General Management in Cancer
• Realistic and achievable
• Open communication and support for the patient
and family
• NOTES: -Complete eradication (Surgery),
Relief of pain, Prolonged survival
SURGERY
• most frequent used method
• varies upon the case
• primary method of treatment, prophylactic,
palliative, and reconstructive
• NOTES:
- Removal of cancer cells
-Breast, Lungs, Bladder, Skin etc
Diagnostic Surgery
• Biopsy
o most cases they get the tissue on the tumor itself,
but sometimes also on the lymph nodes
surrounding the tumor
o injectable dyes and nuclear medicine imaging
o NOTES: -To obtain tissue sample for analysis to
know whether its malignant or not para makapag
plan din sila if need ba ng systemic ttherapy
-Lymph nodes kasi diba tumor metastize via
lymph nodes
• Choice of Biopsy Method
o nutrition, hematologic, respiratory, renal, and
hepatic
• Biopsy types: excisional biopsy, incisional
biopsy, needle biopsy
• NOTES:
-Many factors plus anesthesia effects are also
considered
TYPES OF BIOPSY
Excisional Biopsy
o most frequently used for accessible tumors
• skin, upper respiratory tract, lower/upper
gastrointestinal tract
o grades and stages cell
o prevents dissemination of cancer cells
o NOTES:
Excisional biopsy it grades and stages the cell
stage 1 2 3 4 na ba sya for grading if
naddifferentiate mo pa sa ibang cell or di na
talaga. This biopsy prevents dissemination of
cancer cells. How? Kasi dito tatangalin nadin
nila yung tumor kasi easily accesible sya
TYPES OF BIOPSY
Incisional Biopsy
o used for too large tumors to be removed
o only for the analysis of tumor
Note:
 Excsional and Insicional biopsy - endoscopy and
laparotomy
 NOTES:
-For biopsy only Not the entire tumor
-Laparotomy - surgical incision in which a
surgical incision is made in the stomach
-Endoscopy - for organ examination
TYPES OF BIOPSY
Needle Biopsy
o used for easily accessible mass/growths
o breast, thyroid, lungs, liver, kidney
o avoid surgical biopsy
o FNAB (thyroid), CNB (breast)
o accuracy: If negative doesn’t not mean you don’t
have cancer, if positive it is accurate
 X-ray, MRI, CT scan, UTZ – guides the needle
Surgery as a Primary Treatment
1. Local excision
2. Wide Radical Excision (en bloc dissections)
3. Video-assisted endoscopic surgery
4. Salvage surgery
5. Electrosurgery
6. Cryosurgery
7. Chemosurgery
8. Laser surgery
9. Radiation therapy
Prophylactic Surgery
o removing vital organ
• Considerations: family hx, possible risk and
benefits, patient’s acceptance of postoperative
outcome
• colectomy, mastectomy, oopherectomy
o Angelina Jolie
Palliative Care
o if cure is not possible
• Palliative Surgery – ulceration, hemorrhage,
obstruction, pain, malignant effusion
o honest and informative
o NOTES:
-Relieve complications
-Honest and informative when it comes to giving
information kasi para hindi sila umasa
Reconstructive Surgery
o improve function or obtain desirable cosmetic
effect
• breast, head, neck, skin
o patient/family needs, impact of altered function
and body image to quality of life
Nursing Management in Cancer Surgery
• Perioperative nursing care – age, nutritional
deficits, disorders of coagulation, altered
immunity, organ impairment
• Radiation therapy and chemotherapy – infection,
wound healing problem, altered pulmonary or
renal function, development of DVT
o Provide educational and emotional support
• Nursing Management in Cancer Surgery
• Postoperative nursing care – dehiscence, fluid
and electrolyte imbalance, and organ
dysfunction
• Provide comfort
• Health teaching – wound care activity, nutrition,
medication information
• Discharge plan
Nursing Management in Cancer Surgery
o Pharmacologic/Non-pharmacologic
o Nutrition and counselling
o Physical therapy and assisted devices
CHEMOTHERAPY
 Is the use of drugs (antineoplastic agents) to kill
tumor cells by interfering with cellular functions
and reproduction.
