Possible Causes of Cancer: Antineoplastic Agents

Possible Causes of Cancer
v Genetic Predisposition
v Viral Infection
v Constant Irritation and Cell Turnover
Chapter 14: v Stress
v Lifestyle Factors
Antineoplastic Agents
v Environmental Factors
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Neoplasm Cancer — Mechanisms of Neoplasm Cancer — Mechanisms of

Growth #1 Growth #2
v As the abnormal cells continue to divide, they lose more v Metastasis
and more of their original cell characteristics and they
exhibit the following: o  Cancer cells travel from the place of origin to develop
new tumors in other areas of the body
v Anaplasia
v Angiogenesis
o  Cancerous cells lose cellular differentiation and
organization; unable to function normally o  Abnormal cells release enzymes to generate blood
vessels and supply oxygen and nutrients to the cells,
v Autonomy generating growth
o  Cancerous cells grow without the usual homeostatic
restrictions that regulate cell growth o  Cancerous cells rob the host cells of energy and
nutrients and block normal lymph
o  This allows the cells to form a tumor
Copyright © 2017 Wolters Kluwer • All Rights Reserved Copyright © 2017 Wolters Kluwer • All Rights Reserved
Types of cancer
v Carcinomas- FIGURE 14.1 Malignant tumors develop from one cell, with
somatic mutations occurring during cell division as the tumor
o  tumors that originate in epithelial cells
grows.
v Sarcomas –
o  tumors that originate in the mesenchyme and are
made up of embryonic connective tissue cells
1
Goal of Cancer Treatment Classifications of Tumors
v Destroying cancer cells through several methods: v Solid Tumors
o  Surgery to remove them o  May originate in any body organ
o  Stimulation of the immune system to destroy them o  Carcinomas (originate in epithelial cells)
o  Radiation therapy to destroy them o  Sarcomas (originate in the mesenchyma)
o  Drug therapy to kill them during various phases of v Hematological Malignancies
the cell cycle
o  Leukemias and lymphomas; occur in the blood-
forming organs
Antineoplastic agents Use of Antineoplastic Across the Life Span
v Antineoplastic drugs
o  Alter human cells in a variety of ways. Their action is
intended to target the abnormal cells that compose
the neoplasm or cancer, having a greater impact on
them than on normal cells. Unfortunately, normal
cells also are affected by antineoplastic agents.
Sites of Action of Non–Cell Cycle–Specific Sites of Action of Cell Cycle–Specific

Antineoplastic Agents Antineoplastic Agents
2
Categories of Antineoplastic Agents #1 Categories of Antineoplastic Agents #2
v Alkylating Agents v Mitotic Inhibitors

o  React chemically with portions of the RNA, DNA, or o  Drugs that kill cells as the process of mitosis begins
other cellular proteins
v Hormones and Hormone Modulators
v Antimetabolites
o  Used in cancers that are sensitive to estrogen
o  Have chemical structures similar to those of natural stimulation
metabolites
v Cancer Cell Specific Agents
v Antineoplastic Antibiotics
o  Treat chronic myeloid leukemia (CML) and CD117-
o  Not selective only for bacterial cells; toxic to human positive unresectable or metastatic malignant GI
cells stromal tumors (GIST)
Question #1 Answer to Question #1
Which term is used to describe the process that occurs

when cells lose their cellular differentiation and
organization? C. Anaplasia
A. Autonomy
B. Neoplasm Rationale: The cancerous cells exhibit anaplasia, a loss of
cellular differentiation and organization, which leads to a
C. Anaplasia loss of their ability to function normally.
D. Angiogenesis
Nursing Considerations for

Alkylating Agents Alkylating Agents
v Actions- React chemically with portions of the RNA, DNA, or v Assess:

other cellular proteins
o  History of allergy to any of the alkylating agents
v Pharmacokinetics - Vary in their degree of absorption, and
little is known about their distribution in the tissues. They are o  Bone marrow suppression, CBC
metabolized and sometimes activated in the liver and excreted o  Renal or hepatic dysfunction
in the urine
o  Pregnancy or lactation
v Contraindications- Known allergy, pregnancy, lactation, bone
marrow suppression and suppressed renal and hepatic function o  Physical status
v Adverse Reactions- Many- See table 14.1 o  Orientation and reflexes

o  Respiratory rate, adventitious sounds and VS
v Drug-to-Drug Interactions- Many drugs that cause hepatic,
renal and kidney toxicity
3
Prototype Alkylating Agent Antimetabolites
v Actions- Inhibit DNA production in cells that depend on certain

