There are many types of cancer treatment. The types of treatment that patient receive will depend on the type of cancer, stage of cancer and how advanced it is. Some people with cancer will have only one treatment. But most people have a combination of treatments, such as surgery with chemotherapy and/or radiation therapy.

1. MODALITIES OF
TREATMENT FOR
CANCER

2. OVERVIEW
• There are many types of cancer treatment. The
types of treatment that patient receive will depend
on the type of cancer, stage of cancer and how
advanced it is.
• Some people with cancer will have only one
treatment. But most people have a combination of
treatments, such as surgery with chemotherapy
and/or radiation therapy.

3. Treatment of cancer can involve any of several
modalities:
Surgical interventions
Radiation therapy
Chemotherapy
Gene therapy
Stem cell and bone marrow transplants
Immunotherapy

4. SURGERY
•Surgical removal of the entire cancer
remains the ideal and most frequently used
treatment method.
• Surgery may be the primary method of
treatment, or it may be prophylactic,
palliative, or reconstructive.

5. Surgery:
•Surgery is often the first line of choice for solid
tumors, whenever possible.
• Surgery may/may not be combined with other
modalities.
•The size, type, location of tumor and factors such
as age, comorbid conditions of a patient are key
determinant factors in choosing surgery. In some
cases where primary tumor has not
metastasized surgery may be considered as
curative therapy.

6. Factors that increase operative risk in cancer patients
include
1. Age
2. Comorbid conditions
3. Debilitation due to cancer
4. Paraneoplastic syndrome ( associated with
cancer occur when a cancer causes unusual
symptoms due to substances that circulate in the
blood stream) For E.g. Lung tumor, renal
carcinoma, hepatocellular carcinoma, breast,
ovarian cancer and pancreatic cancer.

7. COMMON TYPES OF SURGICAL
INTERVENTION IN ONCOLOGY
A. Primary Tumor resection
B. Resection of Metastases
C. Cytoreduction
D. Palliative surgery
E. Reconstructive surgery
F. Diagnostic surgery

8. Primary Tumor resection
•If a primary tumor has not metastasized,
surgery may be curative.
• Establishing a complete margin of normal
tissue around the primary tumor (as in breast
cancer surgery) is critical for the success of
primary tumor resection and prevention of
recurrence.

9. Resection of metastases
•When cancer has metastasized to regional
lymph nodes, nonsurgical modalities may be
the best initial treatments, as in locally
advanced lung cancer or head and neck cancer.
•Single metastases, especially those in the lungs
or liver, can sometimes be resected with a
reasonable rate of cure.

10. Resection of metastases
•Patients with a limited number of metastases,
particularly to the liver, brain, or lungs, may
benefit from surgical resection of both the
primary and metastatic tumor.
•For example, in colon cancer with liver
metastases, resection produces 5-yr survival
rates of 30 to 40% if < 4 hepatic lesions exist
and if adequate tumor margins can be obtained.

11. Cytoreduction
•Cytoreduction (surgical resection to reduce
tumor burden) is often an option when
removal of all tumor tissue is impossible, as
in most cases of ovarian cancer.

12. Palliative surgery
•When cure is not possible, the goals of
treatment are to make the patient as
comfortable as possible and to promote a
satisfying and productive life for as long as
possible.

13. Palliative surgery
•Palliative surgery is performed in an attempt
to relieve complications of cancer, such as
ulcerations, obstructions, hemorrhage, pain,
and malignant effusions.

14. Reconstructive surgery
•Reconstructive surgery may improve a
patient’s comfort or quality of life after
tumor resection (e.g., breast reconstruction
after mastectomy).

15. Diagnostic surgery
•Diagnostic surgery, such as a biopsy, is
usually performed to obtain a tissue sample
for analysis of cells suspected to be
malignant. In most instances, the biopsy is
taken from the actual tumor

16. RADIATION THERAPY

17. RADIATION THERAPY

18. WHAT IS RADIATION THERAPY
•Radiation therapy works by damaging the DNA
within cancer cells and destroying their ability to
reproduce.
•When the damaged cancer cells are destroyed by
radiation, the body naturally eliminates them.
•Normal cells can be affected by radiation, but
they are able to repair themselves.

19. WHAT IS RADIATION THERAPY
• Sometimes radiation therapy is the only
treatment a patient needs.
•Other times, it is combined with other treatments,
like surgery and chemotherapy.

