CRM Oncology Treatment and Coding

7 different types of chemotherapy

- antimetabolites - vinca alkaloids - taxanes - type 1 topoisomerase inhibitors - alkylating agents (the oldest of these types of drugs) - platinum agents - antitumor antibiotics

3 routes of chemo administration

- intravenous - intraperitoneal - intra-arterial

Three major forms of cancer tx

- surgery - chemotherapy - radiation therapy

zoledronic acid (Zometa)

a bisphosphonate used to treat hypercalcemia or to lessen the complications of bone mets such as fractures or pain. it works by slowing down the effects of osteoclasts, which can be secreted by cancer cells to dissolve portions of the bone. this and other ancillary drugs are not to be coded as cancer tx.

graft-versus-host disease

a disease that can occur when white blood cells from your donor (the graft) recognize cells in your body (the host) as foreign and attack them. it can cause serious damage to your skin, liver, intestines, and many other organs. it can occur a few weeks after the transplant or much later.

radiation oncologist

a doctor who specializes in using radiation to treat cancer

ethyol (amifostine)

a drug that can help protect the salivary glands from radiation damage if it is given during tx. this type of drug is called a radioprotector.

internal radiation therapy

a form of brachytherapy in which a source of radiation is put inside your body. the source can be solid or liquid.

radioisotopes

a form of brachytherapy that can be given internally. - the most commonly used is I-131, which is given to patients with thyroid cancer after surgery to ablate any remaining thyroid tissue - phosphorus is used for polycythemia vera, malignant ascites, or malignant pleural effusion - strontium 89 is an analog of calcium and concentrates in osteoblastic cancer lesions and is used primarily for pts with bone mets. - strontium 90 is coded as brachytherapy, and because it is used to treat bone pain, it should also be coded as palliative care.

transluminal therapy

a form of brachytherapy where a radioactive source is placed directly into a body lumen such as the esophagus to treat the *surface area and the adjacent tissue*.

mold therapy

a form of brachytherapy where an applicator that contains an array of radioactive sources is used to deliver a uniform dose to the skin or mucosal surface.

stereotactic radiosurgery (SRS)

a form of external beam therapy used for tx of brain or spinal lesions. a special frame is attached to the patient's skull to provide highly accurate landmarks that allow for the localization of intracranial targets. the lesions must be less than 4 cm and have the potential to respond to a single large dose of radiation as the treatment is usually given for a period of one day.

image-guided radiation therapy

a form of radiation therapy that uses imaging taken just before the patient is treated every day. these images are compared with previous images to determine whether the tx needs to be adjusted to accommodate for tumor movement.

proton beam therapy (particle radiation)

a form of radiation therapy that uses linear accelerators that deliver proton/photon beams of up to 250 MV and are used to reach deep-seated tumors.

total body irridation (TBI)

a form of radiation therapy that uses low or high-dose external beam radiation to treat the entire body usually for a few fractions over a few days. When it is used, it is generally part of the prestem cell transplant procedure for leukemia and lymphoma.

cyberknife radiation therapy

a form of radiation therapy where a miniaturized photon linear accelerator is mounted on a highly mobile arm, and a set of ceiling-mounted x-ray cameras provide real-time data on patient position and target exposure during tx.

MammoSite radiation

a form of radiation used after a lumpectomy. a catheter is placed inside the lumpectomy cavity and a balloon is inserted through the catheter and inflated with saline. high-dose radiation is then given through the catheter for a period of 10-15 minutes, often twice a day. tx is completed in 5 days. - tx is limited to pts at least 45 yrs old with a node-negative tumor 3 cm or less with negative surgical margins.

gammaknife therapy

a form of stereotactic radiosurgery that uses cobalt energy. it is expensive to purchase and maintain because it requires a highly shielded space and the cobalt must be replaced after 7 years.

radiation therapy

a form of therapy that damages the genetic material in cancer cells, and thus limits their ability to reproduce. it is targeted to specific areas.

cryosurgery

a form of therapy that involves the freezing of targeted cancer tissues by applying extremely cold temperatures using liquid nitrogen or argon gas to the tumor to destroy it. - some of the cancers being treated by this are retinoblastoma and small AIDS-related Kaposi's sarcoma lesions - used originally for melanoma but then started to be used by some practitioners for prostate cancer

intraventricular and intrathecal therapy

a form of therapy that is a way of injecting drugs into the CNS to circumvent the blood-brain barrier. this is given by way of lumbar puncture or intraventricular reservoir such as the Omaya reservoir, an implantable, closed delivery system.