 Systemic treatment rather than a localized
therapy such as surgery and radiation therapy.
CELL KILL AND THE CELL CYCLE
 Each time a tumor is exposed to a chemo agent a
percentage of tumor cells is destroyed.
 Needs to be repeated to achieve regression of the
tumor.
 The goal is to eradicate enough of the tumor so
that the remaining rumor cells can be destroyed
by the body’s immune system.
Reproduction of both healthy and malignant cells
follows the cell cycle pattern.
The cell cycle time is the time required for one tissue
cell to dived and reproduce two identical daughter cells.
The cell cycle of any cell has four distant phases, each
with a function:
 G1 phase: RNA and protein synthesis
 S phase: DNA synthesis occurs
 G2: premiotic phase: DNA synthesis is
complete.
 Mitosis: cell division occurs.
G0: resting or dormant phase can occur after mitosis
and during the G1 phase.
GOALS OF CHEMOTHERAPY
1) Cure: tumor or cancer disappears and doesn’t return.
2) Control: stop the cancer from growing and spreading.
3)Palliation: when cure and control are not possible the
goal is to relieve symptoms caused by cancer, improve
QoL.
POTENTIAL PATIENT RESPONSE
 Complete response (CR)
complete disappearance of the disease. No disease is
evident on examination, scans or other tests.
 Partial response (PR)
some disease remaining in body, but there has a been a
decrease in size or number of the lesions by 30% or
more.
 Stable disease (SD)
disease has remained virtually unchanged in size and
number of lesions. Generally, a less than 50% decrease
or a slight increase in size would be described as stable
disease.
 Progressive disease (PD)
Disease has increased in size or number on treatment.
TYPES OF CHEMOTHERAPY
Combination Therapy
Prevents resistance.
Adjuvant Therapy
Administered after primary therapy.
e.g. Surgery
Neo adjuvant Therapy
Given before surgery to reduce
tumour size.
Salvage
Control the disease or provide palliation and
may be given after failure of other treatments.
gives relief to the patient.
CLASSIFICATION OF CHEMOTHERAPEUTIC
AGENTS
 Cell Cycle Specific: mostly affect the S phase &
some the M phase. Administered in minimal
concentrations by continuous dosing routes.
 Cell Cycle Non-Specific: affects dividing and
resting cells in all phases of the cell cycle.
Administered in single bolus injection.
 Combination: agents that differ in both cell
cycle specificity & their toxicities are combined
 to maximize tumor cell kill with minimal
toxicity.Administered in repeated courses.
ADMINISTRATION OF CHEMO AGENTS
 Can be administered in the hospital, clinic or
home setting by topical, oral , IV, IM , sub Q,
arterial, etc. to name a few.
 Administration type depends on the type of
agent, the required dose and the type location
and extent of tumor being treated.
Patient education is essential to maximize safety if
chemotherapy is administered in the home.
FACTORS TO CONSIDER WHEN CHOOSING
PATIENT’S CHEMO. TREATMENT
• Type of cancer
• Stage of Cancer (TNM System)
• Patient’s Age
• General State of Health
• Other health problems (liver, renal )
• Types of anticancer treatments in the past
Dosage
Dosage of antineoplastic agents is based primarily on the
patients total body surface.
DOSAGE
 Determined to maximize cell kill while
minimizing impact on healthy tissues and
subsequent toxicities.
 Modification of dosage is often required (for
critical lab values or patient’s symptoms indicate
dangerous toxicities)
 Lab tests: prior to, during and after chemo (to
determine optimal treatment options, evaluate
response and monitor toxicity)
 For certain chemo agents there is a maximum
lifetime dose limit that must be adhered to
because of the danger of irreversible organ
complications.
