Cancer Treatment Modalities

Miscellaneous agents

Acts primarily by inhibiting protein synthesis.

En bloc dissection

Refers to more extensive resection with total tumor removal with or without regional lymphatics.

Repopulation

Refers to regeneration of cells after radiation damage. This process that occurs between radiation fractions is greater in the normal tissue than in the tumor.

Hypoxic cell sensitizers

Sensitizers that replace oxygen and make tumor cells more radiosensitive.

Veno-occlusive disease

A complication of bone marrow transplantation; collagen develops around the central veins of the liver, resulting in venous congestion, stasis, and damage to the hepatic cells.

30-50% drop in platelet count

*CD34 cells* can be collected in one or two sessions in allogenic PBSCs. An adequate number of these cells are available in the circulation *after 4-5 days* of G-CSF administration. What is the most common side effect of this process?

•Stereotactic radiotherapy (SRT) •Total body irradiation (TBI) •Hyperthermia •Intraoperative radiotherapy •Radiosensitizers •Radioprotectors •Radioimmunotherapy •Remote afterloading brachytherapy

8 Special techniques in radiation therapy

•Cell-cycle phase-specific drugs •Cell cycle phase-nonspecific drugs •Alkylating agents •Antibiotics (antitumor agents) •Antimetabolites •Hormones •Antihormonal agents •Nitrosoureas •Vinca plant alkaloids •Miscellaneous agents •Corticosteroids

11 Chemotherapy drug classification

•Internal radiation therapy (brachytherapy) •External radiation therapy (teletherapy).

2 Classifications of Radiotherapy

•5-Fluorouracil (5-FU) •Methotrexate

2 Common types of antimetabolites

•Bleomyin (Blenoxoane) •Doxorubicin (Adriamycin)

2 Common types of antitumor antibiotics

Rituximab Trastuzumab

2 common types of monoclonal antibodies according to its time of discovery

Self-care and independence

2 important aspects of discharge planning after an oncologic surgery

•Tumor-directed therapy •Active immunotherapy •Adoptive immunotherapy

3 Approaches in gene therapy

•malnutrition •infection related to immunosuppression •bleeding related to thrombocytopenia

3 Common side effects of BMT

•Cyclophosphamide (Cytoxan) •Busulfan (Myleran) •Mechlorethamine (Mustargen)

3 Common types of alkylating agents

•Diethylstilbestrol (DES) •Tamoxifen (Novaldex) •Prednisone

3 Common types of hormones and hormone antagonists

•*Multidisciplinary discussions* should occur with review of current clinical research trends before initiating definitive surgery. •The team must *individualize care* and include the patient and their family in the decision-making process, noting the pros and cons of various options. •The goals are to *maximize their potential for cure*, *minimize undesirable co-morbidities*, and *provide satisfaction to patients*.

3 Considerations of surgical treatment

•Size of the treatment field •Exact body tissues being treated •Daily and total dose to be given

3 Factors that predict side effects of radiotherapy

*1*- Agents that *augment*, *modulate*, or *restore* the host's immunologic mechanisms *2*- Agents that have direct antitumor activity (*cytotoxic* or *antiproliferative* mechanisms) *3*- Agents that exert other biologic effects, those that affect *differentiation* or *maturation* of cells, that interfere with the ability of a tumor cell to metastasize.

3 Major Divisions of BMR

•Repair •Redistribution •Repopulation •Reoxygenation

4 "Rs" of Radiobiology

•Etoposide •Cisplatin (Platinol) •Asparaginase •Dacarbazine

4 Common types of miscellaneous agents

•Educate the patient and the family •Provide emotional support •Identify and preventatively treat pain •Create a safe environment

4 Major responsibilities of the surgical oncology team

•Frequent cleansing of the oral cavity using sponge-tipped swabs and rinsing with saline •Topical anesthetics (*dyclonine hydrochloride* or *lidocaine*) to control pain •Analgesics •Topical antibacterial or fungal

4 management of mucositis

•Infections- most common •Pneumonitis - usually within 100 days postop •Veno-occlusive disease •Graft-Versus-Host-Disease •Recurrence of original disease- most significant •Graft failure

6 Complications of hematopoietic stem cell transplantation

•Blood brain barrier (BBB) •Chemoprevention •Chronotherapy/circadian rhythm •Cytoprotectants •Liposomes •Radiosensitizers

6 Factors influencing chemotherapy selection and administration

•adenoviruses- most effective •retroviruses, •vaccinia virus •fowlpox •herpes simplex viruses •Epstein-Barr viruses.

