1. CARE OF THE PATIENT UNDERGOING CHEMOTHERAPY AND/OR RADIOTHERAPY
SHARON HARVEY
23/02/04

2. LEARNING OUTCOMES THE STUDENT SHOULD BE ABLE TO:-
EXPLAIN WHAT CANCER IS AND ITS EFFECTS ON THE INDIVIDUAL
IDENTIFY THE DIFFERENT TYPES OF TUMOURS
DEFINE CHEMOTHERAPY
DISCUSS THE SIDE EFFECTS OF CHEMOTHERAPY
DISCUSS IMMUNOTHERAPY AND HORMONE THERAPY
DEFINE RADIOTHERAPY
DISCUSS THE SIDE EFFECTS OF RADIOTHERAPY
DISCUSS THE RIGHTS OF THE PATIENT TO REFUSE TREATMENT
GIVE EXAMPLES OF SUPPORTIVE THERAPY
EXPLAIN THE ROLE OF THE MACMILLAN NURSES

3. SOME FACTS ABOUT CANCER
THREE IN TEN PEOPLE WILL BE DIAGNOSED WITH CANCER DURING THEIR LIFETIME
THERE ARE CURRENTLY MORE THAN 1.2 MILLION PEOPLE LIVING WITH CANCER IN THE UK
THE RISK OF CANCER INCREASES WITH AGE
AROUND 65% OF ALL NEW CANCERS ARE DIAGNOSED IN PEOPLE OVER THE AGE OF 65

4. WHAT IS CANCER?
CANCER IS THE NAME GIVEN TO A GROUP OF DISEASES THAT OCCUR IN ANY ORGAN OF THE BODY
IT IS THE ABNORMAL OR UNCONTROLLED GROWTH OF CELLS
EACH CELL IN THE BODY HAS GENES
THESE GENES CONTAIN CODED INSTRUCTIONS TELLING THE CELL WHAT TYPE IT SHOULD BE, SUCH AS SKIN, BONE OR BLOOD AND WHEN TO DIVIDE AND REPLICATE.

5. NORMAL CELLS
- replicate themselves exactly
- stop reproducing after they have reproduced times
- stick together in the right place
- self destruct if they are damaged
- become specialised or “mature”

6. HOW DOES CANCER DEVELOP?
THEY DEVELOP WHEN A SINGLE CELL’S GENES DEVELOP A FAULT AND ARE UNABLE TO REGULATE CELL DIVISION
THE CELL BEGINS TO DIVIDE UNCONTROLLABLY
DEVELOPING INTO A LUMP KNOWN AS A TUMOUR

7. CANCER CELLS: CARRY ON REPRODUCING
IGNORE SIGNALS FROM OTHER CELLS AROUND THEM
DO NOT STICK TOGETHER, SO THEY CAN MOVE AROUND THE BODY
REMAIN IMMATURE
DO NOT DIE IF THEY MOVE TO ANOTHER PART OF THE BODY

8. BENIGN TUMOURS
DO NOT INVADE THE SURROUNDING TISSUES OR SPREAD TO OTHER PARTS OF THE BODY
USUALLY GROW SLOWLY
USUALLY HAVE A COVERING MADE UP OF NORMAL CELLS
THEY ARE NOT CANCEROUS

9. BENIGN TUMOURS CAN CAUSE PROBLEMS IF THEY:-
GROW VERY LARGE
BECOME UNCOMFORTABLE OR UNSIGHTLY
PRESS ON BODY ORGANS
TAKE UP SPACE IN THE SKULL
RELEASE HORMONES THAT AFFECT HOW THE BODY WORKS

10. MALIGNANT TUMOURS ARE CANCEROUS
HAVE THE ABILITY TO SPREAD BEYOND THEIR ORIGINAL SITE
MALIGNANT CELLS CAN BREAKAWAY FROM PRIMARY SOURCE AND SPREAD TO OTHER ORGANS VIA THE BLOOD STREAM OR LYMPHATIC SYSTEM

11. PRIMARY CANCER IS THE TERM USED TO IDENTIFY WHERE THE CANCER ORIGINATED
SECONDARY CANCER IS THE TERM USED TO IDENTIFY A SECOND SIGHT OF THE CANCER

12. THE MEANING OF CHEMOTHERAPY
THE WORD CHEMOTHERAPY COMES FROM TWO WORDS, CHEMICAL AND THERAPY
IT LITERALLY MEANS DRUG TREATMENT
IN PRACTICE IT USUALLY REFERS TO CYTOTOXIC DRUGS, CELL KILLING DRUGS