SPECIAL PROBLEMS:
Extravasation
Vesicants are those agents that, if deposited into the
subQ tissue (extravasation), cause tissue necrosis and
damage to underlying tendons, nerve, and blood vessels.
Management:
 Only trained physicians and nurses should
administer vesicants.
 Careful selection of peripheral veins, skilled
venipuncture, and careful drug administration
are essential.
 should never be administered in peripheral veins
involving the hand or wrist.
 peripheral administration is permitted for short
duration infusions only, and placement of the
venipuncture site should be on the forearm area
using a soft plastic catheter
 prolonged or frequent administration of
antineoplastic vesicant: use right atrial silastic
catheters or implanted venous access devices or
peripherally inserted central catheters should be
inserted.
Indications of extravasation during administration of
vesicant agents include the following:
o Absence of blood return from the IC catheter.
o Resistance to flow of IV fluid
o Swelling, pain, or redness at the site.
If suspected:
 stopped immediately and ice is applied to the
site (unless the extravasated vesicant is a vinca
alkaloid)
 The physician may aspirate any infiltrated
medication from the tissues and inject a
neutralizing solution into the area to reduce
tissue damage.
Toxicity
 Can be acute or chronic
 Chemotherapy targets cells which are dividing
rapidly and various body systems may be
affected as well.
 Chemotherapy cannot distinguish between
normal cells and cancer cells
Normal Cells Affected:
– bone marrow
– mouth
– stomach
– intestine
– hair follicles
– reproductive system
Hematopoietic System
Chemotherapeutic agents are apt to impair or
damage cells in the marrow than other normal cells
in the body (myelosuppression).
myelosuppression is the depression of bone
marrow function; decreased production of blood
cells and increased risk of infection and bleeding.
 Only actively dividing cells in the bone marrow are
affected (i.e. stem cells). Cells with shorter life span
are more affected (white vs. red blood cell)
The damage to the bone marrow is directly
porportional to the drug dosage. Thus, the damage to
these tissues is dose limiting.
 The resulting reduction in the body’s RBC
(anemia), WBC (leukopenia), granulocytes
(neutropenia) and platelets (thrombocytopenia)
limits the next dose of chemotherapy that may
be safely given or causes postponement of
further drug treatment of cancer until the patient
recovers from the toxic effects. (Recovery)
Management:
o Frequent monitoring of blood cell counts is
essential because it allows strategies to be
implemented to protect patient from infection
and injury.
o G-CSF, GM-CSF, EPO can be administered
after chemo.
Gastrointestinal System
 Nausea, vomiting are the most common SE (24-
48 hrs. after administration)
 Delayed nausea and vomiting (may persist for as
long as 1 week after chemotherapy)
Management:
o To minimize discomfort some antiemetic
medications are necessary for the first week at
home after chemo.
o Relaxation techniques and imagery.
o Alternating the patients diet to include small
frequent meals, bland foods, and comfort foods
may reduce the frequency or severity of these
symptoms
Renal System
 Chemotherapy can damage the kidneys (direct
effects during excretion and accumulation of end
products after cell lysis. Rapid tumor lysis after
chemo results in increased urinary excretion of
uric acid which can cause renal damage).
 Additionally, intracellular contents are released
into circulation resulting in hyperkalemia,
hyperphospatemia and hypocalcemia.
Management:
o Monitoring BUN, serum creatinine, creatinine
clearance, serum electrolyte level is essential.
o Adequate hydration, diuresis, alkalinization of
the urine to prevent formation of uric acid
crystals and allopurinol may be used to prevent
this.
Cardiopulmonary System
 Decreased cardiac ejection fracture (volume of
blood ejecting from the heart on each beat) and
signs of CHF must be monitored closely if the
patient is taking Anthracyclines (doxorubicin).