20. Radiation therapy
• Radiation therapy is the use of high-energy ionizing rays to
destroy a cancer cell's ability to grow and multiply.
• The goal of radiation therapy is to deliver a precisely
measured dose of irradiation to a defined tumor volume with
minimal damage to surrounding healthy tissue.
• This results in eradication of tumor, high quality of life,
prolongation of survival, and allows for effective palliation
or prevention of symptoms of cancer, with minimal
morbidity.

21. The total number of fractions administered
depends on:
•Tumor size and location
•Cancer type
•Reason for treatment
•Patient’s overall health
•Other treatments the patient is receiving.

22. How Is Radiation
Therapy Used
Radiation therapy is used two different
ways.
a) To cure cancer:
1. Destroy tumors that have not spread to
other body parts.
2. Reduce the risk that cancer will return
after surgery or chemotherapy.
b) To reduce symptoms:
1. Shrink tumors affecting quality of life,
like a lung tumor that is causing
shortness of breath.
2. Alleviate pain by reducing the size of a
tumor

23. Meet the Radiation Oncology Team
1. Radiation Oncologist (The doctor
who oversees the radiation therapy
treatments.)
2. Medical Radiation Physicist :
(Ensures that complex treatment plans
are properly tailored for each patient.)
3. Dosimetrist (Works with the radiation
oncologist and medical physicist to
calculate the proper dose of radiation
given to the tumor).

24. Meet the Radiation Oncology Team
1. Radiation Therapist(
Administers the daily radiation
under the doctor’s prescription
and supervision.)
2. Radiation Oncology Nurse:
Cares for the patient and
family by providing
education, emotional support
and tips for managing side
effects.

25. Types of Radiation Therapy
Radiation therapy can be delivered two ways –
•External radiation therapy and Internal radiation
therapy.
1. External beam radiation therapy delivers radiation using a
linear accelerator.
2. Internal radiation therapy, called Brachytherapy or seed
implants, involves placing radioactive sources inside the
patient.
The type of treatment used will depend on the location, size and
type of cancer

26. •Intracavitary therapy utilizes radioactive
material that is inserted into a cavity such as
the vagina, as in cancer of the uterine cervix.
•Other forms of brachytherapy are systemic
irradiation (parenteral or I.V.), oral cancer
thyroid cancer.

27. Treatment Planning
• Evaluation of tumor extent (staging), including diagnostic
studies before treatment.
• Define the goal of therapy (cure or palliation).
• Select appropriate treatment modalities (irradiation alone or
combined with surgery, chemotherapy, or both).
• All patients undergo simulation and treatment planning.
(Simulation is used to accurately identify target volumes and
sensitive structures. CT simulation allows for accurate three-
dimensional (3-D) treatment planning of target volume and
anatomy of critical normal structures).

28. Treatment Planning
• Usual schedule is Monday through Friday.
• Actual therapy lasts minutes. Most time is spent
on positioning.
• Determine optimal dose of irradiation and
volume to be treated, according to anatomic
location, histologic type, stage, potential regional
nodal involvement (and other tumor
characteristics), and normal structures in the
region.

29. Complications
•Complications depend on the site of
radiation therapy, type of radiation therapy
(brachytherapy or teletherapy), total
radiation dose, daily fractionated doses, and
overall health of the patient.

30. Side Effects of Radiation Therapy
•Side effects, like skin tenderness, are generally
limited to the area receiving radiation. Unlike
chemotherapy, radiation usually doesn’t cause
hair loss or nausea.
•Most side effects begin during the second or third
week of treatment. Side effects may last for
several weeks after the final treatment.

31. Side Effects of Radiation Therapy
In general, acute side-
effects of radiotherapy:
• Anorexia, Nausea &
vomiting & Mucositis
• Malaise,
Myelosuppression
• Oesophagitis, Diarrhoea
• Alopecia

32. Skin schaemia, Ulceration, erythema
Bone Necrosis, fracture, sarcoma
Mouth Ulceration, xerostomia, sialitis
Bowel Stenosis, fistula, diarrhoea Bladder Cystitis
CNS Myelopathy
Lung Fibrosis, Dyspnea, radiation pneumonitis
Heart Pericardial fibrosis, cardiomyopathy
Gonads Infertility

33. Nursing Management Patient
with Radiation Therapy

34. 1. Teaching is a primary responsibility of
nursing care for radiation patients.
E.G What is radiation therapy, purpose,
duration of therapy, possible side effects and
its management.
2. Monitor and assess the patient’s pain level
using a standard 0-to-10 pain scale. Note
what pain medications the patient takes and
whether these are effective.

35. 3. If appropriate, refer patients with fatigue for
physical therapy, which can ease fatigue and
improve stamina.
4. Obtain a complete list of the patient’s
medications and monitor for drug interactions.
Stress the importance of informing all
healthcare providers of medication changes.