laser therapy (light amplification by stimulated emission of radiation)

a form of therapy that uses high-intensity light to treat superficial cancers such as basal cell carcinoma of the skin or early stage of cancers such as cervical, penile, vaginal and nonsmall-cell lung cancer.

biologic therapy (immunotherapy or brms)

a form of therapy that uses the body's immune system to fight cancer. examples are: monoclonal antibodies, interferon, interleukin-2, and colony-stimulating factors

surgical ablative therapy

a form of therapy used primarily for patients with prostate cancer who have become hormone refractory. this therapy is rarely used these days.

photodynamic therapy

a form of therapy where a photosensitizing agent is injected into a patient and is absorbed by all the cells in the body. after 2 days, the agent is found mostly in the cancer cells. laser light is then used to activate the agent and destroy the cancer cells.

Paul Ehrlich

a german scientist who is credited with launching chemotherapy in 1910 when he created a drug to cure syphilis. the first cancer chemotherapy was developed in the 1940s with the use of nitrogen mustard to treat lymphoma.

megestrol (megace)

a hormonal agent that was used in the past as tx for certain cancers, particularly breast cancer. however, now it is most often used as an appetite stimulant for all patients, including cancer patients.

LINAC (linear accelerator)

a machine that delivers external-beam radiation therapy. it uses electricity to form a stream of fast-moving subatomic particles. this creates high-energy radiation that may be used to treat cancer.

RFA (radiofrequency ablation)

a method to remove cancer growth that involves the tumors being destroyed by using heat energy. radiofrequency waves are sent down through the needle to the tumor to heat the tumor for 10-15 minutes to slightly more than 100 degrees. it is hoped that the heat will destroy the cancer cells, as well as tissue immediately surrounding the tumor. - usually done as an outpatient procedure and requires no hospital stay - usually used to eradicate liver cancer, primary or metastatic - has been used successfully to treat lung cancer in patients with early-stage disease who are unable to withstand surgery

radiation physicist

a person trained to ensure that the radiation machine delivers the right amount of radiation to the treatment site. he or she works with the radiation oncologist and dosimetrist to design, plan, and calculate the proper dose for radiation tx

dosimetrist

a person who plans and calculates the proper radiation dose for tx

radiation therapist

a person with special training to work the equipment that delivers the radiation

robotics

a recent advance in the way surgery is performed that consists of three components: a surgeon's console and a patient-side robotic cart with four arms manipulated by the surgeon, and a high-definition 3D vision system.

radioembolization

a special type of internal radiation that's now used only for cancer in the liver that can't be surgically removed. small radioactive beads (called microspheres) are injected into the artery that feeds the liver tumor. once infused, the beads lodge in blood vessels near the tumor, where they give off small amounts of radiation to the tumor site for several days.

intensity-modulated radiation therapy

a specialized form of 3D-CRT that breaks up the beam into man "beamlets", which can then be adjusted to further limit the amount of radiation being given to surrounding normal tissue. sometimes higher doses of radiation can be given, potentially increasing the chance for a cure. unlike other types of radiation therapy, this one is planned in reverse (inverse tx planning). in inverse tx planning, the radiation oncologist chooses the radiation doses to different areas of the tumor and surrounding tissue, and then a high-powered computer program calculates the required number of beams and angles of the radiation tx.

stereotactic body radiation therapy (SBRT)

a term used to describe the similar stereotactic radiosurgery technique when it's used for tumors in other parts of the body, for instance, the spine, liver, pancreas, kidney, lung, and prostate. it delivers radiation therapy in fewer sessions, using smaller radiation fields and higher doses than 3D-CRT in most cases. it treats tumors that lie outside the brain and spinal cord, but they still have to be small, isolated tumors, including cancers in the lung and liver.

IFNs (interferons)

a type of BRM that can improve the way a patient's immune system fights cancer cells. they may also act directly on cancer cells by slowing their growth or turning them into more normal cells. there are three types: a (the most widely used), B, y

ILs

a type of BRM that is a naturally occurring cytokine. the most commonly used is __-2, which stimulates the growth and activity of many immune cells that can destroy cancer cells. it is approved for the tx of metastatic kidney cancer and metastatic melanoma.

CSFs (colony-stimulating factors)

a type of BRM that is also known as *growth factors*. these do not fight cancer but rather encourage the growth of bone marrow stem cells that can be destroyed by cancer tx, particularly high-dose chemo. there are different types of these as well: - granulocyte (-macrophage) ____ - erythropoietin - IL-11

cancer vaccines

a type of CSF that are used to boost the immune system and can be used as preventative medicine or as treatment. Gardisil is an example of this.

