Download Cancer Treatment Modalities

Cancer Treatment Modalities
Overview
Mary M. Gullatte, PhD, RN
UICC Program
Makati Medical Center,
Philippines
October 29, 2008
Surgery
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Diagnosis
Staging
Treatment
Surgery Techniques
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Electrosurgery
Cryosurgery
Chemosurgery
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Chemotherapy
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Administration
– Venous access devices
– Care & maintenance of
VADs
‘Safe Handling and
disposal
Drug classifications
Caring for patients
receiving chemotherapy
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Radiation Therapy
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Principles of Radiation Therapy
Types of Radiation Therapy
– External beam (stereotactic)
– Internal beam (brachytherapy)
– Photodynamic therapy
Radiosensitizers
Total Body Irradiation
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Biotherapy
Major agents
 Gene therapy
 Growth factors

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Multimodal Therapy
Surgery plus chemotherapy
 Chemotherapy plus radiation
 Biotherapy and combinations
 All modalities
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Complimentary and Integrative Therapies
Behavioral
 Nutritional
 Energy work
 Cognitive
 Cultural practices and beliefs
 Botanicals

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Education
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Patient and Family Education
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Community Resources & Support
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Larger community
Patient community
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CHEMOTHERAPY
 Normal
vs
malignant
growth
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Mitosis
 Interphase
 Prophase
 Metaphase
 Anaphase
 Telophase
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Benign and Malignant Cell
Characteristics
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Benign
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Encapsulated
No metastasis
Partially differentiated
Slight vascularity
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Malignant
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Rarely encapsulated
Poorly differentiated
Metastatic
Abnormal cells
Moderate to marked
vascularity
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Cancer Cell Morphology
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Pleomorphism
Hyperchromatism
Aneuploidy
Abnormal chromosomes
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Cancer Cell Cycle
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Go
G1
S
G2
M
Post mitotic resting phase
Post mitotic/pre-synthesis
Synthesis
Post-synthetic/pre mitotic phase
Mitosis
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(C) M.Gullatte, 2008
Cancer Cell Growth

Gompertz Growth Curve
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–
Growth Factor (GF)
Doubling time (DT)
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Cell Cycle Response to Chemotherapy
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Gº:
G¹:
S:
G²:
Resting phase- no replication
RNA and protein synthesis
DNA synthesis
Second growth period- RNA and protein
synthesis
M: Actual cell division
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Cell Cycle Specific Agents
G¹ -Phase
Asparaginase
Prednisone
Ifosfamide
S Phase
Fluorouracil
carboplatin
Cytarabine
Methotrexate
Thioguanine
G² Phase
Bleomycin
Etoposide
Ifosfamide
Amsacrine
M Phase
Vincristine
Vinblastine
Vinorelbine
Vindesine
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Cell Cycle Non-Specific Agents
Alkylating Agents
Busulfan
Chlorambucil
Cisplatin
Cyclophosphamide
Carboplatin
Antibiotics
Nitrosoureas
Carmustine
Streptozocin
Lomustine
Miscellaneous agents
Dacarbazine
Procarbazine
Daunorubicin
Mitomycin
Doxorubicin/Adriamycin
Mitoxantrone
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Tumor Response Criteria
Complete Remission (CR)
 Partial Remission (PR)
 Progression (P)
 Improvement (I)
 Stable Disease (SD)

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Factors Affecting Response
Tumor burden
 Growth fraction
 Tumor drug resistance

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Classification of
Chemotherapy/Antineoplastic Agents
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Alkylating
Antimetabolites
Antitumor antibiotics
Biologics
Hormones
Plant alkaloids
Targeted Therapy
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Biologic Response Modifiers
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Epoetin alpha
Filgrastim
Interferon alpha
Tumor necrosis factor
Rituximab
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Hormones
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Hormone sensitive
cancers
–
Breast
–
Prostate
Glucocorticoids
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–
Dexamethasone
Prednisone
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Plant Alkaloids
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Vinca alkaloids
– vincristine
Taxanes
– paclitaxel
Phodophyllotoxins
– etoposide
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Targeted Therapy
Ideal Target
–
–
–
–
Necessary for tumor
survival
Normal cells +/expression of the target
Blocking the target =
tunor response
Minimal expression
target results in +/- tumor
response
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Stimulators and Inhibitors of
Angiogenesis
Stimulators (growth factors)
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–
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Basic fibroblast
Epidermal
Placental
Transforming factor-α
Tumor necrosis factor
(TNF)
Vascular endothelial gf
(VEGF)
Inhibitors
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–
–
–
–
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Angiostatin
Endpstatin
Interferons α, β, γ
Interleukins 4, 12, 18
Thrombospondin
Tissue inhibitor of
metalloproteinase -1, -2,
-3
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Vesicant Agents
Antitumor
antibiotics
 Alkylating agents
 Vinca alkaloids

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Principles and Standards of
Chemotherapy Administration
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Safe-handling and Disposal guidelines
Preparation and administration
Routes of Administration
Storage and transport
Hazardous drug spills
Patient and family education
(C) M.Gullatte, 2008
Safe Handling and Disposal
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Reconstituting (lamina flow hood)
Personal Protective Equipment (PPE)
Spills (face shield, respirator, gloves, gown)
Patient body fluids (urine, emesis)
Disposal of empty chemotherapy
containers (bags, bottles, IV tubing, vials)
Surface decontamination
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Preparation and Administration
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Orders (check protocol, regimens, BSA, labs, vascular access)
Pharmacy, Nurse, Physician, Responsibility
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Pharm D. (orders, mixing, priming tubing, delivery to unit for nurse)
Nurse (patient education, administration (oral, IV, IP)
Physician or Midlevel (IT, IA)
Personal Protective Equipment
–
gloves, goggles, cuffed gown
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Routes of Chemotherapy Administration
Oral
Intravenous (IV)
Intraperitoneal (IP)
Intra-arterial (IA)
Intrathecal a.k.a., intraventricular (IT)
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Storage and Transport
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Clean area
Label area
No chemicals above eye level
Transport primed solutions to the area
securely
Prime with drug free fluids
Secure clamp
Properly label
(C) M.Gullatte, 2008
Hazardous Chemotherapy Spill
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Emergency code
Secure and contain
the area
Size of spill
PPE and Spill kit
Disposal
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Patient and Family Education
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Medications
Expected side
effects
Precautions
Managing at home
When to call the
nurse or doctor
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Questions?
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