36. PROTECTING THE SKIN AND ORAL
MUCOSA
•The nurse assesses the patient’s skin, nutritional
status, and general feeling of well-being.
•The skin and oral mucosa are assessed frequently
for changes (particularly if radiation therapy is
directed to these areas).
• The skin is protected from irritation, and the
patient is instructed to avoid using ointments,
lotions, or powders on the area.

37. PROTECTING THE SKIN AND ORAL
MUCOSA
•Weigh patients weekly on the same scale. If
appropriate, refer them to a dietitian.
• Be aware that patients who have difficulty
swallowing and maintaining adequate nutrition and
hydration may need a percutaneous endoscopic
gastrostomy tube.

38. PROTECTING THE SKIN AND ORAL MUCOSA
•A dehydrated patient may require I.V. fluids.
Teach the patient to report dehydration signs
and symptoms, such as weakness, dizziness,
and decreased urine output.

39. CHEMOTHERAPY

40. CHEMOTHERAPY
•Chemotherapy-is the use of chemicals to
treat disease.
• -Paul Erlich, considered to be the father of
chemotherapy,

41. What is Chemotherapy.
•Chemotherapy is the use of antineoplastic
drugs to promote tumor cell destruction by
interfering with cellular function and
reproduction.
•It includes the use of various
chemotherapeutic agents and hormones.

42. •Chemotherapy is a term used to describe any
treatments that utilizes the introduction of
chemical agents to an organism to help control,
stop and or terminate the rapid growth of cells.
•There are 60 types of chemotherapy currently
available and new ones being developed all the
time.

43. 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.

44. HOW DO THE DRUGS WORK
•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).

45. Types of chemotherapeutic agents
Drugs acting directly on cells ( cytotoxic drugs)
1. Alkylating agents:
a) Nitrogen mustards (Cyclophosphamide, melphalan)
b) Ethylenimine (Thio-TEPA)
c) Alkyl sulfonates (Busulphan)
d) Nitrosoureas (carmustin)
e) Triazine (Decarbazine)
f) Miscellaneous (Hydroxyurea,Procarbzine)

46. Drugs altering hormonal milieu :
1.Glucocorticoids (Psrednisolone)
2.Estrogen (Diethylstilbestrol)
3.Antiestrogen (Tamoxifen)
4.Androgens (Testosterone)
5.Progestins (Hydroxyprogestrone)

47. Routes of administration of
Chemotherapeutic agents:
A. Oral, capsule, tablet, or liquid
B. I.V, push (bolus) or infusion over a specified time
period
C. Intramuscular
D. Intrathecal/intraventricular given by injection via an
Ommaya reservoir or by lumbar puncture
E. Intra-arterial
F. Intracavitary ”such as peritoneal cavity
G. Intravesical into uterus or bladder
H. Topical

48. Ommaya reservoir
•An Ommaya
reservoir is an
intraventricular catheter
system that can be used
for the aspiration of
cerebrospinal fluid or for
the delivery of drugs (e.g.
chemotherapy) into the
cerebrospinal fluid.

49. TOXICITY
•Toxicity associated with chemotherapy can
be acute or chronic.
•Cells with rapid growth rates (eg,
epithelium, bone marrow, hair follicles,
sperm) are very susceptible to damage, and
various body systems may be affected as
well.

50. Gastrointestinal System.
•Nausea and vomiting are the most common
side effects of chemotherapy and may persist
for up to 24 hours after its administration.
• Delayed nausea and vomiting that occur
later than 48 to 72 hours after chemotherapy
are troublesome for some patients.

51. Hematopoietic System
• Most chemotherapeutic agents cause Myelosuppression
(depression of bone marrow function), resulting in
decreased production of blood cells.
• Myelosuppression decreases the number of WBCs
(leukopenia), red blood cells (anemia), and platelets
(thrombocytopenia) and increases the risk for infection
and bleeding.
• Monitoring blood cell counts frequently is essential, as is
protecting the patient from infection and injury,
particularly while the blood cell counts are depressed.

52. Renal System
• Chemotherapeutic agents can damage the kidneys
because of their direct effects during excretion and the
accumulation of end products after cell lysis.
• Cisplatin, methotrexate, and mitomycin are particularly
toxic to the kidneys.
• Hyperkalemia and hyperphosphatemia and diminished
levels of calcium (hypocalcemia).
• Monitoring blood urea nitrogen, serum creatinine,
creatinine clearance, and serum electrolyte levels is
essential.

