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.
07/05/17

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
07/05/17

4. 07/05/17
Types of cancers
1.Carcinoma
2.Sarcoma
3.Lymphoma
4.Leukemia
5.Melanoma

5. 07/05/17

6. 07/05/17

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
07/05/17

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
07/05/17

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
07/05/17

10. Cancer staging
07/05/17

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.
07/05/17

12. CHEMOTHERAPY
07/05/17

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.
07/05/17

15. 07/05/17

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®)
07/05/17

17. 07/05/17

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
07/05/17

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 head07/05/17

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.
07/05/17

21. Aim of combination therapy
07/05/17
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
07/05/17

23. Palliative therapy
• Symptom Control when previous therapy has failed or
disease has relapsed.
• AIM is to improve survival and improve Quality of life
07/05/17

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 cancer Small cell lung cancer Gastric
Testicular cancer Pancreatic
07/05/17

25. Classification cytotoxic drugs
07/05/17

26. Chemotherapy major classes
•Alkylating agents
•Antimetabolites
•Antitumor antibiotic
•Plant alkaloids
•Hormonal agent
•Immunotherapy
07/05/17

27. Chemotherapy – routes of administration
•Oral
•IV
•IM
•SC
•Intrathecal
•Intraperitoneal
•Intravitreal
07/05/17

28. Side effects of chemotherapy
07/05/17

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
07/05/17

30. Thank you