Vascular - Cancers & Antineoplastic Agents

Question 1

Cancer & Metastases

Answer 1

• any disease where uncontrolled proliferation of cells occurs - alteration in the DNA
• abnormalities in the regulation of cell growth, causes tissue damage & death
• metastases - known as secondaries
• tumors of masses of cells that develop when cancer cells break away from the original cancer
• carried by lymphatic system & blood systems to other parts of the body

Question 2

Cancer - Risk Factors

Answer 2

• tocacco use
• being overweight or obese
• low fruit & vegetable intake
• physical inactivity
• alcohol use
• sexually transmitted HPV-infection
• urban air pollution
• indoor smoke from household use of solid fuels

Question 3

Cancer - Cell Division

Answer 3

• not all cells divide simultaneously, many are dormant, proportion of resting cells varies
• growth factor - proportion of cells in a tissue involved in cell division

Question 4

Cancer - Treatment - Surgery

Answer 4

• remove tissue from specific sites in the body
• primary treatment of choice for many solid tumors such as cancers of the bowel or breast
• often used in combination with chemo or radiotherapy

Question 5

Cancer - Treatment - Radiotherapy

Answer 5

• radiation therapy - uses high energy radiation to destroy cancer cells, or impede their growth
• used both as curative as well as to relieve pain and discomfort

Question 6

Cancer - Treatment - Chemotherapy

Answer 6

• use of drugs to kill or slow the growth of cancer cells

- inhibit or prevent the development, maturation and proliferation of malignant cells

Question 7

Cancer - Treatment - Hormone Therapy

Answer 7

• some Ca growth is dependent on a particular hormone,
• can slow size or growth rate slowed by drugs that suppress the body’s production of the hormone or that block the effect of that hormone
• commonly used in prostate, breast & uterine cancers

Question 8

Cancer - Treatment - Complimentary Therapies

Answer 8

• herbal
• immunological
• metabolic
• mind-body therapies
• nutritional therapies

Question 9

Cancer - Treatment - Cytotoxic - Gendotoxic

Answer 9

• affect nucleic acids & alter function, or may directly bind to DNA, or lead to DNA damage by affecting enzymes involves in DNA replication

Question 10

Cancer - Treatment - Alkylating Agents

Answer 10

• inserts an alkyl group into the structure of the DNA, stops cellular proliferation, cells can no longer divide

Question 11

Antimetabolites

Answer 11

• cell cycle specific, attack cells at very specific stages in the cycle, stopping normal development and division
• inhibit folic acid synthesis
• classified according to the substances with which they occur
• must be administered when cancer cells are profilerating

Question 12

Antibiotics

Answer 12

• prevent cell division
  
  • bind to DNA making it unable to seperate
  • inhibiting RNA preventing enzyme synthesis
• bleomycin sulfate
• dactinomycin

Question 13

Mitotic Poisons

Answer 13

• interfere with mechanics of cell divisions
• block formation of spindle fibres, which are required for cell replication, if the cell cannot replicate it will eventually die
• vinca alkaloids
  
  • vincristine, vinblastine
• taxanes
  
  • paclitaxel, docetaxel

Question 14

Combined Therapies

Answer 14

• treatments combined for several reasons
  
  • one treatement may be more effective at a certain stage than another
  • one treatment may enhance the effectiveness of another synergy
  • one treatment alone may not affect the tumor

Question 15

Adverse Reactions - Early

Answer 15

• GIT: nausea, vomiting, anorexia, constipation & diarrhoea
• mucositis
• hypersensitivity reactions, puritis, rash
• fever, headache
• hypotension
• weakness, pain
• blistering & necrosis of skin (esp alkylating agents)

Question 16

Adverse Reactions - Delayed

Answer 16

• alopecia
• suppression of bone marrow cells
  
  • thrombocytopenia: bleeding
  • agranulocytosis
  • anaemia
  • leucopaenia
• immunosuppression: altered wound healing
• acral erythema: erythema of hands / feet
• photosensitivity: sunburn with minimal exposure
• stomatitis: oesophagitis, mouth ulcers

Question 17

Adverse Reactions - Late

Answer 17

• suppressed ovarian / testicular function
• cardiotoxicity
• neurotoxicity
• nephrotoxicity
• hepatotoxocity
• ototoxicity
• nail changes
• mood swings / chemo brain
• fatigue

Question 18

Cytotoxic - Care Considerations

Answer 18

• IV cannula well secured / sometimes sited in a central vein to avoid extravasation
• handwashing / standard precautions
• monitor vitals, weight, FBC
• bone marrow depression: fever, sore throat, rash, dysuria, altered concious level, severe decrease in WCC
• monitor for bleeding tendencies

Question 19

Cytotoxic - Patient Support

Answer 19

• emotional support
• patient education
• regular blood analysis (before next dose)
• may need to isolate patient (rare)
• caution with visitors

Question 20

Cytotoxic - Considerations

Answer 20

• drugs are potential carcinogens - use extreme care when handling and disposing to minimise personal and environmental risk
• protective apparel when handling cytotoxics
  
  • gloves, gowns, goggles
• chemo may remain in the body for up to three days after treatment, excreted in urine / stools, flush toilet twice
• vomit may also contain traces of chemo, use precautions
• safe storage of capsules / tablets to avoid exposure