Chapter 17

Nitrosoureas

- act similar to alkylating agents - inhibit enzymes that are needed for DNA repair - agents are able to travel to the brain so they are used to treat brain tumors, as well as non-Hodgkin's lymphoma, multiple myeloma, and malignant melanoma

S phase

- chromosomes containing the genetic code (DNA) are copied so that both of the new cells formed will have matching strands of DNA - phase lasts 18-20 hr

photodynamic therapy

- laser therapy - involves the use of special chemical that is injected into the bloodstream ad absorbed by cells all over the body - chemical rapidly leaves normal cells but remains in cancer cells for a long time - can be used to reduce symptoms of non-small-cel lung cancer - can be used to treat very small tumors in patents for whom the usual treatments for lung cancer are not appropriate and in patients with esophageal cancer

key concepts of antineoplastics

- only physicians or those qualified with special certification or education should prepare and administer - curative agents in chariocarcinoma, acute lymphocytic leukemia, some cases of Hodgkin's disease, Burkitt's lymphoma, diffuse histolytic lymphoma, certain testicular tumors, and perhaps osteogenic sarcoma - accomplish tumor regression and enhance survival in acute myelocytic leukemia, non-Hodgkin's lymphoma, multiple myeloma, chronic leukemias, and adenocarcinomas of the breast and ovary - used in conjunction with surgery and radiation and are effective in Wilms' tumor, embryonal rhabdomyosarcoma, and Ewing's sarcoma - used as an adjuvant in breast cancer and other cancerous tumors

Antimetabolities

- substances that interfere with the metabolic process of the cell -- thus preventing cell reproduction - act only on dividing cells - most effective in treating rapid proliferation of malignant cells - often cause toxicity to the hematopoietic system - bone marrow depression/suppresion, anemia, leukopenia, thrombocytopenia, and pancytopenia may occur - may also cause nausea and vomiting

the treatment of cancer depends on

1. type of cancer 2. location 3. invasive process 4. patients state of health

platelet count normal ranges

150,00 - 450,000 thrombocytes per cubic mm of blood

Prostate cancer

- 2nd leading cause of cancer death in American men - 1 out of 39 will die - malignant neoplasm that affects the prostate tissue - tends to spread to other parts of the body -- often to the bones of the spine or pelvis - majority of the neoplasms are classifies as adenocarcinomas - disease is rare before the age of 50 - exact cause is unknown; researchers believe a genetic defect of the enzyme glutathione S-transfease (part go a group of chemicals produced in the body that fights cancer) might trigger prostate cancer by robbing cells of an enzyme that fights the disease symptoms: - inability to urinate - frequent urination especially at night - pain or burning sensation when urinating or ejaculating - blood or pus in the urine or semen -persistent pain in the back, hip, and pelvis -fatigue and anemia benign conditions: infections, prostate stones, and BPH treatment: 1. radical prostatectomy: total removal of the prostate gland that involves surgery and several day hospital stay; leaves 1-2% of men incontinent and 15-20% sexually impotent 2. radiation - regular high energy X-rays are targeted to the prostate area; risk of incontinency and impotency is the same as with surgery 3. interstitial implantation therapy - using needles, radioactive seeds are implanted in the prostate to kill cancerous tissues - impotency is about 10% incontinence is rare 4. hormones - often used in conjunction with radiation or surgery; reduce the level of testosterone; causes impotence in a small number of men 5. cryosurgery - outpatient procedure that carries the risk of impotence and incontience 6. watchful waiting- delay treatment and minor the cancerous cells; theory is that prostate cancerous cells usually grow slowly ; if patients can reasonably expect to benefit from a more aggressive treatment for a period of 10 years or more, physicians usually recommend pursing other treatment options

M phase (mitosis)

- 30-60 mins - cell actually splits into 2 cells

two genes have been linked to familial breast and ovarian cancer

BRCA-1 and BRCA-2

differential

Neutrophils 40-60 percent Eosinophils 1-3 percent Basophils 0.5-1 percent Lymphocytes 20-40 percent Monocytes 4-8 percent

chemotherapy drugs works on cells that are

actively reproducing (cells not in G0 phase)

G2 phase

- cell checks the DNA and prepares to start splitting into 2 cells - 2-10 hr

G0 phase

- cell has not yet started to divide - cells spend much of their lives in this phase - can act for a few hours or a few years - once cell is signaled it moves into G1 phase