 Bleomycin, carmustine and busulfan have toxic
effects on lung function resulting in pulmonary
fibrosis.
Management:
o Patient should be monitored closely for changes
in pulmonary function including pulmonary
function test results.
Reproductive System:
 Testicular and ovarian function can be destroyed
resulting in possible sterility.
 Reproductive cells may be damaged resulting in
chromosomal abnormalities in offspring.
 Men: Azoospermia (permanent or temporary)
may develop.
 Women: early menopause or permanent sterility
may occur.
Management:
o Banking sperm for men before treatment.
o Informed patient and their partners about
potential changes in reproductive function.
o Advise patient to use reliable methods of birth
control while receiving chemo and not to assume
that sterility has resulted.
Neurologic System
 Chemotherapy induced neurotoxicity can affects
CNS and PNS, the cranial nerves.
 Peripheral neuropathies, loss of deep tendon
reflexes and paralytic ileus may occur.
Management:
o These side effects are usually reversible and
disappear after completion of chemotherapy.
NURSING MANAGEMENT IN CHEMOTHERAPY
1. ASSESS FLUID AND ELECTROLYTE STATUS
 Assess the patient’s nutritional and fluid and
electrolytes status frequently.
 Use creative ways to encourage and adequate
fluid and dietary intake.
2 MODIFY RISKS FOR INFECTION AND
BLEEDING
 Practice aseptic technique and gentle handling
with the patient to prevent trauma and infection.
  Monitor lab results closely particularly blood
cell counts.
 Report any untoward changes in blood test
results.
 Report any signs of infection and bleeding.
ADMINISTERING CHEMOTHERAPY
 Monitor patient closely during administration.
 Report immediately to the physician any
difficulties or problems with administration of
chemotherapeutic agents so that corrective
measures can be done.
PROTECTING CAREGIVERS
 Use biologic safety cabinet for the preparation of
all chemo agents.
 Wear surgical gloves when handling
antineoplastic agents and the excretion of patient
who received chemotherapy.
 Wear disposable long sleeved gowns when
preparing and administering chemotherapy
agents.
 Use luer lok fittings on all IV tubing used to
deliver chemotherapy.
 Dispose all equipment used in chemotherapy
preparation and administration in appropriate
leak proof puncture proof containers.
 Dispose all chemotherapy wates as hazardous
materials
GERONTOLOGIC CONSIDERATIONS
 Oncology nurses working with the elderly
population must understand the normal
physiologic changes that occur with aging:
o Decreased skeletal muscle mass, structure and
strength
o Decreased organ function and structure
o Impaired immune system mechanisms
o Altered drug absorption, metabolism and
elimination
 Carefully monitor elderly patients receiving
cancer treatments for signs and symptoms of
adverse reactions.
RADIATION THERAPY
- This is used to interrupt cellular growth.
- Radiation can cure some types of ca, such as non
Hodgkin’s, localized ca of the head and neck
and cancers of the uterine cervix.
- Radiation can also be used as a form of
palliative care to reduce the symptoms of
metastasis disease.
 Used to control cancer when tumor cannot
be removed surgically.
 Palliative RT used to relieved the symptoms
of metastatic disease or spread of cancer
cells to new areas of the body.
 Tumor that is well oxygenated appeared to
be most sensitive to radiation.
 RT may enhance if more oxygen can be
delivered in tumor.
TWO TYPES OF RADIATION THERAPY
EXTERNAL RT
- Can be used to destroy cancerous cells at the
skin surface or deeper in the body.
- The higher the energy, the deeper the
penetration into the body.
- Toxicity is minimized because the radiation is
precisely targeted to the diseased areas, and
exposure to overlying skin and structure.
- is the most common type of radiation therapy
used for cancer treatment. A machine is used to
aim high-energy rays (or beams) from outside
the body into the tumor.
 The energy utilized in EBRT is either
generated from linear accelerator or Gamma
Knife Unit.
