1. CHAPTER 32 Drugs Used in the Treatment of Cancer

2. this new growth of abnormal cells is called a tumor
cells reproduce for tissue growth and repair, cells divide in an orderly way.
cell division and growth can be out of control, a mass or clump of cells develops
this new growth of abnormal cells is called a tumor
tumors are benign or malignant
malignant tumors (cancer): invade and destroy nearby tissue (fig 32-2), can spread to other body parts, may be life-threatening, sometimes will grow back after removal
benign tumors: do NOT spread to other body parts, can grow to a large size but rarely threaten life, usually do not grow back when removed
metastasis: spread of cancer to other body parts (fig 32-3), cells break off of tumor and travel to other part of body, new tumors grow in other body parts, this occurs if cancer is not treated and controlled

3. cancer can occur almost anywhere
common sites: skin, lung, bronchus, colon, rectum, breast, prostate, uterus, ovary, urinary bladder, kidney, mouth, pharynx, pancreas, thyroid gland (fig 32-4)
cancer is 2nd leading cause of death in United States
certain factors increase risk of cancer:
growing older: cancer occurs at all ages, most occur in persons 65 years or older
tobacco: includes smoking, snuff, chewing tobacco, and being around tobacco smoke.
sunlight: sun, sunlamps and tanning booths cause early aging of skin and skin damage, these can lead to skin cancer. Time in sun should be limited

4. certain factors increase risk of cancer cont….
ionizing radiation: can cause cell damage that leads to cancer, X-rays are one source, so is radon gas that forms in soil and some rocks, people who work in mines are at risk, radon is found in homes in parts of the country. Radioactive fallout is another source, it can come from nuclear power plant accidents, also from producing/testing or use of atomic weapons
certain chemicals and other substances: painters, construction workers, and those in chemical industry are at risk. Household substances also contain risk- paint, pesticides, used oil
some viruses and bacteria: infection from viruses increases the risk of these cancers-cervical, liver, lymphoma, leukemia, Kaposi’s sarcoma, stomach

5. certain factors increase risk of cancer cont….
certain hormones: hormone replacement therapy for menopause may increase risk of breast cancer. Diethystilbestrol (DES), a form of estrogen, was given to pregnant women between women who took this are at risk for breast cancer, their daughters are at risk for a certain type of cervical cancer
family history of cancer: certain cancers tend to occur in families, including: melanoma, and cancers of breast, ovary, prostate and colon
alcohol: risk of certain cancers increases with more than 2 drinks/day. Cancers include: mouth, throat, esophagus, larynx, liver and breast. Women should have no more than 1 drink/day
poor diet, lack of physical activity, being overweight: high-fat diet increases the risk of cancers of colon, uterus, prostate. Lack of activity and being overweight increase risk of : breast, colon, esophagus, kidney, uterine cancers

6. goal of cancer treatment:
if detected early cancer can be treated and controlled (box , signs/symptoms of cancer)
treatment depends on type of tumor, its site and size, and if it has spread
goal of cancer treatment:
cure cancer
control disease
reduce symptoms as long as possible
cancer treatments also damage healthy cells and tissues
side effects depend on type and extent of treatment
surgery: removes tumors, done to cure or control cancer, can relieve pain from advanced cancer, some surgeries are disfiguring, self-esteem and body image are affected

7. side effects depend on area being treated
radiation therapy: kills cells, x-ray beams are aimed at tumor, sometimes radioactive material is implanted in or near tumor, cancer cells and normal cells receive radiation and both are destroyed
radiation therapy:
destroys certain tumors
shrinks a tumor before surgery
destroys cancer cells that remain in area after surgery
controls tumor growth to prevent/relieve pain
side effects depend on area being treated
fatigue is common, extra rest is needed
discomfort, nausea, vomiting, diarrhea and loss of appetite are other side effects

8. chemotherapy: involves drugs that are used to kill cells it’s used to:
shrink a tumor before surgery
kill cells that break off the tumor, goal is to prevent metastasis
relieve symptoms caused by cancer
cancer cells and normal cells affected
side effects depend on drug used:
hair loss (alopecia)
GI irritation, poor appetite, nausea, vomiting, diarrhea, stomatitis: inflammation of mouth, may occur
bone marrow depression (decreased production of blood cells) bleeding and infection are risks
person may feel weak and tired

9. side effects of hormone therapy:
hormone therapy: prevents cancer cells from getting or using hormones needed for their growth
drugs are given to prevent the production of certain hormones, organs or glands that produce a certain hormone are removed
side effects of hormone therapy:
fatigue
fluid retention
weight gain
hot flashes
nausea
vomiting
appetite changes
blood clots
fertility can be effected in men and women
men may experience impotence and loss of sexual desire

10. biological therapy: (immuno-therapy)
helps immune system fight the cancer
protects body from the side effects of treatment
side effects include:
flu-like symptoms
chills
fever
muscle aches
weakness
loss of appetite
nausea
vomiting
diarrhea
bleeding, bruising and swelling may occur

11. Drug therapy for Cancer:
chemotherapy is most effective when tumor is small and when cells rapidly divide
agent used depends of type of tumor cells, rate of growth and tumor size
see pgs for chemotherapeutic

12. Delegation Guidelines Drugs Used in the Treatment of Cancer:
Some drugs used to treat cancer are given parenterally- by subcutaneous, intramuscular or intravenous injection. Because you do NOT give parenteral dose forms, they are NOT included in this chapter. Should a nurse delegate the administration of such to you, you must:
- remember that parenteral dosages are often very different from dosages other routes
-Refuse the delegation. Make sure to explain why. Do NOT just ignore the request. Make sure the nurse knows that you cannot give drug and why
Your state and agency may allow you to give some oral dose forms. Make sure you receive the necessary education about any chemotherapy agents that you will give