13. HOWEVER IT IS SLIGHTLY MORE COMPLEX, NOT ALL CANCER KILLING DRUGS ARE CLASSED AS CHEMOTHERAPY
SUCH AS INTERFERON AND MONOCLONAL ANTIBODIES WHICH ARE CLASSED AS IMMUNOTHERAPY
THERE ARE 60 TYPES OF CHEMOTHERAPY CURRENTLY AVAILABLE AND NEW ONES BEING DEVELOPED ALL THE TIME

14. HOW DO THE DRUGS WORK?
THE DRUGS ENTER THE BLOODSTREAM AND REACH ALL PARTS OF THE BODY
CYTOTOXIC DRUGS DESTROY CANCER CELLS BY DAMAGING THEM SO THAT THEY CAN’T DIVIDE AND GROW
THE DRUGS CAN ALSO AFFECT NORMAL CELLS

15. THE SUITABILITY OF CHEMOTHERAPY
THIS DEPENDS ON:-
THE TYPE OF CANCER
WHERE IN THE BODY IT STARTED
WHAT THE CANCER LOOK LIKE UNDER THE MICROSCOPE (GRADE)
WHETHER THE CANCER HAS SPREAD

16. THE PATIENT MAY HAVE CHEMOTHERAPY:-
ON ITS OWN
WITH RADIOTHERAPY
WITH SURGERY
WITH HORMONE THERAPY
WITH IMMUNOTHERAPY
WITH COMBINATION OF ALL OR SOME OF THESE TREATMENTS

17. THE PATIENT MAY HAVE
HIGH DOSE TREATMENT WITH AN INFUSION OF BONE MARROW CELLS AFTERWARDS
THIS IS KNOWN AS A BONE MARROW TRANSPLANT OR STEM CELL TRANSPLANT

18. SIDE EFFECTS OF CHEMOTHERAPY
MOUTH PAIN OR ULCERS
NAUSEA AND VOMITING
SOME CAUSE HAIR LOSS
SKIN THAT IS DRY, DISCOLOURED OR SENSITIVE TO SUNLIGHT
NAILS MAY GROW SLOWLY AND DEVELOP WHITE OR DARK LINES
ANAEMIA
LOW WHITE BLOOD CELL COUNT

19. WAYS OF GIVING CHEMOTHERAPY
In order to damage and kill the cancer cells, the drugs must be absorbed into your blood and carried throughout your body.
The way chemotherapy is given depends on
The type of cancer
The drugs (for example, some must be injected and some can be taken by mouth)

20. WAYS OF GIVING CHEMOTHERAPY
THE THREE MOST COMMON WAYS OF GIVING CHEMOTHERAPY ARE:-
INTRAVENOUS INJECTION
ORALLY
INTRAVENOUS INFUSION
LESS OFTEN DRUGS CAN BE INJECTED:-
INTRAMUSCULARLY / SUBCUTANEOUSLY
INTRATHECALLY
INTRA-ARTERIAL
INTRACAVITARY (INTRAVESICAL,INTRAPERITONEAL, INTRAPLEURAL)
INTRATUMOURAL OR INTRALESIONAL

21. IMMUNOTHERAPY
Immunotherapy is the name given to cancer treatments that use the immune system to attack cancers.
Sometimes immunotherapy drugs are called 'Biological Response Modifiers' (BRM's) because they stimulate the body to respond biologically (or naturally) to cancer. Immunotherapy can be
Local or systemic (treating the whole body) 
Non-specific or targeted

22. LOCAL IMMUNOTHERAPY LOCAL MEANS TREATING ONLY ONE PART OF THE BODY
THE BEST EXAMPLE IS BLADDER CANCER. THE VACCINE BCG CAUSES INFLAMMATION IN THE BLADDER THAT FIGHTS THE CANCER CELLS

23. SYSTEMIC IMMUNOTHERAPY
GIVEN TO TREAT THE WHOLE BODY
INTERFERON IS A SYSTEMIC IMMUNOTHERAPY DRUG
CAN TREAT KIDNEY CANCER AND MALIGNANT MELANOMA

24. NON SPECIFIC IMMUNOTHERAPY
LOCAL AND SYSTEMIC IMMUNOTHERAPY ARE CLASSED AS NON SPECIFIC IMMUNOTHERAPY
THEY ARE GIVEN TO BOOST THE IMMUNE SYSTEM TO FIGHT THE CANCER CELLS

25. TARGETED IMMUNOTHERAPY
THIS TARGETS CANCER CELLS AND HOPEFULLY LEAVES NORMAL CELLS UNTOUCHED
INCLUDES MONOCLONAL ANTIBODIES AND CANCER VACCINES