 Through computerized software program
both approaches are able to shape an
invisible beam of higher charge electrons to
penetrate the body and target the tumor with
pinpoint accurancy.
 RT used CT scan Pet scan and MRI.
INTERNAL RADIATION THERAPY
- Brachytherapy: delivers a high dose of radiation
to a localized area.
Can be implanted by way of needle, seeds,
beads, or catheters into the body cavity.
Usually done to treat gyn cancers.
 It may delivered as temporary or permanent
implant
1. High Dose RT: for short period of time.
Reduced exposure to person and
procedure.
2. Low Dose RT: for more extended of
time. Required hospitalization because
patient is treated over several days.
Radiation Dose:
- It depends on the sensitivity of the target tissue
to radiation and on the tumor size.
- The lethal tumor dose is defined as that dose that
will eradicate 95% of the tumor yet preserve
normal tissue.
- Repeated radiation treatments over time also
allow for the periphery of the tumor to
reoxygenated repeatedly because tumors shrink
form the outside inward.
- Toxicity of radiation is usually localized to the
region being irradiated.
- Toxicity may be increased when the patient is
also on chemo.
- Acute local reaction occur when normal cells in
the treatment area are also destroyed and cellular
death exceeds cellular regeneration.
- Body tissues most affected are those that
normally proliferate rapidly, such as skin,
epithelial lining of the GO tract, and the bone
marrow.
- Alopecia
Shedding of skin (desquamation)
After treatment these things correct themselves.
Xerostomia (dryness of mouth), change and lost
of taste and decreased salivation.
Thrombocytopenia
Nursing management of radiation therapy
- Protecting the skin and oral mucosa (make sure
you instruct the patient not to use things that will
irritate the skin. No lotions, ointments, powders
on the area.
- Protecting the caregivers (protect from radiation)
Shielding equipment.df
HEMAPOETIC STEM CELL THERAPY
- is the transplantation of multipotent
hematopoietic stem cell , usually derived from
bone marrow, peripheral blood, or umbilical
cord blood.
TYPES OF HSTC
• Allogeneic – from a donor
• Autologous - patient
• Syngeneic – from identical twin
• Myeloablative – consist of giving high dose
chemotherapy and occasionally total body
irradiation.
• Nonmyeloablative – also called mini
transplant, it does not completely destroy bone
marrow cells.
AlloHSCT – transplanted cells should not be
immunologically tolerant of patient’s malignancy
and should cause a lethal graft-versus-tumor
effect.
- it may involve either myeloablative
(high-dose) or nonmyeloablative (mini-
transplant) chemotherapy.
 lethal graft-versus-tumor effect –
in which the donor cells recognize the malignant
cells and act to eliminate them.
Implementing Care Before Treatment
• All patient’s must undergo:
 Extensive pretransplantation evaluations to
assess the current clinical status of the disease.
 Nutritional assessments
 Extensive physical examinations
 Organ function tests
 Psychological evaluations
 Blood work w/c includes assessing past
infectious antigen exposure.
Providing Care During Treatment
 Nursing management during stem cell infusion
consists of: monitoring the patient’s vital signs
and blood oxygen saturation
 Assessing for adverse effects: fever, chills,
shortness of breath, chest pain, cutaneous
reactions, nausea, vomiting, hypotension,
tachycardia, anxiety, and taste change.
 Providing strategies for symptom control,
ongoing support, and patient education.

Providing Care After Treatment
• Ongoing nursing assessment during follow-up
visits is essential to detect late effects of therapy
after HSCT, which may occur 100 days or more
after the procedure.
• Late effects include:
 Infections
 Restrictive pulmonary abnormalities
 Recurrent pneumonia
HYPERTHERMIA
 Also known as Thermotherapy which the client's
body will exposed to the higher temperature
raging between 41.5C (106.7F) to 45C (113F)
for 30 to 40 mins for antitumoral effect.