6 Viruses used as vectors that transport a gene into a target cell via the cell membrane

•Tissue damage to target area (erythema, sloughing, hemorrhage) •Immunosuppression •Fatigue •Anorexia •Ulcerations of oral mucous membranes •Nausea, vomiting, and diarrhea •Radiation pneumonia

7 Common side effects of radiotherapy

•Interferons (IFN) •Lymphokines-Interleukins •Hematopoietic Growth Factors •Nonspecific biologic response modifiers •Monoclonal antibodies •Cytokines •Retinoids •Cancer vaccines

8 Major BRM agents in use

Alopecia

A common complication of chemotherapy that, while not serious, has a profound psychological impact on clients. It is known to be temporary and regrowth can actually occur during therapy.

Photofirin

A common photosensitizing compound used in photodynamic therapy. The drug produces a cytotoxic oxygen molecule (*singlet oxygen*).

Vincristine (Oncovin)

A common types of plant alkaloid

Graft-versus-host disease (GVHD)

A complication that occurs following a stem cell or bone marrow transplant in which the transplant produces antibodies against recipient's organs that can be severe enough to cause death

Adjuvant therapy

A course of chemotherapy used in conjunction with another treatment modality (surgery, radiation or biotherapy) and aimed at treating micrometastases.

Lymphokines-Interleukins

A glycoprotein produced by activated T-helper or CD4 cells. The first response is the activation of T-cells by antigen and the second is through interactions with this glycoprotein. It *enhances antibody responses* by activating other lymphocytes to produce lymphokines important for cell function (IL4-IL6)

Needle biopsy

A hollow needle is used to remove a core of tissue for examination. A type of biopsy procedure performed to *sample suspicious masses* that are easily accessible, such as growths in the breasts, thyroid, lung, liver, and kidney.

Stereotactic radiotherapy (*SRT*)

A method of administering precise beam radiosurgery of radiation to a discrete intracranial lesion. Multiple fractions are given with head immobilization.

Photodynamic therapy

A photosensitizing compound is administered IV where it is retained by malignant tissue. 3 days after injection, the drug is activated by a laser treatment which continue for 3 more days. Used to treat specific superficial tumors such as those of the surface of bladder, bronchus, chest wall, head, neck and peritoneal cavity.

Total body irradiation (*TBI*)

A preoperative regimen given prior to bone marrow transplantation. This is to eradicate tumor cells and suppress immune response, allowing engraftment to occur.

Mucositis (stomatitis)

A serious and potentially life-threateing complication that is generally seen with *antimetabolites* and *antitumor antibiotics*. Toxicity manifests as erythema, pain, and ulceration of the oral mucosa.

Hyperuricemia

A side effect that occur when there is a rapid lysis of tumor cells (*breakdown of nucleoproteins or purines*) following chemotherapy. These substances can precipitate in renal tubules and can cause serious or irrervesible kidney failure.

Apheresis

A special form of leukapheresis used to collect peripheral blood stem cells that can be used in bone marrow transplant.

Targeted therapy

A therapy that seeks to minimize the negative effects on healthy tissues by disrupting specific cancer cell functions such as malignant transformation, cell communication pathways, processes for growth and metastasis, and genetic coding.

Allogeneic BMT

A type of BMT wherein the client is infused with donor bone marrow harvested from a healthy individual.

Syngeneic BMT

A type of BMT wherein the client is infused with harvested bone marrow from an identical twin.

Autologous BMT

A type of BMT wherein the client is infused with own bone marrow harvested during remission of disease.

Incisional biopsy

A type of biopsy procedure performed if the tumor mass is too large to be removed.

Chemosurgery

A type of surgery that uses chemicals or chemotherapy applied directly to the tissue to cause destruction.

Electrosurgery

A type of surgery that uses electric current to destroy tumor cells.