G-CSF/GM-CSF (granulocyte/granulocyte-macrophage CSF)

a type of CSF that can increase the number of WBCs, reducing the risk of infection. they can also be used in preparation for bone marrow stem cell transplants.

tumor necrosis factor (TNF)

a type of CSF that is a cytokine protein molecule whose mechanism of action is not known. it is not widely used.

erythropoietin

a type of CSF that is used to increase the number of RBCs, thereby reducing the need for red blood cell transfusion.

IL-11

a type of CSF that stimulates the growth of platelets, reducing the need for platelet transfusions during cancer tx.

passive (adoptive) immunotherapy

a type of immunotherapy that does not rely on the body to attack the disease; instead, it uses the immune system components (such as antibodies) created outside of the body. example - monoclonal antibody therapy

active immunotherapy

a type of immunotherapy that stimulates the body's own immune system to fight the disease. cancer cells are analyzed in a lab and their antigens are identified. then, a tx is designed to stimulate a specific immune response against them. this is *specific*. the *nonspecific* approach uses agents that set in motion a general immune response, activating a wide range of immune cells. the approach aims at strengthening the overall activity of the immune system instead of selectively arosing those elements most able to fight cancer. example - cancer vaccines

carbon ion radiation (aka heavy ion radiation)

a type of particle radiation that can be helpful in treating cancers that don't usually respond well to radiation (radioresistant). because the particle used is heavier than than a proton or neutron, it can do more damage to the target cell than other types of radiation and the effects on nearby normal tissue can be more severe.

neutron beam radiation

a type of particle radiation used for some cancers of the head, neck, and prostate and for certain inoperable tumors. it can sometimes help when other forms of radiation therapy don't work. it's not commonly used because it can damage DNA more than photons and the effects on normal tissue can be severe.

targeted therapy

a type of therapy where monoclonal antibodies that identify and bind to specific antigens on cancer cells induce an immunologic response.

allogenic

a type of transplant that uses stem cells from a matched relative or someone who is not related.

syngeneic

a type of transplant that uses the stem cells of an identical twin.

autologous

a type of transplant where the patient's own bone marrow cells, or most commonly stem cells, are used.

endocrine tx

a type of tx defined as the suppression or withdrawal of hormones through the use of radiation or surgical procedures.

laparotomy

an exploratory surgery that involves abdominal organs and is used to explore the abdomen to determine the extent of disease and the possibility of resectability of the primary cancer.

interstitial high dose rate brachytherapy (HDR)

devices delivering this type of radiation allow radiation oncologists to complete it quickly, in about 10-20 minutes. powerful radioactive sources travel through small tubes called catheters to the tumor for the amount of time prescribed by the radiation oncologist.

adrenocorticoids

drugs known to have an antitumor effect as single agents, as well as reduce adverse effects, such as hemolytic anemia or immune thrombocytopenia.

antiestrogens

drugs that can inhibit cell proliferation, and thus inhibit growth factor stimulation of breast carcinoma.

aromatase inhibitors

drugs that inhibits the formation of estrogens and androgens, and thus have been found to be of use in metastatic breast and prostate cancer. drugs that stop estrogen production in post-menopausal women. they work by blocking an enzyme in fat tissue that is responsible for making small amounts of estrogen in post-menopausal women. they cannot stop the ovaries from making estrogen, so they are only effective in women whose ovaries aren't working, either due to menopause or due to treatment with luteinizing hormone-releasing hormone analogs.

radiosensitizers

drugs that make cancer cells more sensitive to the effects of radiation therapy. some anticancer drugs, such as 5-fluorouracil and cisplatin, make cancer cells more sensitive to radiation therapy.

- Quadramet (samarium-153-lexidronam) - Metastron (strontium-89 chloride)

examples of radiopharmaceuticals used to treat pain from bone mets

3D-CRT (three-dimensional conformal radiation therapy)

one of the ways that external beam radiation is delivered. it uses computers and special imaging techniques to show the exact shape of the tumor so that the radiation oncologist can precisely focus the electron beam to the size and shape of the tumor.

enzymes

proteins that start, help, or speed up the rate of chemical reactions in cells

hypofractionated radiation

radiation tx that breaks the radiation into fewer doses, so that each dose is larger. sometimes, this could mean it's given less often than once a day.

hyperfractionated radiation

radiation tx that divides the daily dose into 2 tx sessions of smaller radiation doses without changing the length of the tx. in this cse, you would be treated twice a day for several weeks.

accelerated radiation

radiation tx that gives the total dose of radiation over a shorter period of time. in other words, giving more frequent doses (more than once a day) to get the same total dose of radiation; it may shorten the course of tx by a week or two.