 In research it has shown that this high
temperature can damage and kill cancer cells or
may shrink the tumor so that heat can trigger the
immune response that may help to fight the
cancer.
 This is also the oldest form of cancer treatment
but not widely available.
 It is most effective when combined with
RADIATION THERAPY, CHEMOTHERAPY,
Or BIOLOGIC THERAPY. Does not offered
alone.
 This is also can be LOCAL, REGIONAL OR
WHOLE BODY.
DEVICES:
 MICROWAVE – its energy is very effective in
heating cancerous tumors, because tumors
typically have high-water content.
 REGIONAL MICROWAVE – Used to heat
large areas of tissue, such as a body cavity,
organ or limbs.
 LOCAL MICROWAVE – heat is applied to a
small areas such as a tumor, using various
techniques that deliver energy to heat the tumor.
 WHOLE BODY MICROWAVE – Systemic
treatment that includes the entire body. Used to
treat metastatic cancer that has spread
throughout the body. It includes using thermal
chambers or hot water blankets.
TREATMENT SITE:
 Skin
 Chest wall
 Lymph nodes
 Breast
 Head and Neck
 Axilla
 Extremities
 Prostate
 Pancreas
 Vagina
 Lower Pelvic
 Rectum
 Bladder
NURSING MANAGEMENT:
 Local skin care at the site of the implanted
probes is necessary.
GENE THERAPY
 Approached that correct genetic defects,
manipulate genes to induce tumor cell
destruction, or assist the body’s immune
defenses in the hope of preventing or combating
disease.
 Transplanting of normal genes into cell in place
of defective cells to correct genetic disorder.
 Vectors – Carrier or vehicle of genetic delivery.
To transport gene into target cells.
SOMATIC GENE THERAPY
 Healthy genes introduced into the somatic cells.
 Changes are not heritable and confined to
individual.
 Most often it may not be possible to achieve
normal level of expression similar to that of
normal gene.
GERMLINE GENE THERAPY
 Healthy gene introduced into the germ cells.
(Sperm, egg, zygotes etc.)
 Changes are heritable and will pass on the future
generations.
 May ethical issues yet to be answered.
 High frequency of insertion mutation are
observed often lead to teratogenic consequences.
METHODS OF GENE DELIVERY
PHYSICAL METHOD
 Gene Gun- accelerated DNA-coated gold
particles in to target cells or tissues. The gold
particles are typically approximately 1mm in
diameter.
 Microinjection- direct-pressure injection of a
solution into cell through a glass capillary. It is
an effective and reproducible method for
introducing exogenous material into cells in
culture.
CHEMICAL METHOD
 Detergent Mixtures – Certain charge chemical
compounds like calcium phosphate are mixed
with functional cDNA of desire function.
 Lipofection – It is a technique used to inject
genetic materials into a cell by means of
liposomes. Liposome are artificial phospholipid
vesicles used to deliver a variety of molecules
including DNA into the cells.
 TARGETED CELL THERAPY
- A disruption of specific cancer cell functions
(malignant transformation, cell communication,
metastasis) to minimize the negative effects on
healthy tissues
- Drugs or substances that block growth and spread of
cancer
- These drugs work by :
o Blocking/ turning off signals that tells
cancer cells to grow
o Keeping cells from living longer than
normal
o Destroying cancer cells
- Researchers have called this a precision medicine
because it is a form of medicine that uses
information about genes and proteins to diagnose,
prevent and treat cancer.
Biologic Response Modifier
- Also called as Immunotherapy
- Use of naturally occurring or recombinant agent
- Uses the body’s immune system to fight cancer.