Cryosurgery

A type of surgery that uses liquid nitrogen or a very cold probe to freeze tissue and cause cell destruction.

Salvage surgery

An additional treatment option that is an extensive surgical approach to *treat the local recurrence* of cancer after the use of a less extensive primary approach.

Hematopoietic Growth Factors

Are a family of glycoproteins responsible for the proliferation, differentiation, and maturation of hematopoietic cells in vitro. The classic examples include colony-stimulating factors (*CSFs*) and *erythropoietin*.

Radiosensitizers

Are compounds that enhance the sensitivity of tumors to the effects of radiation but not to normal tissue.

*Granulocyte colony-stimulating factor*, also known as CSF-3

Are glycoproteins considered safe for mobilization in allogenic PBSCs.

Nonspecific biologic response modifiers

Are nonspecific agents such as Bacille Calmette Guérin (*BCG*) and *Corynebacterium parvum*, when injected into the patient, may serve as antigens that can stimulate an immune response in the hopes of eradicating malignant cells.

Nausea & vomiting

Are the *most common* complication of antineoplastic agents. Although they might occur separately, these s/sx frequently appear as a clinical syndrome associated with physiologic changes such as dizziness, pallor, tachycardia, and diaphoresis.

Cancer vaccines

Are used to mobilize the body's immune response to recognize and attack cancer cells, as these agents contain either portions of cancer cells alone or portions of cells in combination with other substances that can augment or boost immune responses.

Cytoprotectants

Are used to prevent or decrease specific system effects (cardiotoxicity, nephrotoxicity, bladder toxicity and hematopoietic toxicity) related to certain drug therapies. This drug selectively protects normal tissues from the cytotoxic effects of drugs.

Retinoids

Are vitamin A derivatives that play a role in growth, reproduction, apoptosis, epithelial cell differentiation, and immune function. Specific receptors in the cell nucleus are dependent on it, thus when they bind with these receptors, cell *differentiation* and *replication* are affected.

Cell separator

As part of the transplant apheresis, this device is programmed to collect either *lymphocytes* or low-density *leukocytes*.

•Macular/pustular rushes •Desquamation •Epidermolysis

Can also occur as a direct effect if the drug on the skin or as an immunologically mediated allergic reaction. Areas of previous radiation are particularly susceptible to this dermatologic toxicity.

Radiosensitizers

Chemicals administered intravenously or intraarterially to increase the effect of radiation when given concurrently.

Radioprotectors

Chemicals that protect cells from the normal tissue injury caused by radiation by acting as a free radical scavenger.

1. Wash the marked area of the skin with plain water ONLY and pat skin dry. 2. Avoid rubbing, scratching, or scrubbing the treatment site; do not apply extreme temperatures to the treatment site; if shaving, use only an electric razor 3. Wear soft, loose-fitting over the treatment area 4. Protect skin from sun exposure during the treatment and for at least 1 year after the treatment is completed; when going outdoors, use sun-blocking agents with sun protector factor (SPF) 5. Maintain proper rest, diet, and fluid intake as essential to promoting health and repair of normal tissues 6. Hair loss may occur; choose a wig, hat, or scarf to cover and protect head

Client education for external radiation

1. Avoid close contact with others until treatment is completed 2. Maintain daily activities unless contraindicated, allowing for extra rest periods as needed 3. Maintain balanced fluid and diet; may tolerate food better if consumes small, frequent meals 4. Excreted body fluids may be radioactive; double-flush toilets after use 5. If systemic symptoms, such as weakness and fatigue, occur, the nurse explains that these symptoms are a result of the treatment and do not represent deterioration or progression of the disease.

Client education for internal radiation

Radiation kills cells primarily by damaging the DNA. Because cells are mostly water, the majority of the damage is indirect. It is caused when ionizing radiation interacts with the cell's water to produce free radicals.

How do radiation therapy kill tumor cells?

•Performed for 1-3 days •Each session is 3-4 hours long •A flow of 50-70 ml/min is considered optimal

How is transplant apheresis performed in autologous PBSCs?

