Cancer lecture

Karin Reese

3/16 & 3/19

Test flagged questions first!

1. Goal is to kill every cancer cell in the body. Chemotherapy drugs effect different phases of cells. Multiple chemo drugs are necessary (hardly ever use single chemo drug) because we need to kill the cancer cell in whatever cell cycle it is at.

2. Cyclophosphamide (CTX) * been used as long as chemo has been around.

- Alkylating drug – nitrogen mustards (they represent the largest group of alkylating drugs)

- very hard on bone marrow

- suppresses bone marrow can = sepsis/ neutropenia

- Deactivates the cells DNA, cutting short its life

3. Cisplatin

- Alkylating – like drug

- Cell cycle specific and inhibit DNA synthesis

- Prescribed to treat solid tumors, bladder and metastatic ovarian cancer. It is drug of choice for metastatic testicular cancer.

- Tinnitus (ringing in the ears) and hearing loss, which is often permanent, may occur with cisplatin.

- Marked nausea and vomiting.

- Very hard on kidneys – 3 liters of fluids before/during/after (2 -1- 1)

- Verify output of patient before giving medication

- Very myelosuppressive

4. Doxorubicin (adriamycin)

- Antibiotic antineoplastic drug

- Antimicrobial products with tumor – destroying effects by binding with DNA and separating the strands.

- Every breast cancer patient is on this. Bone marrow toxicity (myelosuppressive)

- Emeticogenesis (severe puking!!!)

- Causes baldness (Alopecia) *no hair

- Hair is lost in clumps (shave head once hair starts going to help reduce shock)

- With in 6 weeks grows back curly and different color. If you have a propensity for gray it usually grows back gray.

- Bright orange medication = bright orange urine.

- Most damage = cardiac damage (HAVE MUGA SCAN) measures ejection fracture of heart.

- Nurses keep track of doses, cumulative lifetime dose.

5. Methotrexate

- Antimetabolite drug

- Cell cycle specific

- They’re referred to as S phase specific.

- Does not enter the CNS readily

- Reversibly inhibits the action of enzymes thereby blocking normal biochemical reactions resulting in cell death.

- Corner stone drug for Hodgkin’s lymphoma in very high doses

- Need leucovorin to stop Methotrexate from working * extremely important, the drug does not stop working (can sloughs off entire gut if pt. does not take it)

- Sloughs off mouth and gut tissue (watch for s/s of stomatitis)

- Is used with Rheumatoid Arthritis but dose level is different.

5. Bone marrow suppression

- day 7 to 2 weeks after chemotherapy most critical

- start Neupogen day 5 till labs are at acceptable level

- we tell improvement of patient by lab value

- Sepsis rate risk decreases as levels rise.

- Myelosuppression is a controllable thing with Neupogen.

- 2-4 months for bone marrow regrowth

6. Tamoxifen

- tolerable drug except it sends you into menopause

- make sure that tumor is estrogen sensitive (don’t let them throw breast tissue away without testing for this)

- stages

- chemo first

- chemo/radiation

- tomoxifen

- goal is to block estrogen receptor (feeding source of tumor)

- get all estrogen out of the system

- given to patients with strong maternal history of breast cancer (pre cancer)

7. NADR –

- point of maximum bone suppression

- drug is at maximum

- decrease platelets and RBC = thrombocytopenia

8. Skin reaction is a big side effect of radiation.

- Think of where did the beam go through (marks on chest/neck, anything around that mark and down (organs etc.)) months and years later can have problems in that area. Obtain good history of patients and ask if they ever had radiation therapy.

- Brain Alopecia = permanent with radiation (not whole head, areas of radiation)

9. Acute toxicity’s of total body irradiation (TBI)

- Acute onset 24- 72 hours

- Nausea/vomiting (never let this happen to anyone)

10. Interleukins

- they are immune modulators

- Research is learning that these interleukins can manipulate hosts immune system and can take care of cancer cells.

- Our own immune system currently can not control a cancer cell to kill disease, but with advances in research they hope to boost our own natural immune system to fight it (now being done with IL2)

11. Tumor lysis syndrome

- Metabolic imbalance with rapid release of intracellular potassium, phosphorus. Nucleic acid is released as tumor cells die and release it.

- Results

- Hyperkalemia (dangerously high – cardiac dysrhythmias)

- Hyperphosphotemia

- Hyperurecima – nucleic acid dumps into system is now uric acid and can cause gout.

- Kidneys need to be flushed out immediate hydration.

- If we are treating high tumor burden “lymphomas” major hydration before, during and after.

- Hydrate while ALLOPURINOL is being sent up from pharmacy

12. Hypercalcemia

- patient can die secondary to cardiac rhythms

- watch labs

- sighs/symptoms

- confusion (do not rely on Patient) (also rule out brain mets)

- fluttering in chest (listen with stethoscope)

- SOB

- Happens to bony mets. – goes to bones, eats bones and releases calcium

- key is albumin level

- if albumin is low and calcium is low THE CALCIUM IS A FALSE LOW

- Call lab for corrected count (normal lab measures bound form, you need to know the amount of free form).