About cervical cancer IV B treatment, care plan. monitoring parameters, dietary changes, precautions

1. CERVIX CANCER IVB
SUBMITTED BY
K.Goutham
V PharmD
612171602008

2. Mrs.Jagan Mohini is a 50 years old female admitted in to oncology with complaints of pain in abdomen, pelvic
pain, vomiting's, white discharge per vagina from 3 months. She is a house wife and her family history was not
significant.
Her body weight is 63kg, height-152.5cms and body surface area is1.63sqmetres.
History of Present illness – Two years back white discharge per vagina, blood mixed foul smelling per
vagina for 3months and pain in abdomen were reported
Past Medical History – Cervix Cancer IIIB
Past Medication History -Received EBRT to pelvis on Siemens Linac with 15MV photons to dose of
50Gy in 25 fractions
- Received 4 cycles concurrent weekly Inj.cisplatin 50mg IV
- Received 3 fractions ICR to dose of each 7Gy to point A. central tandem 5
cm and 2 large ovoids
Laboratory Investigations – Haemoglobin-10.6gm%
Total RBC- 4.62 (3.8-4.8)millions/cumm
Total WBC- 7400 (4000-10000)/ cumm
Ulcerative growth involving entire anterior vaginal wall bleeding on touch

3. Differential Count Neutrophils- 72% (40-80)
Lymphocytes- 21% (20-40)
Eosinophils- 2% (1-6)
Monocytes- 5% (2-10)
Basophils- 0% (0-2%)
Fasting Blood Sugar- 93mg/dl (70-110)
Post lunch Blood Sugar- 121mg/dl (70-150)
ESR- 36mm/hr
Platelet count- 246000 (150000-410000)/cumm
HPV- Negative
Creatinine- 0.9(0.5-1.0)mg/dl
Ultra Sound- Liver- 1. Increased in size(177cms) and increased in echotexture
2. Evidence of large hypoechoic mass lesion measuring 12*10mm noted in the right lobe
of liver.
Uterus- 1. Evidence of large hypoechoic mass lesion measuring 7.8*5.7cms noted in anterior
myometrium
anterior margin of the uterus not clearly visualised.
2. Endometrial thickness is normal and measures 5mm
3. Enlarged cervix measuring 5.25cms
Biopsy- S/o Large cell non keratinizing squamous cell carcinoma

4. Now recently diagnosed as she has cervix cancer recurrent post RT and metastasis to Liver, so She was
suffering from CERVIX CANCER IVB
She was on the following therapeutic regimen-
Cycle-1
Drugs Dose Rout
e
Frequency 12/11/15 13/11/15 14/11/15
Cisplatin 60mg IV OD  
5FU 1500mg IV OD   

5. Cycle-2
Drugs Dose Route Frequency 28/12/15 29/12/15 30/12/15
Cisplatin 60mg IV OD  
5FU 1500mg IV OD   
Cycle-3
Drugs Dose Route Frequency 3/12/15 4/12/15 15/12/15
Cisplatin 60mg IV OD  
5FU 1500mg IV OD   

6. Drugs Dose Route Frequency 21/1/16 22/1/16 23/1/16
Cisplatin 60mg IV OD  
5FU 1500mg IV OD   
Cycle-4
Drug Dose ROA Frequency 21/1 – 24/1 25/1 – 26/1 27/1 – 29/1
Tab. Ondansetron 4mg oral TID 
Tab. Rantac 150mg oral BD  
Tab. B complex 1tab oral OD   
Tab Ultracet 1tab oral SOS

7. PLAN
Goals for the problem
1. To prevent further progression of cancer to bladder, rectum and other organs.
2. To relieve pain.
3. To treat adverse effects associated with the chemotherapy by giving supportive care.
Necessity of Current Drugs
All Drugs are necessary and are given in correct doses to treat cervix cancer in this
patient
Correctness of Dose/ Dosage Form/ ROA of drug regimen
All Drugs are given in Correct doses in correct dosage form through correct route.
Recommend Treatment: Continue treatment/Discontinue treatment

