Cancer Chemotherapy: stoma course

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Cancer Chemotherapy stoma course

• DKD Smyth
• Lecturer-Practitioner in Cancer and Palliative
  Care

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What is chemotherapy?

• Probably one of the most dreaded words in the
  English language
• David Izod (1996) The patients perspective

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What Is Chemotherapy ?

• Chemotherapy is a systemic treatment relying on
  the use of CYTOTOXIC (cell killing) agents to
  destroy cancer cells
• Can destroy both the primary tumour and distant
  metastases

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Why is chemotherapy given to patients with
cancer?

• Cure
• Control
• Palliation

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Why is chemotherapy given to patients with
cancer (contd)?

• primary
• induction
• neoadjuvant or
  pre-operative chemoradiation
• adjuvant

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List the ways chemotherapy may be given

• Oral
• Subcutaneous intra-muscular
• Topical
• Intra-arterial
• Intra-cavity
• Intra-vesical
• Intra-peritoneal
• Intra-pleural
• Intrathecal
• Intravenous

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How does chemotherapy work?
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How does chemotherapy work?
5-FU Cytosine MTX 6-MP Thioguanine
vincristine
Cyclophos-phomide bleomycin
MTX 5-FU Cyclophosphamide Cytosine
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The effect of a single course of cytotoxic
therapy on tumour growth
Treatment
No. of cells
Time (linear scale)
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The effect of cytotoxic therapy on normal tissues
Treatment
Normal cells
Tumour cells
No. of cells
Time (linear scale)
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The effect of multiple courses of cytotoxic
therapy on normal and tumour cell populations
Treatment 1
Treatment 2
Treatment 3
No. of cells
Normal cells
Tumour cells
Time (linear scale)
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Multiple courses of cytotoxic therapy with too
long an interval
Normal cells
No. of cells
Tumour cells
Time (linear scale)
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Some drugs used in the treatment of colorectal
cancer

• Fluorauracil (5-FU)
• Stage III or Dukes C disease, and advanced Ca
• Combined with Leucovorin (Folinic Acid)
• Capsules / IV injection or infusion
• S/E mouth ulcers, diarrhoea, gritty eyes,
  reversible skin pigmentation, BM suppression,
  fertility
• Irinotecan (Campto)
• Advanced disease
• IV infusion
• S/E increased sweating salivation, delayed
  diarrhoea, NV, anorexia, BM suppression, hair
  loss

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Some drugs used in the treatment of colorectal
cancer (contd)

• Oxaliplatin (Eloxatin)
• IV infusion
• S/E numbness tingling in hands or feet, BM
  suppression, NV, diarrhoea
• Tegafur with uracil (Uftoral)
• Tablet tid, 4/52 on 1/52 off taken with folinic
  acid tablets
• Tegafur inactive metabolite of 5FU. Uracil stops
  breakdown of 5FU.
• S/E N, fatigue, BM suppression, mucositis, LFTs
• Capecitabine
• Tablet, bd. 14/7 on 7/7 off
• S/E sore mouth, GIT disturbance, skin changes
  Palmar Planter Syndrome

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Some drugs used in the treatment of colorectal
cancer (contd)Monoclonal antibodies
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Safety issues

• Many agents are
• Carcinogenic
• Mutagenic
• Teratogenic
• Take care with
• Drug administration
• Drug disposal
• Drug spillage
• Patient excreta