Complementary and Alternative Medicine (CAM)

Defined as diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine. Because of the possibility of herb-vitamin-drug interactions, there is concern about the use of biologicals and dietary supplements, which are not regulated by the FDA nor subjected to rigorous scientific evaluation.

Myeloablative therapy

Dose intensive therapy used in preparation for peripheral blood stem cell transplantation.

Induction Chemotherapy

Drug therapy given as the primary treatment for patients who have cancer for which no alternative treatment exists.

Corticosteroids

Exert an anti-inflammatory effect on body tissues. They promote a feeling of well-being and increase their appetite.

Constipation

Generally related to a direct effect on the nerve supply of the bowel, causing hypomotility. The *vinca alkaloids* are the group of drugs most often associated with this side effect.

•During intravenous administration, monitor for chills, nausea, rash, local skin reactions, and temporary photosensitivity •Drug remains in tissues 4-6 weeks after injection; direct or indirect exposure to sun activates drug, resulting in chemical sunburn; educate client to protect skin from exposure to sun

Important nursing considerations during photodynamic therapy

Video-assisted endoscopic surgery

In this minimally invasive procedure, an endoscope with intense lighting and an attached multichip mini-camera is inserted into the body through a small incision.

Wide or radical excisions

Includes removal of the primary tumor, lymph nodes, adjacent involved structures, and surrounding tissues that may be at high risk for tumor spread.

•Leukemia •Aplastic anemia •Fanconi's anemia •immunodeficiency •Genetic and metabolic disorders

Indications for UCB

•Hematologic malignancies, •Acute Myelogenous Leukemia (AML) •Acute Lymphocytic Leukemia (ALL) •Myelodysplastic syndrome (MDS) •NonHodgkin's lymphoma (NHL)

Indications for allogeneic BMT

•Hematologic malignancies •Multiple myeloma •NonHodgkin's lymphoma •Treatment of diseases in which a patient's own bone marrow contains adequate stem cells.

Indications for autologous BMT

Photodynamic therapy

Intravenous administration of a light-sensitizing agent that is taken up by cancer cells, followed by exposure to laser within 24-48 hours

Prophylactic surgery

Involves removing nonvital tissues or organs or precancerous lesions that are at increased risk to develop cancer. Examples include colectomy, mastectomy, and oophorectomy

Diarrhea

It can occur as a result of GI mucosal irritation secondary to a direct toxic effect of the drug on the bowel.

Anorexia

It can occur in conjunction with nausea & vomiting or it might be related to physiologic changes such as GI obstruction and ageusia induced by tumor. It might also stem from emotional disturbances, especially depression and anxiety.

Gene therapy

It includes approaches that correct genetic defects or manipulate genes to induce tumor cell destruction in the hope of preventing or combating the disease

Cord blood transplantation

It involves the collection and transplantation of umbilical cord blood (*UCB*) since it is rich in stem stems. After the placenta is delivered, the umbilical cord is clamped and the blood is withdrawn from the umbilical vein, using a needle and syringe, then it is cryopreserved just like PBSCs or bone marrow.

Radiation therapy

It is a local treatment, which attempts to destroy cancer cells by damaging the DNA with radiation: electrons, photons, or protons. It is given alone or in combination with surgery, chemotherapy or biotherapy. Maybe used to cure cancer by eradicating the disease.

IL-2

It is a potent modulator of immune responses. It increases immune response effective and destroys abnormal cells.

Chronotherapy or circadian rhythm

It is a term used to describe a regular repeated fluctuation in biologic functions during a 24 hr period. This can influence drug absorption, metabolism, distribution and elimination. It also allows dose intensification and reduction of cytotoxic side effects.

Biologic response modifier (*BMR*) therapy

It is an *immunotherapy* or the treatment with agents derived from biological sources affecting biologic responses. This therapy involves the use of naturally occurring or recombinant agents or treatment methods that can alter the immunologic relationship between the tumor and the host to provide a therapeutic benefit.

Reoxygenation

It is based on the fact that the presence of oxygen enhances the effect of ionizing radiation, particularly when x-rays or gamma rays are the source. As the tumor shrinks, the oxygenation deprived core is exposed to the oxygen rich blood supply, increasing the tumor's sensitivity to radiation.