G1 phase

- cell starts making more proteins and grow larger -- new cells will be of normal size - phase last 18-30 hr

antitumor antibiotics

- certain antibiotics have an antineoplastic effect - derived from species of microorganism and are not to be confused with antibiotics that are used in treatment of infections. - action is not known - appears to interfere with one or more stages of RNA and DNA synthesis - interfere with the cell's ability to grow and reproduce - cause toxicity

alkylating agents

- chemical compounds that cause chromosome breakage and prevent the formation of new DNA - integers with cell division - affect all rapidly proliferating cells and often cause toxicity to the hematopoietic system - bone marrow depression or suppression, anemia, leukopenia, thrombocytopenia & pancytopenia may occur - most disrupt cells within the gastrointestinal tract -- producing nausea and vomiting

signs of infection

- elevated body temp. - sneezing, coughing, and malaise = usual indications of a viral upper respiratory function - signs of inflammation, such as pain, heat, redness, swelling, and impaired function

care of chemotherapy patients

- encourage patients to express their emotional feelings about the disease process; take time to listen to each patient - encourage patients to ask questions, and if you cannot answer the question, find someone who can - be sure the patient understand their chemotherapy regimen - be sure the patient understand about possible adverse reactions and what to do if they occur - if a patient experiences nausea and vomiting, the physician should be informed so appropriate antiemetics may be prescribed -- can be effective against vomiting and nausea

immunotherapy

- uses the body's own defense system to attack cancer - uses body's natural defense system - collection of organs, cells, and special molecules that helps protect an individual from infections, cancer and other disease - when foreign substance/organism enters the body, the immune system recognizes it and then attacks it, preventing it from causing harm = immune response cancer cells often disguise themselves as normal cells so the body's defense system does not recognize and fight then There are three types of immunotherapy: active specific (the use of various agents (medications) to produce a specific host-immune response), passive (the use of serum or other products from an immunocompetent individual that are given to an immunodeficient individual to produce an immune response), and adoptive (the process of transferring a form of specific immune response from a donor to a recipient)

BRCA-1 & BRCA-2

- may encourage breast cancer to develop - genes tell cells how to produce a protein called cyclin D - one of several proteins that tell cells to produce an extra set of genetic material to be passed alone when the cell divides

chemotherapy drugs

- some specifically attack cells in a particular phase of the cell cycle - attack reproducing cells, they cannot tell the difference between reproducing cells of normal tissues and cancer cells - damage to normal cells can cause side effects - each time chemotherapy is given it involves trying to find a balance between destroying the cancellation cells (to cure or control the disease) and sparing the normal cells (lessen unwanted side effects)

surgery

- treatment of choice when the tumor is small and localized and the surrounding tissue is accessible for removal - aim of surgery is the removal of all cancerous tissue plus some of the surrounding normal tissue - may be used to alleviate some of the complications of cancer, such as the obstruction of an area caused by the enlargement of a tumor

hormone therapy

-alter the action or production of female or male hormones - use to slow the growth of breast, prostate and endometrial (uterine cancers) , which normally grow in response to natural hormones in the body - prevent the cancer cell from using the hormone it needs to grow or by preventing the body making the hormones

antineoplastic

-anticancer agents do injury to individual cells, interfere with their vital functions and kill or destroy malignant cells - render cancer cells and may destroy certain normal cells - normal cells with greatest sensitivity are hematopoietic cells, epithelial cells, and hair follicles -agents are potentially hazardous and fatal complications can occur - most are cytotoxic, mutagenic, and carcinogenic

factors that play a role in the development of cancer

1. environmental 2. hereditary 3. biological

risk factors for breast cancer

1. family history - increased risk when breast cancer occurs before menopause in mother, sister, or daughter especially if cancer occurs in both breast 2. over age 50 and nullipara 3. having a first baby after age 30 4. history of chronic breast disease, especially epithelial hyperplasia 5. exposure to ionizing radiation of more than 50 rad during adolescence 6. obesity 7. early menarche, late menopause

signs and symptoms of breast cancer

1. new lump in the breast 2. lump that has changed 3. change in the size or shape of the breast 4. pain in the breast or nipple that does not go away 5. flaky, red, or swollen skin anywhere on the breast 6. nipple that is very tender or that suddenly turns inward 7. blood or any other type of fluid coming from the nipple that is not milk when nursing a baby

white blood cell count (WBC)