8. Drugs that are to be avoided in this patient
1.Vaccines should be avoided
2.Ototoxic drugs(Ex: Gentamycin, Erythromycin, Aminoglycosides, Loop diuretics) should
be avoided with cisplatin.
3. Simultaneous use of antihistamines(buclizine, cyclizine, meclozone) loxapine,
phenothiazines may mask ototoxicity symptoms (such as dizziness and tinnitus).
4. Simultaneous use of Ultracet with SSRIs, tricyclic antidepressants, other opioids, MAOIs,
neuroleptics, or other agents that reduce the seizure threshold may increase the risk for
seizure
Any Adverse Effects:
Alopecia, Nausea and Vomiting, Discolouration of vein along through which 5FU was
given.
Suggest Alternate therapy (if current therapy is not working or results in adverse effect)
Apply ice to the injection site for 5 to 20 minutes at a time for at least four times per day

9. Monitoring Parameters:
Therapeutic- Hepatic Function tests, Peripheral Blood Count, Serum Creatinine, Platelet
Count, Total WBC count, Total RBC count, Differential count, Platelet count
Toxic- Monitor for Nephrotoxicity symptoms
Monitor signs/symptoms for Neurotoxicity, Myelosuppression and Ototoxicity
About Disease:
For cervical cancer, there are five stages: stage 0 (zero) and stages I through IV (one through
four). In Stage IV Cervical Cancer, cancer has spread to parts of the body away from the
cervix, such as the liver, intestines, lungs, or bones.
Symptoms: irregular vaginal bleeding, vaginal discharge with an unpleasant odour, watery
vaginal discharge, vaginal discharge tinged with blood, pelvic or back pain, problems
urinating, problems defecating.

10. Dietary Changes
1. Drink Green tea 2-3 times daily.
2. Eat at least two portions of fruit but only on an empty stomach.
3. Take 2.5-3 gms of turmeric powder(curcumin) as it can inhibit unwanted bacterial action in the stomach and
intestine, anti-inflammatory, and maintains correct oxygen levels in cells, shown to inhibit metastases
4. Carrots contain beta carotene, which is helpful for preventing cervical cancer growth
5. Cruciferous vegetables such as broccoli, cauliflower and cabbage contain Indole-3-carbinol has been shown
to promote the detoxification of many harmful substances, including carcinogens, and to have strong
antioxidant properties (lutein and zeaxanthin) that help reduce cervical cancer growth and are also excellent
source for Vitamin-B folate.
6. Vitamins A(orange, carrots, squash, eggs, liver, tuna and leafy vegetables), C(orange, papaya, lemon) and
E(almond, nuts) are antioxidants, which help protect cells from damage caused by free radicals, thus
preventing cervical cancer.
7. For loss of appetite eat small meals more frequently in a day.

11. 8. Concentrate on food and drink that you enjoy, try to stimulate your taste
buds with sharp tasting foods and drinks like fresh fruit and fruit juices
9. Ellagic acid containing foods like red fruits and berries, raspberries and
strawberries can effectively eliminate cervical cancer causing substances by
activating certain detoxifying enzymes in the body. Ellagic acid also seems
to be able to prevent carcinogens from attaching to cellular DNA.

12. Life Style Modifications
Cancer and its Chemotherapy suppresses the body immune system. This can increase
the risk of infection, So
 Wash hands thoroughly and often
 Try to avoid crowds especially during cold and flu seasons.
 Clean and disinfect object surfaces often.
Keep your mouth clean and fresh
Exercise regularly, it helps in withstanding physical and emotional stress in cancer
Try to do meditation or yoga which relaxes your mind.

13. Precautions
• Consult doctor immediately if there are any infections.
• Do not take OTC drugs or any drugs without prior consulting the doctor
• Any sheaths or clothes soiled with body fluids should be washed twice with detergent in warm
water.
• After using any devices for bodily waste, patients should thoroughly was their hands and
devices with soap and water.
• Drug 5FU may cause sun-sensitivity. Advise patient to use sunscreen.
• Consult doctor when pain or redness at the IV site where the chemotherapy was given.
• Live vaccines should be avoided.

14. Thank
You