Redistribution

It is based on the sensitivity of the cell to radiation at different phases of the cell. Dividing the radiation dose into smaller daily doses disrupts the cellular life cycle, causing a greater number of cells to enter the more sensitive mitotic phase. Tumor cells may be more susceptible to this process than normal cells.

Pre-treatment workout

It is done to establish the recipient's physical and psychosocial status. A team approach is usually used and typically includes psychology, social work, surgery, chaplaincy and radiology. It ensures an adequate support system.

BBB

It is made up of cellular structures that can inhibit certain substances from entering the brain or CNS tumors and acts as a screening device, thereby protecting the brain and cerebrospinal fluid from harmful agents.

Radiation oncology

It is the medical discipline concerned with the causes, prevention, and treatment of cancer involving special expertise in the therapeutic use of radiation therapy either alone or in conjunction with other treatment modalities.

Harvesting

It is the process of obtaining bone marrow for transplantation.

Conditioning regimens

It is the process of preparing the patient to receive bone marrow or stem cell.

Purging

It is the process of removing residual malignant cells from the marrow for autologous transplant. It is performed using *monoclonal antibodies*.

Therapeutic ratio

It is the ratio or a measure of radiocurability and is dependent on the overlap of the normal tissue tolerance dose and the dose required to destroy the tumor.

Chemotherapy

It is the use of *cytotoxic drugs* in the treatment of cancer. It is one of the four treatment modalities that provide cure, control or palliation. It is a *systemic treatment*, rather than localized therapy.

Radioimmunotherapy

It is the use of monoclonal antibody radioactive isotopes to selectively implant specific tumors and tumor proteins.

Medulla oblongata

It is where chemoreceptors are located,

Mucositis

It occurs when renewal of the epithelial cells lining in the GI tract is inhibited by chemotherapeutic agents. *Bone marrow depression* also influences its development because lower granulocyte and platelet counts in conjunction with mucositis result in a higher incidence of infection and bleeding.

Fractionation

It refers to the process of dividing the total radiation dose into equal daily fractions. It allows healthy tissues to repair and achieve greater cell kill.

Reconstructive surgery

May be performed in an attempt to improve function or obtain a more desirable cosmetic effect. May follow curative or radical surgery. and may be indicated for breast, head and neck, and skin cancers.

Excisional biopsy

Most frequently used biopsy procedure for easily accessible tumors of the skin, breast, and upper and lower gastrointestinal and upper respiratory tracts.

•Chemotherapy (*Cyclophosphamide*) •Growth factors (*Cytokines*)

Most significant mobilization for autologous PBSCs

1. Patient's condition 2. The goal of therapy 3. Dosage, route, and schedule of the drug 4. Principles of administration 5. Potential side effects

Nursing care for chemotherapy begins with a thorough understanding of these 5 elements

•Limit contact time to 30 minutes and observe minimum distance of 6 feet •Use lead shields and other precautions to reduce exposure to radiation •Place client in private room •Ensure proper handling and disposal of body fluids, assuring the containers are marked appropriately •Ensure proper handling of bed linens and clothing •In the event of a dislodged implant, use long-handled forceps and place the implant into a lead container; never directly touch the implant •*Do not allow pregnant* woman to come into any contact with radiation

Nursing management of client receiving internal radiation

Local excision

Often performed on an outpatient basis, is warranted when the mass is small, and it includes removal of the mass and a small margin of normal tissue that is easily accessible.

Multiple somatic mutations

One of the challenges confronting cancer gene therapy, making it difficult to identify the most effective gene therapy approach.

•Impaired tissue integrity •Fatigue •Anxiety •Risk for infection •Social isolation •Imbalanced nutrition: less than body requirements •Disturbed body image

Priority nursing diagnoses in radiotherapy

•Verify the patient's identification, drug, dose, route and time of administration against the Physician's order. •Review drug allergy history of patient. •Anticipate and plan for possible side effects or major system toxicity. •Review appropriate data and other tests. •Verify informed consent for treatment. •Select the appropriate therapy equipment and supplies. •Calculate and verify drug dosages. •Explain procedure to patient and family. •Ensure prescribed premedications such as antiemetics. *Documentation recommendations:* Site assessment before and after the infusion; catheter or device patency; chemo agent, drug dose, route, time administered, pre/post medications. Record any complaints of patient.