- One of the functions of immune system is to rid of
bacteria and abnormal cells. Boosting the immune
system rather than giving a foreign drug to fight
cancer cells
- Three types:
o Non-specific Biologic Response Modifier
 Stimulates immune response in a
general way to fight off cancer
 Drugs or other substance are used to
boost the overall immune response
 Ex.: BCG – when injected to a
bladder cancer patient, it helps
eradicate malignant cells and
prevent from getting worse or
coming back.
o T-cell Transfer Therapy
 T-cells are taken from patient and
changed in the laboratory to make
them better able to target the
patient’s cancer cells and kill them,
millions of copies are grown then
given back to the patient to fight the
cancer.
o Immune Checkpoint Inhibitors
 Immune checkpoints on cell
surfaces help control an immune
response, usually immune
checkpoints keep T-cells inactive
until they are needed these keeps T-
cells from harming normal cells,
cancer cells may take advantage of
these to switch T-cells off which
keeps cancer cell from being killed.
 Immune checkpoint inhibitors are
drugs that block the checkpoints,
which frees the T-cells to attack the
cancer
o These three ways are effective ways to treat
cancer but they don’t work for every cancer
patient.
Monoclonal Antibodies
- Drugs block a specific target on the outside of
cancer cells and/or the target might be in the area
around the cancer. These drugs work like a plastic
plug you put in an electric socket. The plug keeps
electricity from flowing out of the socket.
- Monoclonal antibodies can also send toxic
substances directly to cancer cells. For example,
they can help chemotherapy and radiation therapy
gets to cancer cells better. You usually get these
drugs intravenously (IV).
- Have high specificity (can recognize single antigen
binding site and have specific antigen to fight)
- Specificity in targeting the cancer cells depends on
key-antigen proteins
o CEA, growth factors and oncogenes
- When MoAbs bind to cell surface antigen, signal
transduction is blocked.
- These antibodies are designed to attach to specific
targets found on cancer cells.
- Some monoclonal antibodies mark cancer cells so
that they will be better seen and destroyed by the
immune system.
- Other monoclonal antibodies directly stop cancer
cells from growing or cause them to self-destruct.
Still others carry toxins to cancer cells.
- Before monoclonal antibodies are used in humans,
they are "humanized" by replacing as much of the
mouse antibody molecule as possible with
corresponding portions of human antibodies.
- Humanizing is necessary to prevent the human
immune system from recognizing the monoclonal
antibody as "foreign" and destroying it before it has
a chance to bind to its target protein. Humanization
is not an issue for small-molecule compounds
because they are not typically recognized by the
body as foreign.
- Can only attack one disease each time because of its
specificity.

SMALL MOLECULE
MONOCLONAL
TYROSINE KINASE
ANTIBODIES
INHIBITOR
• Extracellular • Intracellular
• Larger molecules • Smaller molecules
• Intravenous • Orally
Epidermal Growth Factor Receptors (EGFR)
- Normal cell growth is regulated by well-defined
communication pathways between the environment
surrounding the cell and internal cell environment.
- The cell membrane contains important protein
receptors that respond to signals transmitted from
EC to IC using enzymatic pathways called signal
transduction pathways.
- Proteins found on normal cells (expressed) but found
in abundance (overexpressed) in many types of
cancer,
such as colon, rectal and head and neck cancers.
- Activation in cancer cells can influence malignant
growth, survival and ability to metastasize.
- Overexpression is associated with advanced tumor
stage, more aggressive tumors, poor patient
prognosis and resistance to standard chemotherapy
- Drugs that bind to specific protein receptor block a
specific signal transduction pathway expressed by a
tumor.
- Efficacy depends on consistent and reliable delivery
because they involve the patient’s natural immune
system they can precipitate very significant adverse
events.
Nurses must be familiar to administration issues
related to patient education about self administration oral
agent and safety related to adverse events.
Vascular Endothelial Growth Factors (VEGF)
- Angiogenesis requires growth factors, cytokines,
enzymes, and proteins, all generated by the tumor to
stimulate the formation of new capillaries to deliver
oxygen and other nutrients to the hypoxic tumor.
- Major pathway for angiogenesis is VEGF when
activated attaches to endothelial cell receptors.