natural metabolites to produce their DNA.
v Pharmacokinetics- Absorbed well in GI tract, metabolized in
the liver and excreted in the urine
v Contraindications- Pregnancy, lactation, bone marrow
suppression and hepatic dysfunction
v Adverse Reactions- Many- See table 14.1
v Drug-to-Drug Interactions- Many drugs that cause hepatic,
renal and kidney toxicity
Nursing Considerations for Antimetabolite Prototype Antimetabolite Agent
v Assess:
o  History of allergy to the specific antimetabolite
o  Bone marrow suppression to prevent further suppression
o  Renal or hepatic dysfunction
o  Physical status
o  Orientation and reflexes
o  Respirations, adventitious sounds, VS, CBC,
o  Renal and liver function tests
Antineoplastic Antibiotics #1 Antineoplasic Antibiotics #2
v Actions- Are cytotoxic and interfere with cellular DNA v Drug-to-Drug Interactions- Known to cause hepatic or renal
synthesis by inserting themselves between base pairs in the toxicity should be used with care with any other drugs known
DNA chain to have the same effect
v Pharmacokinetics – Not well absorbed in the GI tract,
metabolized by the liver and excreted in the urine. Long half
life (up to 5 days)
v Contraindications- Known allergy, Pregnancy, lactation,
bone marrow suppression and hepatic dysfunction
v Adverse Reactions- bone marrow suppression, with
leukopenia, thrombocytopenia, anemia, and pancytopenia
4
Antineoplastic Antibiotics Prototype Antineoplastic Antibiotics
v Assess:
o  History of allergy to the antibiotic in use
o  Bone marrow suppression
o  Renal and hepatic dysfunction, respiratory or cardiac
disease
o  Pregnancy and lactation
o  Physical assessment
o  Orientation and reflexes, monitor the results of laboratory
tests such as complete blood count with differential
Mitotic Inhibitors #1 Mitotic Inhibitors #2
v Actions- Kill cells as the process of mitosis begins which inhibit v Adverse Reactions- bone marrow suppression, with
DNA synthesis leukopenia, thrombocytopenia, anemia, and pancytopenia,
secondary to the effects of the drugs on the rapidly multiplying
v Pharmacokinetics – Given IV since they are not well cells of the bone marrow. GI effects include nausea, vomiting,
absorbed in the GI tract, metabolized in the liver and excreted anorexia, diarrhea, and mucous membrane deterioration
primarily in the feces, making them safer for use in patients
with renal impairment than the antineoplastics that are cleared v Drug-to-Drug Interactions- Known to be toxic to the liveror
through the kidney. the CNS should be used with care with any other drugs known
to have the same adverse effects
v Contraindications- Known allergy, pregnancy, lactation, bone
marrow suppression and hepatic dysfunction

Mitotic Inhibitors Prototype Mitotic Inhibitors
v Assess:
o  History of allergy
o  Pregnancy, lactation
o  Orientation and reflexes
o  Respiratory rate, adventitious sounds and CBC with
differential
5
Hormones and Hormone Modulators #1 Hormones and Hormone Modulators #2
v Actions- Hormone modulators used as antineoplastics are v Adverse Reactions- Menopause-associated effects include hot
receptor site specific or hormone specific to block the flashes, vaginal spotting, vaginal dryness, moodiness, and
stimulation of growing cancer cells that are sensitive to depression. Other effects include bone marrow suppression
the presence of that hormone (IE: breast cancer) and GI toxicity, including hepatic dysfunction, hypercalcemia
and cardiovascular risks
v Pharmacokinetics- Readily absorbed from the GI tract,
metabolizedin the liver, and excreted in the urine v Drug-to-Drug Interactions- Oral anticoagulants
v Contraindications- Known allergy, hypercalcemia,

pregnancy, lactation, bone marrow suppression, renal
and liver dysfunction
Nursing Considerations for Hormones and Prototype Hormones and Hormone

Hormone Modulators Modulators #1
v Assess:
o  History of allergy to the drug in use or any related drugs
o  Assess orientation and reflexes
o  Laboratory tests such as complete blood count with
differential
Prototype Hormones and Hormone

Modulators #2 Question #2
You are caring for a patient with a Wilm’s tumor who is

receiving doxorubicin. What is an adverse effect of
doxorubicin that you would teach the patient and their
family about?
A. Brown urine
B. Red urine
C. Orange urine
D. Gold urine
6
Answer to Question #2
B. Red urine
Rationale: Adverse effects: Cardiac toxicity, complete but

reversible alopecia, nausea, vomiting, mucositis, red
urine, myelosuppression, fever, chills, rash
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Possible Causes of Cancer

Neoplasm Cancer — Mechanisms of Neoplasm Cancer — Mechanisms of

Antineoplastic agents Use of Antineoplastic Across the Life Span

Sites of Action of Non–Cell Cycle–Specific Sites of Action of Cell Cycle–Specific

v Alkylating Agents v Mitotic Inhibitors

Question #1 Answer to Question #1

Which term is used to describe the process that occurs

Nursing Considerations for

v Actions- React chemically with portions of the RNA, DNA, or v Assess:

v Adverse Reactions- Many- See table 14.1 o Orientation and reflexes

v Actions- Inhibit DNA production in cells that depend on certain

Nursing Considerations for Antimetabolite Prototype Antimetabolite Agent

Antineoplastic Antibiotics #1 Antineoplasic Antibiotics #2

Mitotic Inhibitors #1 Mitotic Inhibitors #2

Nursing Considerations for

v Contraindications- Known allergy, hypercalcemia,

Nursing Considerations for Hormones and Prototype Hormones and Hormone

Prototype Hormones and Hormone

You are caring for a patient with a Wilm’s tumor who is

Rationale: Adverse effects: Cardiac toxicity, complete but

Copyright © 2017 Wolters Kluwer • All Rights Reserved

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v Alkylating Agents v Mitotic Inhibitors

v Actions- React chemically with portions of the RNA, DNA, or v Assess:

v Adverse Reactions- Many- See table 14.1 o  Orientation and reflexes

v Actions- Inhibit DNA production in cells that depend on certain

v Contraindications- Known allergy, hypercalcemia,