Procedures for administering chemotherapeutic drugs

Remote afterload brachytherapy

Radioactive sources are loaded into an applicator that has been inserted into a patient by using a remotely activated system. Can be an outpatient procedure and can be used in *gynecologic* and *bronchial cancers* and *sarcomas*.

•Fatigue •Anorexia •Weight loss •Lethargy •Lack of concentration •Neutropenia •Peripheral neuropathies •Nausea and vomiting •*Cardiac failure*- common life-threatening toxicity.

Side effects of IFNs

•Flu-like symptoms •Nausea and vomiting •Diarrhea •Anorexia •CNS toxicity (confusion, lethargy, decreased concentration, depression, hallucination) •If not stopped may lead to coma and death.

Side effects of ILs

Cytokines

Substances produced by cells of the immune system to enhance the production and functioning of components of the immune system, are also the focus of cancer treatment research.

True

TRUE or FALSE Chemotherapeutic drugs are most active against frequently dividing cells or in all the phases except for G0.

True

TRUE or FALSE The regulatory mechanism that controls the growth of cancer cells differs from that of normal cells. Tumor cells are more sensitive than normal cells to chemotherapy agents that are toxic to rapidly dividing cells.

True

TRUE or FALSE When surgery is the primary approach in treating cancer, the goal is to remove the entire tumor or as much as is feasible and any involved surrounding tissue, including regional lymph nodes.

Repair

The ability of cells to recover from sublethal damage. Initially, both normal and tumor cells can recover, but as the radiation dose accumulates, the ability of the tumor cells to repair damage decreases.

Vesicant extravasation (doxorubicin, mechlorethamine)

The accidental leakage of a drug into the subcutaneous tissue that causes *pain* and *necrosis* or sloughing of tissue.

Neoadjuvant chemotherapy

The administration of chemotherapy to shrink a tumor before it is removed surgically.

Active immunotherapy

The administration of genes that will invoke the antitumor responses of the immune system.

Adoptive immunotherapy

The administration of genetically altered lymphocytes that are programmed to cause tumor destruction.

Combination chemotherapy

The administration of two or more chemotherapeutic agents to treat cancer, allows each medication to enhance the action of the other or act synergistically with it.

Hyperthermia

The application of heat to tumors. Heat kills cells in a *resting* or radioresistant phase, inhibiting the repair of radiation damage and can work synergistically with radiation and chemotherapy.

Surgery

The branch of medicine that uses manual and instrumental means to deal with the diagnosis and treatment of injury, deformity, and disease. Remains one of the best options for many high-risk individuals.

Surgical oncology

The branch of surgery focusing on the surgical management of malignant neoplasms, including biopsy, staging, and surgical resection.

Intraoperative radiotherapy (*IORT*)

The delivery of a large single dose of a high energy electron beam to a surgically exposed tumor or resected tumor bed with the goal of improving local tumor control and minimizing radiation exposure to normal tissues.

Myelosuppression

The most common dose-limiting toxicity that is associated with chemotherapeutic drugs. It is manifested by anemia, thrombocytopenia, and leukopenia and can sometimes be manages with blood component therapy.

Primary therapy

The treatment of patients who have localized cancer for which an alternative but less than completely effective treatment is available.

Mobilization

The use of certain drugs to increase the number of stem cells in the peripheral blood prior to collection for the transplant.

*Brachytherapy* (internal radiation)

The use of radioactive materials in contact with or implanted into the tissues to be treated.

Cell cycle phase-nonspecific drugs

These agents are active in all phases of the cell cycle and may be effective in large tumors that have few active cells dividing at the time of administration. They act independently of the cell cycle phases and usually have *prolonged effect* on cells.

Antibiotics (antitumor agents)

These drugs *disrupt DNA transcription* and inhibit DNA and RNA synthesis.

Cell-cycle phase-specific drugs

These drugs are most effective against actively growing tumors that have a greater proportion of cells cycling through the phase in which the drug attacks the cancer cell. Examples: antimetabolites and vinca plant alkaloids and miscellaneous agents such as asparaginase and dacarbazine.