- New blood vessels differ from normal vessels with
less well-structured, increased permeability allowing
migration of tumor cells, increased interstitial
pressure preventing chemotherapy to reach tumor.
- Bevacizumab – a MoAb directed toward VEGF to
prevent activation of endothelial cells and inhibit
growth of new blood vessels
o currently only approved drug by FDA
o S/E : delayed wound healing, hemorrhage,
hypertension, thromboembolism and
proteinuria
Cytokines
- Substances produced by cells of immune system to
enhance the production and functioning of
components of immune system
- Interferons:
o Has antitumor and antiviral properties
o Antiangiogenesis, direct destruction of
tumor cells, inhibition of growth factors and
disruption of the cell cycle
o IFN-a is administered SQ, IM, IV and
intracavity
o Indicated for hairy cell leukemia, kaposi’s
sarcoma, renal cell cancer.
- Interleukins:
o Signals and coordinates other cells of the
immune system to achieve their therapeutic
effects
o Requires intact immune system to achieve
their therapeutic effects.
o IL-2 stimulates production and activation of
lymphocytes, enhances production of other
types of cytokines.
o Indicated for renal cell cancer and metastatic
melanoma
o S/E: Flu-like symptoms, fatigue, anorexia,
and serious side effects (profound diarrhea,
pulmonary edema, hypotension and oliguria)
Cancer Vaccines
- Used to mobilize immune system response to
recognize and attack cancer cells.
- Contains cancer cells that can boost immune
response.
o Autologous – patient’s own cancer cells,
killed and prepared back
o Allogenic – made from other cancer cells
that are obtained from other people who
have a specific cancer
o Prophylactic – given to prevent disease.
 Ex.: HPV recombinant vaccine
(Gardasil) protects against HPV 6,
11, 16 & 18 associated with
common genital warts (type 6 and
11) and development of cancer (type
16 and 18). Administered in three
doses to female aged 9 to 26.
o Therapeutic – given to kill existing cancer
cells to provide long lasting immunity
against further cancer development.
 Challenges include the size of the
tumor, mechanisms that allow tumor
cells to avoid recognition as “non-
self” by the immune system and
immune tolerance as result of
previous exposure to tumor
antigens.
Nursing Management
• Assess the need for education, support, and
guidance for both patient and family (often the
same needs as patients having other treatment
approaches, but BRMs may be perceived as a
last-chance effort by patients who have not
responded to standard treatments)
• Also, manipulation of and stimulation of
immune system with patients receiving
BRM creates unique challenges
• Monitor therapeutic and adverse effects and life-
threatening side effects
• (eg, fever, myalgia,nausea, and
vomiting, as seen with interferon
therapy) – IFN
• And life-threatening side effects (eg,
capillary leak syndrome, pulmonary
edema, and hypotension). – IL-2
• Provides instructions about side effects
and help the patient and family identify
strategies to manage many of the
common side effects of BRM therapy
• Promoting home and community-based care
• Nurses must be familiar with each agent
given and its potential side effect and
impact to life.
• The nurse also reminds the patient about
the importance of keeping follow-up
appointment and assesses need in
changes in care
COMPLEMENTARY AND ALTERNATIVE
MEDICINE
- The term for medical products and practices that are
not part of standard of medical care
- Second Choice in treating cancer
- Based on belief
Complementary Medicines
- Used together with the conventional medicine
- Usually used to relieve pain, nausea and other
symptoms which is caused by the conventional medicine
- Acupuncture and aromatherapy are some example.
Alternative Medicine
- Used in place of conventional medicine
- Herbs, Special diet and dietary supplements are some
alternative medicine.
- Ayurveda is also an alternative medicine that
originated from india which uses meditation, diet and
yoga because they believe that illness is caused by
imbalance in body chemicals.
Nursing Management
- Encourage patient to inform their physicians about
such use which can help prevent interactions with
medications.