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CANCER and Anti Cancer Agents

CANCER and Anti Cancer Agents. MAYA FE NG-DARJUAN, MD-RN. What is CANCER? . What is CANCER ?. Neoplastic disorder that can involve all body organs Cells lose their normal growth-controlling mechanism Growth of cells uncontrolled. How do cells know when to stop growing?.

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CANCER and Anti Cancer Agents

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  1. CANCER and Anti Cancer Agents MAYA FE NG-DARJUAN, MD-RN

  2. What is CANCER?

  3. What is CANCER? • Neoplastic disorder that can involve all body organs • Cells lose their normal growth-controlling mechanism • Growth of cells uncontrolled

  4. How do cells know when to stop growing? via Contact inhibition andSuppresor gene

  5. CELL CYCLE 2-5 hrs 6-8 hrs 8hrs or more Go – Resting phase Restriction checkpoint Source: Core Curriculum for Oncology Nursing (Itano and Taoka)

  6. PARTS OF A CELL

  7. CARCINOGENESIS Acquired (environmental DNA damaging agents) Chemicals Radiation viruses Normal Cell Successful DNA repair DNA Damage Failure of DNA repair Mutations in the genome of somatic cells Activation of growth promoting oncogene Alteration of genes that regulates apoptosis Inactivation of cancer suppresssor genes Expression of altered gene products Loss of regulatory gene product • Clonal expansion • Additional mutations • Heterogeneity MALIGNANT NEOPLASM Source: Core Curriculum for Oncology Nursing (Itano and Taoka)

  8. Classification of Cancer • Clinical Staging • 0: cancer in situ • 1: tumor limited to tissue of origin • 2: limited local spread • 3: extensive local and regional spread • 4: metastasis

  9. Classification of Cancer • TNM Classification • Tumor size • Spread to lymph nodes • Metastasis

  10. Prevention and Detection of Cancer • Reduce or avoid exposure to known or suspected carcinogens • Eat balanced diet • Exercise regularly • Adequate rest • Health examination on a regular basis

  11. Prevention and Detection of Cancer • Eliminate, reduce, or change perceptions of stressors and enhance ability to cope • Enjoy consistent periods of relaxation and leisure • Know 7 warning signs of cancer • Self-examination • Seek medical care if cancer is suspected

  12. Diagnosis of Cancer • Patient may experience fear and anxiety • Clear and repeated explanations may be necessary • Diagnostic plan includes • Health history (emphasis on risk factors) • Physical exam • Specific studies

  13. Diagnosis of Cancer • Biopsy - involves histologic examination by a pathologist of a piece of tissue • Imaging techniques – CT scan, MRI, UTZ • Laboratory test and tumor markers.

  14. TREATMENT modalities for Cancer • SURGERY • CHEMOTHERAPY • RADIOTHERAPY • IMMUNOMODULATION • BONE MARROW TRANSPLANT

  15. Chemotherapy • Goal is to reduce number of cancer cells in the tumor site(s) • Directed to cells with high mitotic index Main problem: • Cancer cells can escape death by staying in the G0 phase • drug- resistant

  16. ChemotherapyClassification of Drugs • Cell-cycle Nonspecific (CCNS) • Alkylating agents - CYCLOPHOSPHAMIDE • Antitumor antibiotics - DOXORUBICIN • Hormones - CORTICOSTEROIDS • Cell specific (CCS) • Antimetabolites – FLOUROURACIL • Mitotic inhibitors – VINCA ALKALOIDS

  17. ChemotherapyMETHODS OF ADMINISTRATION • Oral • IM • IV • Intracavitary • Intrathecal • Intraarterial • Continuous infusion • Subcutaneous • Topical

  18. Alkylating agents: • causing cross- linking of DNA strands • Cell cycle-nonspecific (CCNS)

  19. CANCER DRUG THERAPY

  20. Anti-metabolites: • acts like a natural metabolite thus disrupting cancer metabolic processes • CCS – S phase

  21. Antimetbolites: • SIDE EFFECTS • same as alkylating agents • Bone marrow depression • Infection • Bleeding • anemia • GI disturbance • hemorrhagic cystitis • Skin – stomatitis, alopecia

  22. MITOTIC INHIBITORS:VINCA ALKALOIDS MOA: • Block the formation of the mitotic spindle during mitosis, thus inhibiting cell division • Cell cycle specific agents PERIWINKLE PLANT