5,000 - 10,000 leukocytes per cubic mm of blood

alopecia

pertaining to hair loss

carcinogenic

pertaining to producing cancer

remission

the time when the symptoms of a disease process are lessened

Granisetron

Action: selective 5-HT (hydroxytryptamine) 3 receptor antagonist. It blocks serotonin stimulation and subsequent vomiting after emetogenic (pertaining to formation of emesis) stimuli. It is an antiemetic and antinauseant. Uses: prevent nausea and vomiting that may occur after treatment with chemotherapy Dosage and Route: Adults and teenagers - oral dosage (tablets): dose is usually 1mg taken up one hour before the anticancer medicine; 1mg is taken again 12 hr after the 1st dose

Dolasetron (Anzemet)

Action: selective 5-HT (hydroxytryptamine) 3 receptor antagonist. It blocks serotonin stimulation and subsequent vomiting after emetogenic stimuli. It is an antiemetic and antinauseant Uses: prevent and treat the nausea and vomiting that may occur after treatment with anticancer medicines or after surgery Dosage and Route: For Adults - trade dosage (tablets): 100 mg given within one hour before the anticancer medicine is given Children 1-16 years of age - 1.8mg/kg of body weight given within one house before the anticancer medicine is given - dose is generally not greater than 100 mg

hemoglobin

Adult female: 12 - 16 g/100mL of blood Adult male: 14 - 18 g/100 mL of blood Children: varies with age

Hematocrit

Adult female: 37-47 percent Adult male: 40-54 percent Children: varies with age from 35-49 percent Newborn: 49-54 percent

BREAST acronym

B - being informed could save your life R - risk factors in order of importance E - examine your breasts every month A - appearance S - size, shape, symmetry T - tenderness thickening, texture changes

Antineoplastic adverse reactions

GI : anorexia, nausea, committing, mucositis, stomatitis, colitis, liver dysfunction Hematopoietic: bone marrow depression or suppression, anemia, leukopenia, thrombocytopenia & pancytopenia Secondary neoplasia: may increase incidence of a second malignant tumor Gentiourinary: sterile hemorrhagic cystitis, hyperuricemia, and renal failure Gonadal Suppression: amenorrhea, azoospermia Integument: alpoceia, skin and fingernails may become darker, rash, maculopapular skin eruption Pulmonary: interstitial pulmonary fibrosis Cardiac: acute left ventricular failure, arrhythmia, cardiomyopathy Respiratory: dyspnea Immunosuppressive activity: may predispose patient to bacterial, viral (herpes zoster), or fungal infection Chromosomal Abnormalities: mutagenic teratogenic effects: may produce or cause teratogenic formation of. severely malformed fetus; women of childbearing potential should be advised to avoid becoming pregnant extravasation: may result when IV fluids escape into subcutaneous tissues, resulting in a painful inflammation; area usually becomes indurated and sloughing of tissue may occur

cytotoxic

destructive to cells

mitotic inhibitor drugs

docetaxel (Taxotere) paclitaxel (Taxol) vinblastine sulfate vinorelbine (Navelbine)

laminar airflow

filtered air flowing along separate planes or layers. This method of airflow helps to prevent bacterial contamination and collection of hazardous chemical fumes in areas where pollution of the work environment could be detrimental to one's health. The use of a laminar airflow hood in the preparation of antineoplastic agents is recommended

hormone therapy drugs

antiestrogens fulvestrant (Faslodex), tamoxifen citrate (Soltamox), toremifene citrate (Fareston) aromatase inhibitors, such as anastrozole (Arimidex), exemestane (Aromasin), letrozole (Femara) progestins such as megestrol acetate (Megace) estrogens, such as estramustine phosphate sodium (EMCYT) antiandrogens, such as bicalutamide (Casodex), flutamide, nilutamde (Nilandron) gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide (Lupron), goserelin (Zoladex)