Vinca plant alkaloids

These drugs exert a cytotoxic effect by *binding to microtubular proteins* during metaphase, causing mitotic arrest.

Antimetabolites

These drugs exhibit their action by *blocking essential enzymes* necessary for DNA synthesis so that a false message is transmitted.

Nitrosoureas

These drugs have the ability to *cross the BBB* with similar action to that of alkylating agents, inhibit synthesis of both DNA and RNA.

Antihormonal agents

These drugs neutralize the effect or inhibit the production of natural hormones used by hormone-dependent tumors.

Hormones

These drugs prevent cell division and further growth of hormone-dependent tumors.

Interferons (IFN)

They have a wide range of biologic effects including antiviral, antiproliferative and immunomodulatory. They are divided into three major classes, according to antigenic type: *alpha*, *beta*, and *gamma*.

Liposomes

This allows better administration of poorly soluble cancer drugs, thus enhancing drug delivery and uptake in the tumor overcoming drug resistance and decreasing chemotherapy toxicities.

Alkylating agents

This category of drugs has a phase activity similar to that observed in radiation therapy. Interferes with *nucleic acid duplication*, preventing mitosis.

Tumor-directed therapy

This is the introduction of a therapeutic gene (*suicide gene*) into tumor cells in an attempt to destroy them.

*Telotherapy* (External radiation therapy)

Treatment is usually given *15-30 min/day*, *5 day/week*, for *2-7 weeks*. The client does not pose a risk for radiation exposure to other people. The radiation oncologist marks specific locations for radiation treatment using a semipermanent type of ink.

•Immediately stop the drug infusion •Maintain an IV line with isotonic saline •Position the patient for comfort and to promote perfusion of the vital organs. •Notify the physician, nursing agency or emergency medical services. •Maintain the airway, and anticipate the need for cardiopulmonary resuscitation •Monitor vital signs •Administer appropriate medications with an approved physician's order. •Document the incident in the patient's medical record.

Treatment strategies for managing anaphylaxis

•Use specific antidotes •The nurse should know which drugs have vesicant potential and test the vein or ensure catheter patency with normal saline.

Treatment strategies for managing extravasation

Unproven unconventional treatments

Treatments without scientific evidence of the ability to cure or control cancer. Hopelessness, desperation, unmet needs, lack of factual information, and family and social pressures are major factors that motivate patients to seek this kind of treatment method.

Bone marrow transplant (*BMT*)

Used in the treatment of leukemias, usually in conjunction with radiation or chemotherapy. A process that involves harvesting the bone marrow usually from the *iliac crest*. Once collected, the marrow is mixed with a heparinized solution, filtered to remove bone fragments and fat and placed in a blood bag. Then it is frozen and stored until transfusion. Before receiving the bone marrow, the client must first undergo a phase of immunosuppressive therapy. After such, the marrow is then transfused IV through a central line.

Laser surgery (light amplification by stimulated emission of radiation

Uses light and energy aimed at an exact tissue location and depth to vaporize cancer cells.

Radiofrequency ablation

Uses localized application of thermal energy that destroys cancer cells through heat.

Biopsy

Usually performed to obtain a tissue sample for analysis of the cells suspected to be malignant.

Chemoprevention

Via pharmacologic intervention, it refers to the concept of reducing cancer risk in individuals who are highly susceptible to certain cancers by prescribing certain natural or chemical synthetic products that may reduce or suppress the process of carcinogenesis. It seeks to arrest the process of carcinogenesis.

Palliative surgery

When a cure is not possible, the goals of treatment are to make the patient as comfortable as possible. This type of surgery offers relief of distress in signs and symptoms and retardations of metastasis.

Monoclonal antibodies

When introduce to the body, the humoral immune response produces immunoglobulins against the invading antigen from B cell derived plasma cells.

Leukopenia

With this adverse effect, patients are susceptible to the development of infection. This is often due to a combination of *granulocytopenia* and *impaired immunocompetence*. Classic s/sx of infections are often absent because of the lack of granulocytes. Early detection of infection, thus, is essential.

10-15 ml/kg body weight

Yield the amount of stem cells needed for bone marrow harvest.