chemoradiation/radiochemotherapy

the combination of chemotherapy and radiation therapy given at the same time.

multimodality tx

the mainstay of cancer tx

NOTES (Natural Orifice Transluminal Endoscopic Surgery)

the most recent form of minimally invasive surgery that involves accessing the abdominal cavity through one of the body's natural orifices such as the mouth, the anus, vagina or urethra. A flexible endoscope is advanced into the peritoneal cavity, and the surgery is performed using conventional endoscopic instruments.

external beam radiation therapy (photon radiation)

the most widely used radiation therapy. it's delivered by a linear accelerator that produces high-energy electrons that are aimed at your cancer. also known as *teletherapy*

ionizing radiation

the term for radiation used for cancer tx. its called this because it forms ions (electrically charged particles) in the cells of the tissues it passes through it creates ions by removing electrons from atoms and molecules. this can kill cells or change genes so the cells stop growing.

debulking

the term used to describe when the surgeon removes as much of the tumor as possible to decrease the tumor burden for later chemotherapy or radiation therapy.

anthracyclines

these are anti-tumor antibiotics that interfere with enzymes involved in copying DNA during the cell cycle. they are widely used for a variety of cancers. Examples are: daunorubicin, doxorubicin (Adriamycin), epirubicin, idarubicin *These can permanently damage the heart if given in high doses, so lifetime dose limits are often placed on these drugs*

plant alkaloids

these are antitumor agents derived from plants. these drugs act specifically by blocking the ability of a cancer cell to divide and become two cells. although they act throughout the cell cycle, some are more effective during the S-and M- phases, making these drugs cell cycle specific. Examples are: actinomycin-D, doxorubicin, and mitomycin

monoclonal antibodies

these are man-made versions of immune system proteins that attack only a specific molecular target on certain cells. scientists have learned how to pair these antibodies with radioactive atoms. when put into the bloodstream, the antibodies act as homing devices. they attach only to their target, bringing tiny packets of radiation directly to the cancer.

radioprotectors

these are substances that protect normal cells from radiation. these types of drugs are useful in areas where it's hard not to expose vital normal tissues to radiation when treating a tumor, such as the head and neck area.

anti-tumor antibiotics

these chemotherapy drugs work by changing the DNA inside cancer cells to keep them from growing and multiplying. Examples (that aren't anthracyclines) are: actinomycin-D, bleomycin, mitomycin-C, mitoxantrone (also acts as a topoisomerase II inhibitor)

topoisomerase inhibitors

these drugs interfere with enzymes called topoisomerases, which help separate the strands of DNA so they can be copied. they are used to treat certain leukemias, as well as lung, ovarian, gastrointestinal, and other cancers. they are grouped according to which type of enzyme they affect. Topoisomerase I inhibitors include: topotecan, irinotecan (CPT-11) Topoisomerase II inhibitors include: etoposide (VP-16), teniposide, mitoxantrone (also acts as an anti-tumor antibiotic) *Topoisomerase II inhibitors can increase the risk of a second cancer (AML) as early as 2-3 years after the drug is given*

antimetabolites

this class of chemotherapy drugs interferes with DNA and RNA growth by substituting for the normal building blocks of RNA and DNA. these agents damage cells during the phase when the cell's chromosomes are being copied. they are commonly used to treat leukemias, cancers of the breast, ovary, and the intestinal tract, as well as other types of cancer. Examples are: 5-fluorouracil (5-FU), 6-mercaptopurine (6-MP), capecitabine (Xeloda), cytarabine (Ara-C), floxuridine, fludarabine, gemcitabine (Gemzar), hydroxyurea, methotrexate, pemetrexed (Alimta), purine antagonists, pyrimidine antagonists, folate antagonists

alkylating agents

this class of chemotherapy drugs keeps the cell from reproducing by damaging its DNA. these drugs work in all phases of the cell cycle and are used to treat many different cancers, including cancers of the lung, breast, and ovary as well as leukemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma. they are the most commonly used agents in chemotherapy today. Examples are: altretamine, busulfan, carboplatin, carmustine, chlorambucil, cisplatin, cyclophosphamide, dacarbazine, lomustine, melphalan, oxalaplatin, temozolomide, thiotepa

tositumomab and iodine I 131 tositumomab (Bexxar)

this combination drug regimen has been approved for the tx of certain types of NHL. in this regimen, nonradioactive antibodies are given to the pt first, followed by tx with antibodies that have I 131 attached. the nonradioactive form of the antibody helps protect normal B lymphocytes from being damaged by radiation from I 131.