26. HORMONE THERAPY
ALTHOUGH HORMONES DO NOT USUALLY AFFECT CANCE CELLS, OESTROGEN AND PROGESTERONE AFFECT THE GROWTH OF SOME BREAST CANCERS, WHILE TESTOSTERONE AFFECTS THE GROWTH OF SOME PROSTATE CANCERS. THIS MEANS DRUGS THAT BLOCK THE EFFECTS OR LOWER THE LEVELS OF THESE HORMONES CAN BE USED TO TREAT SOME TYPES OF BREAST AND PROSTATE CANCER

27. HORMONE THERAPY DRUGS FOR BREAST CANCER
TAMOXIFEN IS A COMMON AND SUCCESSFUL ADJUVANT TREATMENT USUALLY GIVEN FOR FIVE YEARS AFTER SURGERY
AROMATASE INHIBITORS BLOCK THE PRODUCTION OF OESTROGEN BY THE ADRENAL GLANDS IN POST MENOPAUSAL WOMEN
PITUITARY DOWNREGULATORS ARE USED TO TREAT PREMENOPAUSAL WOMEN. THEY PREVENT THE OVARIES FROM WORKING UNTIL THERAPY IS DISCONTINUED.

28. HORMONE THERAPY DRUGS FOR PROSTATE CANCERS
PITUITARY DOWNREGULATORS MAY INITIALLY EXACERBATE SYMPTOMS, KNOWN AS TUMOUR FLARE, THIS CAN BE PREVENTED BY GIVING AN ANTI-ANDROGEN
ANTI-ANDROGENS BLOCK THE EFFECTS OF TESTOSTERONE
BOTH TYPES OF DRUGS TOGETHER ARE CALLED MAXIMAL ANDROGEN BLOCKADE (MAB)

29. RADIOTHERAPY THIS USES IONISING RADIATION TO KILL CANCER CELLS
IT IS USED TO TREAT BREAST, LUNG, HEAD, NECK, PROSTATE, COLORECTAL, BRAIN AND GYNAECOLOGICAL CANCERS
AT LEAST 50% OF PEOPLE WITH CANCER RECEIVE RADIOTHERAPY

30. DIFFERENT TYPES OF RADIOTHERAPY
TELETHERAPY OR EXTERNAL BEAM RADIOTHERAPY USES X-RAY BEAMS OF VARIOUS ENERGIES
BRACHYTHERAPY USES SEALED SOURCES OF RADIATION TO DELIVER A HIGH DOSE TO A TUMOUR AND CAN INVOLVE INTERSTITIAL THERAPY OR IMPLANTS OR INTRACAVITY TREATMENT

31. SIDE EFFECTS OF RADIOTHERAPY DEPENDS ON:-
THE AREA OF THE BODY BEING TREATED AND TISSUES/ORGANS IN THAT AREA
THE SIZE OF THE TREATMENT AREA
THE DOSE OR AMOUNT OF RADIOTHERAPY GIVEN
THE FRACTIONATION OF THE TREATMENT
THE GENERAL HEALTH OF THE PATIENT
PREVIOUS OR CONCURRENT CHEMOTHERAPY OR SURGERY

32. SIDE EFFECTS OF RADIOTHERAPY
SKIN REACTION
HAIR LOSS
DIARRHOEA
MUCOSITIS
STERILITY
FREQUENCY OF PASSING URINE
FATIGUE
ANOREXIA
PSYCHOLOGICAL EFFECTS
NAUSEA AND VOMITING

33. SUPPORTIVE CARE OF PATIENT WITH CANCER
SYMPTOM CONTROL
CARING FOR THEM IN THEIR OWN HOME IF THEY SO WISH
SUPPORTING THEM IF THEY DECIDE TO REFUSE TREATMENT FOR THEIR CANCER
EMOTIONAL SUPPORT
PSYCHOSOCIAL SUPPORT
PAIN
NAUSEA AND VOMITING
EATING PROBLEMS
FATIGUE
TREATABLE COMPLICATIONS

34. MACMILLAN NURSES There are currently 2000 Macmillan nurses in the U.K
They are registered nurses with at least 5 years post registration experience, 2 years have to be within cancer care or palliative care
They have specialist knowledge, for example in breast or lung cancer, or in chemotherapy.
Macmillan paediatric nurses help children with cancer and their families.

35. Macmillan community-based nurses play a vital role in helping people with cancer to stay at home with their families.
Macmillan hospital-based nurses see people with cancer from the time they are diagnosed and right through their treatment.
Macmillan lead cancer nurses are senior nurse managers, who help shape the future of cancer and palliative care services in their area.