53. Cardiopulmonary System
• Antitumor antibiotics (daunorubicin and doxorubicin) are
known to cause irreversible cumulative cardiac toxicities,
especially when total dosage reaches 550 mg/m2.
• Cardiac ejection fraction (volume of blood ejected from
the heart with each beat) and signs of congestive heart
failure must be monitored closely.
• Pulmonary fibrosis can be a long-term effect of prolonged
dosage with these agents.
• Therefore, the patient is monitored closely for changes in
pulmonary function, including pulmonary function test
results.

54. Reproductive System
•Testicular and ovarian function can be affected by
chemotherapeutic agents, resulting in possible
sterility.
• Normal ovulation, early menopause, or
permanent sterility may result. In men, temporary
or permanent azoospermia (absence of
spermatozoa) may develop.
•Reproductive cells may be damaged during
treatment, resulting in chromosomal abnormalities
in offspring.

55. •Banking of sperm is recommended for men
before treatments are initiated to protect against
sterility or any mutagenic damage to sperm.
•Patients and their partners need to be informed
about potential changes in reproductive function
resulting from chemotherapy.

56. Neurologic System
•The Taxanes and plant alkaloids, especially
vincristine, can cause neurologic damage with
repeated doses.
• Peripheral neuropathies, loss of deep tendon
reflexes, and paralytic ileus may occur.
•These side effects are usually reversible and
disappear after completion of chemotherapy.

57. Adverse Effects of Chemotherapy
1. Alopecia (Most chemotherapeutic agents cause some
degree of alopecia. This is dependent on the drug dose,
half-life of drug, and duration of therapy).
2. Anorexia (Chemotherapy changes the reproduction of
taste buds and absent or altered taste can lead to a
decreased food intake).
3. Fatigue (The cause of fatigue is generally unknown but
can be related to anemia)
4. Nausea and Vomiting (Caused by the stimulation of the
vagus nerve by serotonin released by cells in the upper GI
tract and severity of N & V is deepened on type of agents
and dosage).

58. Adverse Effects of Chemotherapy
1. Mucositis (Caused by the destruction of the oral mucosa,
causing an inflammatory response).
2. Anemia
3. Neutropenia
 Defined as an absolute neutrophil count (ANC) of
1,500/mm3 or less.
 Risk of infection is greatest with an ANC less than
500/mm3.
 Caused by suppression of the stem cell.
 Usually occurs 7 to 14 days after administration of
chemotherapy.

59. Others
1.Thrombocytopenia
•Caused by suppression of megakaryocytes.
•Incidence depends on the agent being used.
•Risk of bleeding is present when platelet count
falls below 50,000/mm3.
2. Hypersensitivity Reactions

60. Nursing Management in Chemotherapy
•The nurse has an important role in assessing
and managing many of the problems
experienced by the patient undergoing
chemotherapy.
•Requires knowledge about the treatment -,
skill in assessment - technical expertise, -
ability and desire to support the client
physically and emotionally

61. •Nursing care begins with thorough understanding
of the patients condition; -goal of therapy , drug
dose, route, schedule, administration principles; -
and potential side effect - monitoring responses to
the therapy, - reassessing - documenting signs and
symptoms, - communicating pertinent
information to other members of the health care
team.

62. ASSESSING FLUID AND ELECTROLYTE STATUS
•Anorexia, nausea, vomiting, altered taste, and
diarrhea put the nutritional and fluid and
electrolyte disturbances patient at risk for.
•Therefore, it is important for the nurse to assess
the patient’s nutritional and fluid and electrolyte
status frequently and to use creative ways to
encourage an adequate fluid and dietary intake.

63. Nursing Management in Chemotherapy
•Nurse should check that the patient's name,
prescribed drugs, doses and route of
administration on the prescription chart
corresponds to information on patient's
chemotherapy labels.

64. Management of Extravasations
•Extravasation: is Leakage or infiltration of a
vesicant drug or irritant agent from the vein into
the subcutaneous tissue which may result in pain,
necrosis or sloughing of tissues.
• Nerves ,tendons, joints ,some drugs (vesicants)
can cause extensive necrosis and the damage can
continue for several weeks or months after the
incident.

65. Management of Extravasations
•Use care in selecting vein puncture site
•‘Clean’ smooth cannula insertion
• Check with patient frequently regarding pain,
sensation of cold, burning, pressure, etc.
•

66. Management of Extravasations
•Flush well with normal saline after administration
of vesicants
• If vesicant drug is administered as a continuous
infusion, drug must be given through a central
line.
• In case suspected Extravasations Stop
administration immediately & notify physician.