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Principles of Cancer Treatment

• Aims to prevent cancer from spreading

locally or recurring/ relapsing at sites
distant from the original location.
• Surgery
• Radiation Therapy
• Hormonal Therapy
• Targeted Therapy
• Antibodies
• Cancer Vaccines
• Complimentary and Alternative Medicines
• Chemotherapy
Treatment Modalities
A. Loco- Regional Treatment
1. Surgery
2. Radiation Therapy
B. Systemic Treatment
1. Cytotoxic Chemotherapy
2. Hormonal, Biologic Therapy
I. Loco- Regional Treatment
• A local treatment used to remove visible
– Diagnosis
– Cure
– Control
– Palliation
Types of Treatment
• Local Excision- simple surgery with small margin
of normal tissue surrounding tumor.

• En bloc Dissection- removal of tumor, tissues,

and any contiguous structures.
Surgery on Cancer in Situ
• Electrosurgery- application of electrical
current to cancerous cells
• Cryosurgery- deep freezing with liquid
• Chemosurgery- applied chemotherapeutic
agents layer by layer with surgical incision.
• Co2 laser- use of laser for laser excision.
II. Radiation Therapy
• The use of high- energy ionizing rays to
treat a variety of cancers.
• Destroys the cell’s ability to reproduce by
damaging the cell’s DNA.
• Rapidly dividing cells are more vulnerable
to radiation than are slower dividing cells.
Biological Effects of Radiation on living
• Cells experience DNA damage and are able to detect
and repair the damage.
• Cells experience DNA damage and are unable to repair
the damage. These cells may go through the process of
programmed cell death, thus eliminating the potential
genetic damage from the larger tissue.
• Cells experience a nonlethal DNA mutation that is
passed on to subsequent cell divisions. This mutation
may contribute to the formation of a cancer.
Pre- operative Radiation
• It can kill tumor cells at margins of the
tumor site.
• It can keep the cancer under control and
prevent metastases, and also convert
technically inoperable tumors into
operable ones.
Postoperative Radiation
• It can destroy cancer cells still present
around the margins after a tumor has
been surgically removed.
Types Of Radiation Therapy

1. External Radiation Therapy

2. Internal Radiation Therapy
External Radiation
• It utilizes a machine to deliver
radiation to the tumor.
• This therapy is primarily an
outpatient treatment.
• Series of daily radiation
exposure as patient is left
alone in a room.
• Also called as Teletherapy-
external source of radiation.
( machine is a distance from
External Radiation: Nursing
• Marks must not remove
• Keep the skin dry
• Talcum and Lotions are contraindicated
• Avoid strong sunlight, extremes
temperature, constricting clothes.
• No Eating (NPO)
• Patient is not the SOURCE of Radiation
after the procedure.
Internal Radiation
• Is the process of implanting
radioactive material onto or
near the tumor or placing
radioactive sources into the
• Implantation of radioactive
substance within a client.
• It can be temporary or
• Also called Brachytherapy
Types of Internal Radiation

Sealed Source RT
( Brachytherapy)
Un Sealed- Source RT
Sealed- Source RT

• Sealed radiation source is placed in a

cavity or adjacent to cancer.

• Ex: Radium, Iridium, Cesium

Sealed- Source RT
• Radioisotope is placed into an applicator, then
placed into the body cavity for a carefully
calculated time (usually 24 – 72 H)

Ex: Radioisotopes: Celsium 137

Radium 226
Sealed – Source of RT
• Radioisotope of choice is placed into
needles, beads, seeds, ribbons or catheters
and then implanted directly into the tumor.
• Implants may be left in the tumor
temporarily or permanently.
• Ex: Iridium 192, Iodine 125, Celsium 137,
Gold 198, Radon 222
• Used in Systemic therapy.
• Source of Radiation is given orally,
• PO Administration: Low dose: Graves
131I High Dose: Thyroid Ca
• IV Administration: 32p Treats
Polycythemia Vera
Nursing Care Highlight
Care of the Client with Sealed Implants of
Radioactive Sources

• Assign the client to a private room, with

private bath.
• Place “Caution: Radioactive Material” sign
on the door of the clients room.
• Pregnant nurses should not care for these
clients; do not allow children younger than
16 and pregnant women to visit.
• Limit each visitor to ½ hour per day
• Never touch the radioactive material with
bare hands
• Save all dressings and bed linens until
after the radioactive source is removed.
Three factors which determine the total exposure
one receives in a given radiation field are:

1. Time of exposure.

2. Distance from Source.

3. Amount of shielding present.


The Shortest Possible Time

• The less time you spend

near a source, the less
radiation you will receive
• As far as possible
( can spend more
time at a distance of
20 feet)

• The farther you get

from a source, the
less radiation you will
Protective Lead Apron

• The more shielding you

have, the less radiation
you will receive.
• Fights cancer by • Referred to by many terms
altering the including: Immunologic therapy,
amounts of Immunotherapy, biotherapy.
hormones in the (Interferon, Interleukin)
body. • Often used to help restore the
functioning of the immune
• Stimulates the disease- fighting
ability of the body.

• The use of powerful drugs to:

– Kill Cancer Cells

– Control their Growth
– Relieve Pain Symptoms
• A systemic treatment.
• Directly or indirectly disrupts reproduction
of cells by altering essential biochemical
• The desired outcome is control or
eradication of all malignant cells.
Types of Chemotherapy
1. Primary Chemotherapy
The use chemotherapy alone for the cure
of a specific tumor.
2. Adjuvant Chemotherapy
The use of chemotherapy after primary,
loco –regional treatment, with the intent
of decreasing the relapse rate and
improving survival.
3. Neo- adjuvant Chemotherapy
The use of chemotherapy before loco-
regional treatment with the intent of
decreasing tumor size enhancing chances
for resectability and preservation of normal
4. Concurrent Chemotherapy
The use of chemotherapy combined with
radiotherapy in order to increase local
response and control systemic spread.
5. Palliative Chemotherapy
The use of chemotherapy in advanced
malignancies, the intent of which is not
cure but control of the disease and tumor
related symptoms.
Types of Chemotherapy Drugs

• Antimetabolites
• Genotoxic Drugs
• Spindle Inhibitors
• Other Chemotherapy Agents
Anti- Metabolites
• Drugs that interfere with the formation of
key bio-molecules within the cell including
nucleotides, the building blocks of DNA.
• These drugs ultimately interfere with DNA
replication and therefore cell division.
Types of Anti- metabolites
• Folate Antagonists

• Purine Antagonists

• Pyrimidine Antagonists
Folate Antagonist
• also known as antifolates
• It inhibit dihydrofolate reductase (DHFR), an
enzyme involved in the formation of
• When this enzyme is blocked, nucleotides are
not formed, disrupting DNA replication and cell
• Methotrexate and Pemetrexed
Purine Antagonists

• It function by inhibiting DNA


• 6-Mercaptopurine, Dacarbazine,
Pyrimidine Antagonists

 act to block the synthesis of pyrimidine

containing nucleotides (C and T in DNA;
C and U in RNA).
 The drugs used to block the construction
of these nucleotide have structures that
are similar to the natural compound.
• By acting as 'decoys', these drugs can prevent
the production of the finished nucleotides. They
may exert their effects at different steps in that
pathway and may directly inhibit crucial enzymes.

– 5-fluorouracil
– Arabinosylcytosine
– Capecitabine
– Gemcitabine
– Decitabine
Genotoxic Drugs
• Drugs that damage DNA. By causing DNA
damage, these agents interfere with DNA
replication, and cell division
• 3 Treatments:
– Alkylating Agents
– Intercalating Agents
– Enzyme Inhibitors
The genotoxic chemotherapy
treatments include:

Alkylating agents:
• The first class of chemotherapy agents
used. These drugs modify the bases of
DNA, interfering with DNA replication and
transcription and leading to mutations
Intercalating agents
• These drugs wedge themselves into the
spaces between the nucleotides in the DNA
double helix. They interfere with
transcription, replication and induce
Enzyme inhibitors
• These drugs inhibit key enzymes, such as
topoisomerases, involved in DNA replication
inducing DNA damage.
Spindle Inhibitors
• These agents prevent proper cell division by
interfering with the cytoskeletal components
that enable one cell to divide into two.

• Vinca Alkaloids
Paclitaxel (Taxol®)
Docetaxel (Taxotere®)
Ixabepilone (Ixempra®)
Additional Chemotherapy Agents
• Drugs that work through mechanisms that
do not neatly fit into one of thecategories.