  23. MITOTIC INHIBITORS:VINCA ALKALOIDS • NATURAL PRODUCTS • 1. Etoposide ( VePesid) • 2. Docetaxel ( Taxoterel) • 3. Paclitaxel ( Taxol) • 4. Vinblastine sulfate ( Velban) • 5. Vincristine sulfate ( Oncovir) • 6. Vinorelbine ( Navelbine) PERIWINKLE PLANT

  24. ANTI-TUMOR ANTIBIOTICS: MOA: • Bind to DNA, inhibiting DNA or RNA synthesis, eventually inhibits protein synthesis, preventing cell replication • CCNS

  25. ANTI-TUMOR ANTIBIOTICS:

  26. ANTI-TUMOR ANTIBIOTICS: Note: Doxurubicin is cardiotoxic

  27. OTHER CANCER AGENTS • CORTICOSTEROIDS – anti-inflammatory • HORMONE • ESTROGEN – retards prostate cancer • PROGESTINS – retards breast and uterine cancer • TAMOXIFEN – synthetic anti-estrogen,

  28. CHEMOPROTECTIVE AGENTS

  29. ChemotherapyEFFECTS ON NORMAL TISSUE • Chemotherapeutic agents cannot distinguish between normal and cancer cells • Body’s response to products of cellular destruction in circulation may cause fatigue, anorexia, and taste alterations

  30. ChemotherapyEFFECTS ON NORMAL TISSUE • Acute toxicity • Vomiting • Allergic reactions • Arrhythmias • Delayed effects • Mucositis • Alopecia • Bone marrow suppression

  31. ChemotherapyEFFECTS ON NORMAL TISSUE • Chronic toxicities • Damage to • Heart • Kidney • Liver • Lungs

  32. Anti-cancer agents: • SIDE EFFECTS: • Bone marrow depression • Infection • Bleeding • anemia • GI disturbance • hemorrhagic cystitis • Skin – stomatitis, alopecia

  33. Anti-cancer agents: • CLIENT TEACHINGS • Take drug in the day – prevent drug accumulation at night • Excreted in breast milk • Reversible oligospermia – sperm bank

  34. Anti-cancer agents: • CLIENT TEACHINGS • Avoid pregnancy for 3-4 mos • Protective isolation • Good oral hygiene – soft bristled toothbrush • Recommend wig, head scarf • Low purine diet – organ meats, beans and peas • - alkalinize the urine • Small frequent meals

  35. ChemotherapyTreatment Plan • Drugs usually given in combination • synergistic efffects • CCNS and CCS combination • note: combined side effects also • Carefully calculated according to body weight or body surface area

  36. Nursing ManagementChemotherapy • Must differentiate between tolerable side effects and toxic side effects • Serious reactions must be reported • Some toxicities are not reversible

  37. Nursing ManagementNursing Implementation • Administration of antiemetic drugs • Monitor lab results, particularly WBCs, platelet, and RBCs • Assess for signs of bleeding if platelet count falls below 50,000/μl

  38. Nursing ManagementNursing Implementation • Patient must be told what to expect to decrease anxiety • Encourage discussion of fears • Reassure patient that situation is only temporary • Inform patient of supportive care that will be provided

  39. Late Effects of Radiation and Chemotherapy • Risk for leukemias and other secondary malignancies resulting from therapy • Secondary malignancies have been reported • Includes breast, ovarian, uterine, thyroid, and lung cancers, fibrosarcomas

  40. A client is scheduled to receive doxorubicin (Adriamycin) as part of his treatment for cancer. You note in his medical record that he is taking a calcium channel blocker (e.g., verapamil). As the nurse you will monitor closely the client because: • doxorubicin decreases the effectiveness of verapamil. • doxorubicin increases the toxicity of verapamil. • calcium channel blockers increase the risk of cardiac toxicity. • calcium channel blockers decrease the risk of cardiac toxicity.

  41. Practice Question #1 (cont’d) Answer: C

  42. Your client is scheduled to receive fluorouracil (5-FU) to treat colon cancer. Which of the following statements made by your client indicates a need for additional teaching about 5-FU? • “I should call the physician if I develop signs of infection.” • “I should examine my mouth occasionally for soreness or ulceration.” • “I should not visit anyone who has the flu or a cold.” • “I should use sunscreen when I go outside during the daylight.”

  43. Practice Question #2 (cont’d) Answer: B

  44. THANK YOU!!!

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