Chemotherapy of Malignancy

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5/2/12

Chemotherapy Of Malignancy

BHARAT INSTITUTE OF TECNOLOGY

Mr.B.CHAKRAPANI M.pharm (ph.D)ASSISTANT PROFESSOR

DEPARTMENT OF PHARMACOLOGY

MANGALAPALLY,IBRAHIMPATNAM(M), R.R Dist.

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qChemotherapy is a common treatment for a variety of cancers.

qIt has proven to be safe and effective.

qAn understanding of this treatment helps patients

better recognize and tolerate side effects, if they occur

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qAntineoplastic agents are used in an attempt to

destroy tumor cells by interfering with cellular functions including replication.

qChemotherapy is used primarily to treatsystemic disease rather than localized lesions thatare amenable to surgery or radiation.

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qTo understand how chemotherapy works as a treatment,it is helpful to understand the normal life cycle of a cell inthe body.

qAll living tissue is composed of cells. Cells grow andreproduce to replace cells lost during injury or normal"wear and tear." The cell cycle is a series of steps that

both normal cells and cancer cells go through in order toform new cells.

Working

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q Assess fluid and electrolyte status(Anorexia, nausea & vomiting,altered taste and diarrhea put patient

at risk)q Modifying risk for infection and

bleeding(suppression of the bone marrowand immune system)

qAdministering Chemotherapypatient is observed for extravasation

(particularly of vesicant agents, whichmay produce necrosis if deposited in

subcutaneous tissuesØProtect caregivers

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Nursing Management in

Chemotherapy

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CELL CYCLE

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The cell cycle phases are:resting (G0; nothing ishappening), G1 (or gap 1; agrowth phase), S (synthesis; thereplication of DNA occurs), G2(gap 2; another growth phase),

and M (mitosis; the actualdivision from 1 cell into 2).

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6-12 h

3-4 h 1 h

Cell Cycle

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S PHASE

Ø S phase – the s phase is the phase during

which dna replication is occurring.

Ø Out of sight of most people’s ability to see, thedna is undergoing replication so, at the end

of the s phase, there would be two complete

sets of dna in the nucleus of that cell.

Ø In the s phase the cell has copied the contents

of its nucleus

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G2 PHASE

Ø G2 Phase- In this phase, the cell makes copies of the importantorganelles found in the cytoplasm.

Ø If a cell is going to divided, it needs enough mitochondria, (power plants) endoplasmic reticulum, (highways) and so on to support itself after cell division.

Ø If there are not enough mitochondria in one of the new cells, that cellwill die and the main purpose of cell division, to make two cells out of one cell, will be for nothing.

Ø In G2 phase, the important organelles in the cytoplasm are copied toensure that the two new cells will have enough organelles each tosurvive.

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G1 PHASE

Ø G1 Phase– This is the phase in which the cell

spends almost all of its time.

Ø It is the normal phase of the cell.Ø The cell is doing what ever that cell was

designed to do.

Ø For example: a skin cell would function as a skincell during G1 and a liver cell would function asa liver cell during G1.

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PROPHASE

Ø Prophase – Spindle fibers form, Chromosomesshorten, thicken and become visible (under a

microscope) and the nuclear membrane beginsto dissolve.

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METAPHASE

Ø Spindle fibers move the chromosomes, whichhave their copies wrapped around themselves, tothe middle of the nucleus and line them up.

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M-PHASE

Ø M Phase- This phase is the phase during

which the nucleus divides into two nuclei.

There are four parts to this phase;1) PROPHASE,

2) METAPHASE,

3) ANAPHASE ,

4) TELOPHASE.

At the end of the M Phase, there will

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ANAPHASE

Ø Spindle fibers shorten and pull the identicalchromosomes away from each other to theopposite side of the nucleus.

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TELOPHASE

Ø Spindle fibers dissolve, chromosomeslengthen out and become invisible again,nuclear membrane reforms around both sets of

separated chromosomes.

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CYTOKINESIS

Ø The cytoplasm divides leaving you with twoidentical cells, each with one nucleus.

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qNEUROLOGIC SYSTEM•

Peripheral neuropathies•Loss of deep tendon reflexes•Paralytic ileus

qMISCELLANEOUS•Fatigue•Alopecia

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REPRODUCTIVE SYSTEM

Take effective contraceptive precautions whenhaving chemotherapy, as the chemotherapy drugsmight harm the baby if pregnancy occurs.

In some women, chemotherapy brings on an earlymenopause. This may cause symptoms such as drynessof the vagina and a decreased interest in sex.

C f B l i di t l

5/2/12 Second years II-I

Cancer of Buccal mucosa invading extra-oraltissues following tobacco quid habit

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5/2/12 Dr Suwas Darvekar

Cancer of Tongue following tobacco consumption

Alveolar cancer after tobacco quid habit

ORAL LEUCOPLAKIA PATCH

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ORAL LEUCOPLAKIA PATCH

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Diarrhea can also be a side effect of chemotherapy. Caused by the destruction of normal, dividing cells of the

gastrointestinal (GI) tract, diarrhea varies from patient to patient. It is better managed if treated early

RENAL SYSTEMRapid tumor cell lysis- increased urinary excretion of uric

acid, which can cause renal damage

Myelosuppression- depression of bone marrowfunction, resulting in decreased production of blood

cells.- Decreases the number of RBCs (anemia), WBCs

(leukopenia) and platelets (thrombocytopenia)

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Nausea & Vomiting- most common sideeffects of chemotherapy and may persist for as

long as 24-48 hrs. after its administration.

Mucositis – inflammation of the mucosallining

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qIt can cause irritation which can eventually lead toinflammation of the mouth, a condition known asstomatitis .

qA stinging sensation in the throat may develop andlead to dysphagia (difficulty in swallowing).

Management:qGood oral hygiene

GASTROINTESTINALSYSTEM

h h id ff f

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What are the side effects of Chemotherapy?

SKINAlopecia

q Hair loss occurs because

chemotherapy cansometimes damage healthycells.

q It is so common because

hair follicle cells multiplyvery quickly like cancer cells and chemotherapydrugs have difficulty indiscerning the difference.

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Sequence of treatments:

qAdjuvant therapy: Therapy given after surgeryto reduce the likelihood of the cancer returning.

q Neo-adjuvant therapy: Therapy given before

surgery to shrink the tumor, allowing thesurgery to be more successful.

qConcurrent therapy: When 2 or more therapiesare given together, such as chemotherapy and

radiation.

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qOrally (by mouth, in pill form)qIntravenously (IV, through a vein, either as a short infusion or continuously for oneor more days)

qAs an injection or needleqDirectly into a body cavity (i.e.: the

bladder, abdominal cavity)qIntra-arterially (in special cases, such aslimb perfusion treatment for melanoma)

How is chemotherapy given?

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Rand 50.3

Chemotherapy of Malignancy

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