zevalin (ibritumomab tiuxetan)

this drug has been approved by the FDA for the tx of certain types of B-cell non-Hodgkin lymphoma. the antibody part of this drug recognizes and binds to a protein found on the surface of B lymphocytes.

biologic response modifiers

this form of biologic therapy can perform many functions to treat cancer or promote the body's ability to recover from other cancer tx such as chemo or radiation. they are being used alone or in combination with other forms of tx. there are five different kinds: - IFNs - ILs - CSFs - Tumor Necrosis Factor - Cancer vaccines

intraperitoneal chemotherapy

this form of chemotherapy exposes the tumor in the cavity to higher doses for longer periods that can safely be given with systemic treatment such as continuous infusion. it is used now primarily for ovarian carcinoma. it is generally thought to be best used for small-volume residual disease either as first-line or salvage tx.

brachytherapy

this form of radiation therapy places sealed radioactive sources in or near the tumor and are left in for a short time or permanently depending on the type of tumor. it is often used in conjunction with external beam radiation. - it is given *intracavitarily* by placing applicators filled with a radioactive substance into a body cavity in close proximity to the target tissue and is a temporary application. it is widely used in the treatment of cervical and endometrial cancer. - when it is given *interstitially*, radioactive seeds are placed directly into tumor tissue either temporarily or permanently.

hyperthermia (thermotherapy)

this form of therapy involves heating the tumor to 41C to 42C to exploit the weakness of the tumor compared with normal tissue. it is used primarily in conjunction with radiation therapy so that the radiation becomes more cytotoxic than it would be by itself. it is not frequently used.

interstitial low dose rate brachytherapy (LDR)

this form of therapy is usually performed in a hospital setting, requiring radioactive seeds to be surgically implanted in or near the patient's tumor, delivering a higher dose of radiation to the tumor and keeping the dose to the normal surrounding tissues to a minimum.

orthovoltage

this form of therapy was the forerunner of linear accelerators. this type of external beam radiation uses lower energy photons for tumors that are either on or very close to the skin. It cannot be used for deeper tumors.

tomotherapy

this is a type of image-guided IMRT. it's machine is a hybrid between a CT imaging scanner and an external-beam radiation therapy machine. the part of the machine that delivers radiation for both imaging and tx can rotate completely around the pt in the same manner as a normal CT scanner. it can capture CT images of the pt's tumor immediately before tx sessions, to allow for very precise tumor targeting and sparing of normal tissue.

cancer treatment

this is defined as tx intended to modify or control a malignancy.

radioactive iodine

this radiopharmaceutical can be used to destroy the thyroid gland and thyroid cancer with little effect on the rest of the body. this tx is often used after thyroid cancer surgery to destroy any thyroid cells left behind. it's also used to treat some type of thyroid cancer that spread to lymph nodes and other parts of the body.

intra-arterial chemotherapy

this route of chemo administration is also known as chemoembolization when it is given with therapeutic microspheres such as Gelfoam. the Gelfoam is infused with the chemotherapeutic agent and then inserted through a catheter into the selected artery. it is most widely used in the treatment of primary liver cancer and liver metastasis.

intravenous chemotherapy

this route of chemo administration is the most common. it requires chronic venous access, a continuous infusion pump, and an appropriate drug reservoir and drug vehicle. it has been shown to decrease or alter the toxicity of a number of chemotherapeutic agents.

proton beam

this type of beam (charged particle) deposits much of their energy at the end of their path (called the Bragg peak) and deposit less energy along the way. in theory, the use of this type of beam should reduce the exposure of normal tissue to radiation, possibly allowing the delivery of higher doses of radiation to a tumor.

photon beam

this type of beam deposits energy in small packets all along their path through tissue.

electron beam

this type of beam is used to irradiate superficial tumors, such as skin cancer or tumors near the surface of the body, but they cannot travel very far through tissue. therefore, they cannot treat tumors deep within the body.

adjuvant therapy

tx given after surgery with the purpose of controlling macroscopic residual tumor or possible microscopic residual tumor and to prevent recurrence.

neoadjuvant therapy

tx given before planned surgery. it's purpose is to shrink the tumor to increase the possibility of resectability, decrease the morbidity of surgery, and protect bodily functions that otherwise might be impaired.

hyperbaric oxygen therapy

tx that consists of breathing pure oxygen while in a sealed chamber that's been pressurized at 1.5-3 times normal atmospheric pressure. it helps to increase the sensitivity of certain cancer types to radiation. it's also being tested to see if it can reverse some of the damage to normal body tissues caused by radiation.

curative tx

tx that is defined by the probability of long-term survival after adequate therapy.

palliative tx

tx used for patients with no hope of long-term survival.