Chemotherapy drugs are managed by the trained healthcare professional with many standard precautions. Most of the cancer patients must gone through the chemotherapy treatment

1. Presenter
Sonika gupta malhotra
Nursing Officer
AIIMShttp://surgicaltechie.com

2. INTRODUCTION
HISTORY
WARNING SIGNS
GOALS
TYPES OF CHEMOTHERAPY
MODE OF ACTION
CLASSIFICATION
SIDE EFFECTS
HEALTH EDUCATION
PROTOCOLS
Introduction to cancer chemotherapy
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3. Cancer cell characterised by
•Uncontrolled proliferetion
•Dedifferentiation(anaplsia)
•Invasiveness
•metastasis

6. Chemotherapy may be used
conventionally to:
•Cure patients-Wilm’s tumor, ALL, Testicular cancer,
Burkitt’s lymphoma, NHL
Prolong survival-Prolong remission
Decreases rate of relapse
•Palliative care symptom control-Relive
symptoms and improved quality of life

7. 1. Primary
Chemotherapy
2. Adjuvant
Chemotherapy
3. Neoadjuvant
chemotherapy
4. Concurrent
chemotherapy
•Chemotherapy is
main modality of
treatment
•Can be single
drug or
combination
chemotherapy
•e.g.
Hematological
malignancy-
•ABVD regimen for
hodgkins
lymphoma.
•Combined with
radiation or
surgery.
•For advanced
cancer
•e.g. Ca breast
after surgery to
remove
microscopic focci.
•Chemotherapy is
given before
surgery.
•Shrink a large
cancerous tumour
to make surgery
easy.
•e.g. Laryngeal
carcinoma before
surgery.
•Simultaneously
with radiation.
•Mainly act as
radiation
sensitizer,
encourages the
cancer cells to
take
radiotherapy.
•e.g. Head and
neck ca, Rectal
ca, Lung ca.

8. Anti
neoplastic
drugs

9. •Oral
•Intravenous
•Intramuscular
•Intrathecal
•Subcutaneous
•Intraperitoneal
•Central venous catheter
•Inplantable access

10. •A cycle- one dose followed by several days or weeks
usually 21 to 28 days but may vary according to protocols .
•Number of cycles-based on the type and stages of
cancer and side effect as well
•Dose calculationDosage of chemotherapy are difficult: If
the dose is too low, it will be ineffective , whereas excessive causes toxicity . In
most cases, the dose is adjusted for the patient's body surface area (BSA), a
measure that correlates with blood volume.
• W is weight in kg, and H is height in cm.

11. Platelet - 1,00,000 cumm , Red Blood Cell (Hb)- 8 gms%
• Total Leucocyte Count-2,000 cumm, Absolute Neutrophil
Count- 1,000 cumm, Liver function test , Renal function
test

14. 1.Cytotoxic agents
2.Targeted therapies

15. CLASS DRUGS
Nitrogen Mustards
Cyclophosphamide
Ifosfamide
Etylenimine ThioTEPA- ca breast
Alkyl sulfonte Busulfan
Nitrosoureas
Carmustine
Lomustine- CNS
tumors
Triazine Dacarbazine

16. CLASS DRUGS
Folic acid analogue
Methotrexate –
choriocarcinoma,ca
breast,ALL
Pemetrexed
Pyrimidine analogue
5 Fluorouracil
Cytarabine
Gemcitabine
Purine analogue and
related inhibitors
Mercaptopurine
Fludarabine

17. Obtained from microorganisms yet intercalated between specific
base pair as adenine,guanine,cytosine thiamine
CLASS DRUGS
Antibiotics
Dactinomycin
(actinomycin D)
Daunorubicin
Doxorubicin
Mitoxantrone
Bleomycin
Mitomycin
Enzymes L-Asparaginase

18. CLASS DRUGS
Vinca
alkaloids –obtained
from vinca rosea
plants
Vinblastine
Vinorelbine
Vincristine
Taxanes
Paclitaxel,
Docetaxel
Epipodo-
phyllotoxins
Etoposide
Camptothecins Topotecan, Irinotecan

19. Act on specific receptors on tumour cell and not inhibit normal cells
rituximab CLL
cetximab CA colon
trastuzumab CA breast

20. CLASS DRUGS
Glucocorticoides Prednisone
Estrogens Diethylstilbestrol, Ethinyl estradiol
Substituted urea Hydroxyurea
Differentiating
agents
Arsenic trioxide
cisplatin Acts analgouly to alkylating agents

22. Febrile neutropenia-Temperature greater than or equal to 38.3 deg c
Absolute Neutrophil count (ANC) less than 1.0
One of the few Oncologic EMERGENCIES
Wash your hands
Note signs of infections: sore throat,chills,productive cough and
burning urination.
Meet your doctor as early as possible

23. Bleeding-if the platelet count are low notice
•Bruises or small purple spots on body
•Nose bleed
•Bleeding gums
•Bloody stool or urine
•MUCOSITIS-Presents with mouth sores,
inflammation, sometimes sloughing of
mucosa
•MAGIC MOUTHWASH
•SALT WATER GARGLES
•TOPICAL ANALGESIA ie Xylocainviscous, tantum

24. Nausea-
Types of Nausea
Anticipatory—conditioned reflex to sight and smell of
chemotherapy area
Acute—within 24hrs and related to chemotherapeutic
agents
Delayed—more than 24 hrs. post chemotherapy--specific
agents—cisplatin, cyclophosphamide, adriamycin
•Take antiemetics as and when prescribed eg ondensetron
•Take small but frequent meal and water.
Loss of appetite (anorexia)-try to avoid spicy and smelly
food.
Eat high caloric and proteineous food.avoid fluid with
food.

25. Diarrhea-GI tract consist of rapidly growing cells
thats why diarrhea occurs
•Take lots of fluid and blend diet and small
but frequent meal.
Take prescribed medicines and go to emergency if
more than 24 hours
Constipation-increas fluid ,fiber,cooked fruits
and cooked vegetables
•Speak to your doctor and take medicine at bed time

26. Hair loss -may have total hair loss,thinning or no loss at all.
•Wear caps and wigs
•Take care of scalp
•Skin changes -may develop skin sensitivity
•Use sunscreams
•Wear hat and keep covered when outdoor
•Fatigue and anemia
•Plan activities and rest time.never overburden
•Do regular exercise
•Inform to doctor if unmanageable and blood tranfusion may
be needed.

27. DISEASE PROTOCOLS
CANCER BREAST FEC / Docetaxel
Gastro – esophageal carcinoma PF
Carcinoma of gall bladder Gem+Cis(Gemcitabine +CDDP)
Neuro endocrine tumour EP (Etoposide+Platinum)
Ovarian cancer TP
Cervix cancer CDDP
Hodgkin lymphoma ABVD
Non hodgkin lymphoma Rituximab,CHOP
CARCINOMA OF HEAD AND NECK PF
CARCINOMA OF LUNG TP

28. STS IA
PNET VAC
IE
GCT BEP
TIP
Bone metastases(Ca.breast,MM) Zoledronic acid
Cancer prostate Docetaxel
Urinary bladder carcinoma GEM+CDDP
GEM+CARBO
GTN EMA – CO
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