Serotonin

hormone secreted by the pineal gland; neurotransmitter, vasoconstrictor, and smooth muscle stimulated found in many tissues (blood platelets, intestinal mucosa, and the CNS); has many physiological properties (inhibition of gastric secretion, stimulation of smooth muscles and production of vasoconstriction)

antitumor antibiotics drugs

bleomycin sulfate dactinomycin (Cosmegen) duanorubicin HCl (Cerubidine)

alkylating agent drugs

bushulfan (Myleran) chlorambucil (Leukeran) cisplatin (Platinol) mechlorethamine Hal (Mustargen) melphalan (Alkeran) thiotepa

targeted therapies drugs

imatinib (Gleevec) erlotinib (Tarceva) bortezomib (Velcade)

immunotherapy therapy precision medications

Yervoy, Opdivo, and Keytruda - approved by FDA for metastatic melanona, lung cancer, or kidney cancer - administered by IV usually in cancer treatment center or physicians office

medications for nausea and vomiting

Zofran (ondanestron) or (granisteron) or together with Anzemet (dolasetron) administered at the time of chemotherapy

deoxyribonucleic acid; DNA

a complex protein that is found in the nucleus of every cell

anorexia

a loss of appetite

ribonucleic acid (RNA)

a nucleic acid, found in all living cells, which is responsible for protein synthesis

differentiating agents

act on cancer cells to make them mature into normal cells

combination chemotherapy has been used to treat

acute leukemia Hodgkin's disease non-Hodgkin's lymphoma carcinoma of the breast, testis, and ovary childhood neuroblastoma Wilms' tumor osteogenic sarcoma

nitrosoureas drugs

carmustine (BICNU) lomustine (CEENU)

antimetabolites drugs

cytarabine (Cytosar) flurouracil (5-FU) mercaptopurine (Purinethol)

adjuvant chemotherapy

in cancer therapy, the use of chemotherapy in addition with other treatments. For example, patients who had surgery as their primary therapy are often given drugs to kill unseen cancer cells that can remain after surgery. The goal of adjuvant therapy is to kill any hidden cells the goal is to kill unseen cancer cells can also be used after using radiation to kill the cancer

neoadjuvant chemotherapy

in cancer therapy, this is when chemotherapy is given before the main cancer treatment (such as surgery or radiation) giving chemo therapy first can shrink a large tumor, making it easer to remove with surgery shrinking it may also allow it to be treated more easily with radiation kills small deposits of cancer cells that cannot be seen on scans or X-rays

stomatitis

inflammation of the mouth

photodynamic therapy

laser therapy that involves the use of a special chemical injected into the bloodstream and absorbed by cells all over the body

prostate-specific antigen (PSA) test

men every year

sigmoidoscopy

men and women every 3-5 years

Digital rectal exam (DRE)

men and women every year

stool guaiac slide test

men and women every year

oncologist

one who specializes in tumors, especially neoplasms (new growths)

teratogenic

pertaining to producing or forming a severely malformed fetus

mitotic inhibitors

plant alkaloids and natural products that can inhibit mitosis or inhibit enzymes that prevent protein synths needed for reproduction of the cell - cell cycle specific and work during the M(mitosis) phase

Prostate glands

size - 4 cm wide wight - 20 g composition - glandular, connective, and muscular tissue location - lies behind the urinary bladder; surrounds the first 2.5 cm of the urethra secretion - alkaline fluid that aids in maintaining the viability of spermatozoa - produces semen (the thick fluid that carries sperm from the testicle) - normal function depends on the male hormone testosterone (made by testicles) - male hormones such as testosterone are believed to stimulate prostate cancer growth

malignant

tending to metastasize; cancerous usually multiply rapidly, forming a mass of abnormal cells that enlarges, ulcerates, and sheds malignant cells to surrounding tissue - this process destroys the normal cells, with malignant cells taking their place, and often results in the formation of a tumor

liver function and kidney function

tests determine these vital organ's functioning abilities

proliferation

the process of rapid reduction

extravasation

the process whereby fluids (especially IV) escape into surrounding tissues

differentiation

the process whereby normal cells have a distinct appearance and specialized function abnormal process wherein a cell or group of cells undergoes changes and no longer carries normal cell functions

dedifferentiation

the process whereby normal cells lose their specialization and become malignant failure of immature cells to develop specialized functions process involves.a disturbance in the DNA of the affected cells

differentiating agent drugs

tretinoin (Atralin) bexarotene (Targretin) arsenic trioxide

systemic therapy

type of treatment in which drugs can be given by mouth or directly into the bloodstream to reach cancer cells anywhere in the body. Chemotherapy, hormone therapy, and targeted therapy are systemic therapies

local therapy

type of treatment that is intended to treat a tumor at the site without affecting the rest of the body. Surgery and radiation therapy are examples of local therapies

breast self exam

women every month

breast physical exam

women every year

mammogram

women every year

pap test

women every year

Benign Prostatic Hyperplasia (BPH)