• Arsenic trioxide (Trisenox®)

• Oral
• IM/ SQ
• IV
• Central Venous Catheter
• Venous Access Devices (VAD)
• Intraarterial Route
• Intraperitoneal Route
Chemo Drugs Major Side Effects Nursing Interventions

Doxurubicin Cardiotoxicity Monitor VS & HR

Encourage OFI,
Cyclophosphamide Hemorrhagic Cystitis unexpected bleeding,
hematuria or dysuria.

Vincristine Peripheral Neuropathy Tell the client to report

numbness or tingling in
finger and toes.

F- Asparaginase Allergic Reactions Skin test to assess allergic

reaction before first use.
Watch for signs of
anaphylactic shock.
Terms related to Chemotherapy Drugs

Drugs that are capable of producing pain
at the IV site or along the vein, with or
without inflammatory reaction.

Escape of agents from a vein to a tissue
Drugs that can be given by IV bolus
through the side arm of free flowing IV
containing no additives.
Drugs that are capable of causing blister
formation and tissue destruction.
• Stem cells are able to
grow into other blood
cells that mature and
function as needed in
the body.
• Stem cells create the
three main types of
blood cells:
– red blood cells
– white blood cells
– platelets
Where are stem cells located?
• Bone marrow (the spongy center of the bone
where blood cells are made)
• Peripheral blood (found in blood vessels
throughout the body)
• Cord blood (found in the umbilical cord and
collected after a baby’s birth)

Stem cells for transplantation are obtained from any of these three places.

• Is a process that
takes healthy stem
cells from a donor
and gives them to
the patient through a
central line.
Types of Stem Cell
• Bone marrow transplants are those that
are obtained from the bone marrow
• Peripheral blood stem cell (PBSC)
transplants are obtained from the
peripheral blood.
• Cord blood transplants refer to
transplants where the stem cells are
obtained from umbilical cord blood.
Stem cell transplants are further
categorized based on the donor who
provides the stem cells.

Autologous stem cell transplants

- It refer to stem cells that are collected from
an individual and given back to that same
Allogeneic stem cell transplants
• It refer to stem cells that are taken from
one person and given to another.
Syngeneic Stem Cell
• It refer to stem cells that are taken from an
identical twin of the recipient. These types
of transplants are quite rare
Transplant Care

In cancer is the most feared
and distressing symptom
of the disease.
• WHO reveals that everyday at least 4
million people suffer from cancer pain.
• 30 – 50% of cancer patients undergoing
treatment, and up to 95% of patients with
advanced disease, suffer from pain.
• More than 50% of patients still suffered
from unrelieved cancer pain.
WHO: 3 Step Analgesic Ladder For Cancer
Pain Management

Basic Principles:

If the patient can swallow, oral
administration is the route of choice.
Analgesics should be given regularly and

Use a few drugs well than many badly.
3 Medications for Pain Ladder
• Non- Opoid Analgesics

• Opoid Analgesics

• Adjuvant Drugs
• “There is an UPPER LIMIT to how
effective they are.”

• “DO NOT have an upper limit of

WHO Three-Step Analgesic
• Step I For patients with mild to moderate pain, the
use of non-opioids is the treatment of choice.
These may or may not be combined with adjuvant
drugs (drugs that are used to hasten or add to the
primary mode of treatment).
• Step II For patients with moderate pain, who did
not feel relief after using only non-opioids, a
combination of opioids and non-opioids should be
tried. Again, adjuvants may or may not be used.
• Step III For moderate to severe pain, opioids
should be used, with or without non-opioids, and
with or without adjuvants.
Cancer : Management
• C – Comfort
• A- Altered Body Image
• N – Nutrition
• C – Chemotherapy
• E- Evaluate the Response in Treatment
• R - Rest
• Early detection and screening of high risk
individuals play significant roles in treating
• Patient and family caregivers should be
involved in all aspects of nursing care.
• Various treatment modalities are available
to cure, control and palliate cancer.
• Safety Standards of treatment must
always implemented.
• Life long surveillance for recurrence after

• If pain occurs, there should be prompt oral administration
of drugs in the following order: nonopioids (aspirin and
paracetamol); then, as necessary, mild opioids (codeine);
then strong opioids such as morphine, ntil the patient is
free of pain. To calm fears and anxiety, additional drugs –
“adjuvants” – should be used. To maintain freedom from
pain, drugs should be given “by the clock”, that is every 3-
6 hours, rather than “on demand” This three-step
approach of administering the right drug in the right dose
at the right time is inexpensive and 80-90% effective.
Surgical intervention on appropriate nerves may provide
further pain relief if drugs are not wholly effective.