Activity

13
Discussion Topics
1. James, a 3-year-old, has been diagnosed with acute lymphoblastic
leukemia and will begin receiving chemotherapy with the mitotic inhibitor
teniposide (Vumon) and the alkylating agent cyclophosphamide (Cytoxan) in
the morning.
a. Explain how mitotic inhibitors and alkylating agents prevent or inhibit
the growth of cancer cells.
b. What special considerations are needed for a child James’ age who
will receive chemotherapy?
2. Ms. Smith will be receiving chemotherapy for advanced breast cancer.
She is 75 years old and resides in a long-term care facility. Her treatment
plan will include the use of the hormone goserelin (Zoladex) and
capecitabine (Xeloda), which is an antimetabolite.
a. What special monitoring might Ms. Smith require during her
treatment?
b. What adjustments to Ms. Smith’s living arrangements might be
required?

Possible Causes of Cancer

 Genetic Predisposition
 Viral Infection
 Constant Irritation and Cell Turnover
 Stress
 Lifestyle Factors
 Environmental Factors

Neoplasm Cancer — Mechanisms of Growth

 As the abnormal cells continue to divide, they lose more and more of their
original cell characteristics and they exhibit the following:
 Anaplasia
o Cancerous cells lose cellular differentiation and organization; unable to
function normally
 Autonomy
o Cancerous cells grow without the usual homeostatic restrictions that
regulate cell growth
o This allows the cells to form a tumor
 Metastasis
o Cancer cells travel from the place of origin to develop new tumors in
other areas of the body
  Angiogenesis
o Abnormal cells release enzymes to generate blood vessels and supply
oxygen and nutrients to the cells, generating growth
o Cancerous cells rob the host cells of energy and nutrients and block
normal lymph

Types of cancer
 Carcinomas-
o tumors that originate in epithelial cells
 Sarcomas –
o tumors that originate in the mesenchyme and are made up of
embryonic connective tissue cells
FIGURE Malignant tumors develop from one cell, with somatic mutations occurring during
cell division as the tumor grows.

Goal of Cancer Treatment

 Destroying cancer cells through several methods:
o Surgery to remove them
o Stimulation of the immune system to destroy them
o Radiation therapy to destroy them
o Drug therapy to kill them during various phases of the cell cycle

Classifications of Tumors
 Solid Tumors
o May originate in any body organ
o Carcinomas (originate in epithelial cells)
o Sarcomas (originate in the mesenchyma)
 Hematological Malignancies
o Leukemias and lymphomas; occur in the blood-forming organs

Antineoplastic agents
 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 Antineoplastic Agents

Categories of Antineoplastic Agents

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

Alkylating Agents
 Actions- React chemically with portions of the RNA, DNA, or other cellular
proteins
 Pharmacokinetics - Vary in their degree of absorption, and little is known
about their distribution in the tissues. They are metabolized and sometimes
activated in the liver and excreted in the urine
 Contraindications- Known allergy, pregnancy, lactation, bone marrow
suppression and suppressed renal and hepatic function
 Adverse Reactions- Many- See table 14.1
 Drug-to-Drug Interactions- Many drugs that cause hepatic, renal and kidney
toxicity
Nursing Considerations for Alkylating Agents
 Assess:
 o History of allergy to any of the alkylating agents
o Bone marrow suppression, CBC
o Renal or hepatic dysfunction
o Pregnancy or lactation
o Physical status
o Orientation and reflexes
o Respiratory rate, adventitious sounds and VS

Antimetabolites
 Actions- Inhibit DNA production in cells that depend on certain natural
metabolites to produce their DNA.
 Pharmacokinetics- Absorbed well in GI tract, metabolized in the liver and
excreted in the urine
 Contraindications- Pregnancy, lactation, bone marrow suppression and
hepatic dysfunction
 Adverse Reactions- Many- See table 14.1
 Drug-to-Drug Interactions- Many drugs that cause hepatic, renal and kidney
toxicity

Nursing Considerations for Antimetabolite

 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
 Actions- Are cytotoxic and interfere with cellular DNA synthesis by inserting
themselves between base pairs in the DNA chain
 Pharmacokinetics – Not well absorbed in the GI tract, metabolized by the liver
and excreted in the urine. Long half life (up to 5 days)
 Contraindications- Known allergy, Pregnancy, lactation, bone marrow
suppression and hepatic dysfunction
 Adverse Reactions- bone marrow suppression, with leukopenia,
thrombocytopenia, anemia, and pancytopenia
 Drug-to-Drug Interactions- Known to cause hepatic or renal toxicity should be
used with care with any other drugs known to have the same effect
Nursing Considerations for Antineoplastic Antibiotics
 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
 Actions- Kill cells as the process of mitosis begins which inhibit DNA synthesis
 Pharmacokinetics – Given IV since they are not well absorbed in the GI tract,
metabolized in the liver and excreted primarily in the feces, making them safer
for use in patients with renal impairment than the antineoplastics that are
cleared through the kidney.
 Contraindications- Known allergy, pregnancy, lactation, bone marrow
suppression and hepatic dysfunction
 Adverse Reactions- bone marrow suppression, with leukopenia,
thrombocytopenia, anemia, and pancytopenia, secondary to the effects of the
drugs on the rapidly multiplying cells of the bone marrow. GI effects include
nausea, vomiting, anorexia, diarrhea, and mucous membrane deterioration
 Drug-to-Drug Interactions- Known to be toxic to the liveror the CNS should be
used with care with any other drugs known to have the same adverse effects
Nursing Considerations for Mitotic Inhibitors
 Assess:
o History of allergy
o Bone marrow suppression
o Renal or hepatic dysfunction
o Pregnancy, lactation
o Physical status
o Orientation and reflexes
o Respiratory rate, adventitious sounds and CBC with differential

Hormones and Hormone Modulators

 Actions- Hormone modulators used as antineoplastics are receptor site
specific or hormone specific to block the stimulation of growing cancer cells
that are sensitive to the presence of that hormone (IE: breast cancer)
 Pharmacokinetics- Readily absorbed from the GI tract, metabolizedin the liver,
and excreted in the urine
 Contraindications- Known allergy, hypercalcemia, pregnancy, lactation, bone
marrow suppression, renal and liver dysfunction
 Adverse Reactions- Menopause-associated effects include hot flashes,
vaginal spotting, vaginal dryness, moodiness, and depression. Other effects
include bone marrow suppression and GI toxicity, including hepatic
dysfunction, hypercalcemia and cardiovascular risks
  Drug-to-Drug Interactions- Oral anticoagulants

Nursing Considerations for Hormones and Hormone Modulators

 Assess:
o History of allergy to the drug in use or any related drugs
o Bone marrow suppression
o Renal or hepatic dysfunction
o Physical status
o Assess orientation and reflexes
o Laboratory tests such as complete blood count with differential

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