lung, breast, ovary cancer

Briefly describe antimetabolites in terms of

• function

• side effect

• drug example

• to treat which cancer

• function : interfere with DNA and RNA synthesis

• side effects : nausea, vomiting, diarrhea

• example : Capecitabine (Xeloda), Gemcitabine (Gemzar)

• to treat leukemia, breast, ovary, intestinal tract cancer

Briefly describe anti-tumor antibiotics in terms of

• function

• side effect

• drug example

• to treat which cancer

• function : bind to DNA to prevent RNA synthesis and cell growth

• side effect : nausea, vomiting, bone marrow suppression

• example : Daunorubicin, Epirubicin, Bleomycin

• to treat breast, lymphoma and leukemia

Briefly describe plant alkaloids in terms of

• function

• drug example

• function : block the ability of cancer cells to divide

• two types and example : vinca alkaloids (vinblastine, vinorelbine), taxanes (paclitaxel, docetaxel)

Briefly describe topoisomerase inhibitors in terms of

• function

• side effect

• drug example

• to treat which cancer

• classified as Topoisomerase I or II

• function :inhibit the enzyme topoisomerase that help to unwind DNA replication

• side effects : diarrhea, nausea, vomiting

• example : Topoisomerase I (Topotecan), Topoisomerase II (Etoposide (VP16))

• to treat leukemia, lung cancer, ovarian cancer, GI cancer

Briefly describe miscellaneous agents in terms of

• side effect

• drug example

• to treat which cancer

• side effects : fever, chills, nausea, vomiting

• example : L-asparaginase (Elspar)

• to treat leukemia (AML, ALL)

Briefly describe Nitrosoureas in terms of

• function

• side effect

• drug example

• to treat which cancer

• function : inhibit synthesis of DNA and RNA

• side effect : thrombocytopenia, nausea, vomiting

• example : carmustine, semustine

• to treat brain tumor

What are the issues with chemotherapy ?

• toxicity and side effects

• cancer cells can develop resistance to chemotherapy drugs

• immunosuppression

• psychosocial impact

• long term effects such as heart problems

• financial burden

• adherence issues due to severity of side effects

What is radiotherapy ?

• treatment method that uses high-energy radiation from x-rays, gamma rays, electrons to destroy cancer cells

What are the goals of radiotherapy ?

• as a curative

• as adjuvant therapy

• as neoadjuvant therapy

• as palliative radiotherapy to relieve symptoms

• as prophylactic radiotherapy to prevent spread of cancer

What are the radiotherapy treatment planning process ?

1. Consultation and assessment

2. Simulation

3. Treatment planning

4. Treatment delivery

5. Monitoring and adjustments

What are the types of radiation therapy ?

• External Beam Radiation Therapy (EBRT) : uses high-energy x-rays delivered from outside the body to target the tumor

• Brachytherapy (Internal Radiation Therapy) : placing radioactive sources directly inside or near tumor

• Systemic Radiation Therapy : giving radioactive substances orally or via injection to target specific cancer cells

What are the examples of External Beam Radiation Therapy (ERBT) ?

What are the example of brachytherapy (internal radiation therapy) ?

• Low-Dose Rate (LDR) Brachytherapy : Involves placing radioactive seeds in or near the tumor, which emit radiation over a long period.

• High-Dose Rate (HDR) Brachytherapy : Involves the temporary placement of a higher-intensity radiation source for a short period.

What are the types of internal radiation therapy ?

• interstitial radiation

• intracavitary radiation

What are the issues with radiotherapy ?

• acute side effects such as skin reactions, fatigue

• late side effects such as fibrosis

• Physical side effects (men: erectile dysfunction, women : vaginal dryness)

• some cancer cells develop resistance to radiation

• emotional impact such as anxiety