- enlargement of the prostate gland may occur in men who are 50 years of age and older - as the prostate enlarges it compresses the urtethra (restricts the normal flow of urine) - restriction can cause protastism (any condition of the prostate gland that interferes with the flow of urine from the bladder) symptoms: - weak or hard-to-start urine stream - feeling that the bladder is not empty - need to urinate often, especially at night - feeling of urgency - abdominal straining, a decrease in size and force of the urinary stream - interruption of the stream - acute urinary retention - recurrent urinary infections treatment: surgery - transurethral resection of the prostate (TURP or TUR) - most common surgery used - endoscopic instrument that has ocular and surgical capabilities is introduced directly through the urethra to the prostate and small pieces of the prostate gland are removed by using an electrical cutting loop medication - Prosper (finasteride): oral medication, relieve symptoms of BPH, lowers the levels of dihydrotestosterone (DHT), which is a major factor in enlargement of the prostate - lowering DHT leads to shrinkage of the enlarges prostate gland in most men - does not work for all cases - sometimes the prostate may shrink without improvement in symptoms and it may take 6 months or more to determine if it is working for an individual side effects: may include impotence and less desire for sex - can alter the prostate-specific antigen test (PSA) that is used to screen for prostate cancer Balloon Dilation - balloon catheter is placed in the distal urethra and is inflated by injecting a dilute contrast media at high pressure; balloon is left in place for approx. 10 minutes and then the pressure is released and the catheter is removed

signs of bleeding

- excessive brusing - nosebleed (epistaxis), rectal bleeding, abnormal vaginal bleeding, and bleeding gums - small, purplish, hemorrhagic spots on the skin (petechiae), possible indications of abnormality in blood clotting

dosage of antineoplastic agents

- individualized for each patient - based on body surface area or kg of body weight - physician will order the chemotherapy regimen, giving the patients name, the agent or agents to use, the dose, route, rate, and time for administration - those preparing and administering these agents should have a second qualified person check and verify the order and their preparation of the drug or drugs

radiation therapy

- ionizing radiation - aim is to deliver a precise, calculated dose of radiation of diseased tissue, such as tumor, causing the least possible damage to surrounding normal tissue - malignant cells are more sensitive to radiation than are normal cells. - malignant cells are less able to repair themselves; therefore radiation is frequently used in the treatment of patients with cancer as curative or palliative mode of therapy

Ondansetron (Zofran)

Action: selective 5-HT (hydroxytryptamine) 3 receptor antagonist; suppress vomiting and nausea by inhibiting serotonin binding to the 5-HT3 receptors antiemetic and antinauseant Uses: prevent nausea and vomiting that may occur after treatment with chemotherapy or radiation, or after surgery Dosage and Route: 1. For adults and children 12 years of age and older—Oral dosage (tablets): At first, the dose is 8 mg taken 30 minutes before the anticancer medicine is given. The 8-mg dose is taken again eight hours after the first dose. Then, the dose is 8 mg every 12 hours for one to two days. 2. For children 4 to 12 years—At first, the dose is 4 mg taken 30 minutes before the anticancer medicine is given. The 4-mg dose is taken again 4 to 8 hours after the first dose. Then, the dose is 4 mg every eight hours for one to two days. For children up to 4 years, the dose must be determined by the patient's physician. NOTE: Instruct the patient that if vomiting starts within 30 minutes after taking this medicine, the same amount of medicine should be taken again. If vomiting continues, the patient should check with his or her physician for further instructions. If the patient misses a dose of this medicine and does not feel nauseous, skip the missed dose and go back to the regular dosing schedule. If the patient misses a dose of this medicine and feels nauseous or vomits, the missed dose should be taken as soon as possible.

targeted therapies

attach cells with mutant versions or certain genes or cells that express too many copies of a particular gene - can be used as primary treatment or after treatment to maintain remission or decrease recurrence

metastasis

the spreading process of cancer cells from one part of the body to another cancer (if not detected and treated early) continues to grow, invade, and destroy adjacent tissue, and spread into surrounding lymph nodes - can be carried by the lymph or blood or both to other areas of the body - at this rate cancer is usually advanced and/or disseminated and the five-year survival rate is low

exacerbation

the time when the symptoms of a disease process are most severe