Handout in

MPN 1
PRELIMS
Short Term AY 2021- 2022

Elleine Ruth C. Mendoza, RN

Instructor

TREATMENT MODALITIES FOR CLIENTS WITH CANCER

1. SURGERY
• Oldest form of cancer treatment and was the first method to cure cancer.
• Surgery for cancer involves the removal of diseased tissue
• Oldest form of cancer treatment and was the first method to cure cancer.
• Surgery for cancer involves the removal of diseased tissue
PURPOSES:
a.PROPHYLAXIS
-Prophylactic surgery is performed when a client has either an existing
premalignant condition or a known family history that strongly predisposes the
person the development of cancer
-the “at risk” tissue or organ is removed
b. DIAGNOSTIC SURGERY(BIOPSY)
-all or part of the suspected lesion is removed for examination and testing
-the diagnosis of cancer is established by microscopic identification of malignant
cells from tumor tissue
c.TREATMENT/CURE
-surgery alone can result in a cure rate of 27%-30%
-cancers that are localized to the organs of origin and regional lymph nodes are
potentially curable by surgery
d. DETERMINATION OF THERAPY EFFECTIVENESS
-” SECOND LOOK” surgery is rediagnosis after treatment
-assess the in clients who have been treated and have no symptoms of remaining
tumor
e. PALLIATIVE SURGERY
-improve quality of life during survival time.
-tumor or tissue that causing pain or obstruction is removed
2. RADIATION THERAPY
-Use of high energy ionizing radiation to treat variety of cancers
-ionizing radiation destroys a cell’s ability to reproduce by damaging its DNA or
inducing apoptosis
Rapidly dividing cells are more vulnerable to radiation the slow dividing cells
TYPES OF RADIATION THERAPY
1. EXTERNL BEAM RADIATION THERAPY
• aka as TELETHERAPY
• therapy given by an external radiation source at a distance from the body (usually 80-
150 cm)
• most common type of radiotherapy used in cancer treatment
• Administered in the RT department by high x-ray or gamma-ray machine such as linear
accelerator or cobalt
• Skin sparing effect
SAFETY PRECAUTIONS:
• Keep skin dry
• Do not wash treatment area until instructed to do so
• Do not remove inks or markings placed on skin
• Wear loose-fitting clothes to avoid friction
• Avoid using lotions, powder, creams. deodorant
• Avoid exposure to sunlight and temperature extremes
2. INTERNAL RADIATION THERAPY
• Aka BRACHYTHERAPY
• Involves placement of specially prepared radio isotopes directly into or near the tumor
itself or into the systemic circulation
• It has two major types
1. SEALED-SOURCE RADIATION THERAPY
• Used for both intracavity or interstitial therapy
• Placed in needles, beads, seeds, ribbons or catheter which are implanted
directly into the tumor (e.g. prostate cancer pt. may receive implanted
seed therapy
• Radioisotope is enclosed by a non radioactive material- cannot circulate
through clients body
 2. UNSEALED-SOURCE RADIATION THERAPY
• Used in systematic therapy
• Uses colloid suspension that come into direct contact with body tissues
• Can be administered intravenously, orally or installation directly into body
cavity (e.g iodine 131 given orally for thyroid cancer)
• Radioisotope circulates throughout the body
RADIATION SAFETY STANDARDS
• SHIELDING-use of proper shielding devices whenever possible reduces radiation
exposure
-lead apron
-dosimeter badge-measures amount of radiation
• TIME-exposure time should be limited to 30 minutes in a 8 hour shift
-task should be organized
-care for clients should be rotated
Pregnant nurses should not be assigns to pts. Under radiation therapy
• DISTANCE-the greater the distance from the radiation source, the less exposure dose of
ionizing rays
RADIATION SAFETY STANDARDS
SEALED SOURCE UNSELAED SOURCE

• Private room + private cr located at far • Private room + private cr located at far
end of the station end of the station
• long handed forceps should always • Wear proper protective devices when
be present inside the room having contact with body fluids

3. HORMONAL THERAPY
• Hormone therapy is a cancer treatment that that works to add, block or remove
hormones from the body to slow or stop the growth of cancer cells
• MECHANISM OF ACTION
-Neo-adjuvant therapy -Make a tumor smaller before surgery or radiation therapy
-Adjuvant therapy -Lower the risk that cancer will come back after the main treatment
-Destroy cancer cells that have returned or spread to other parts of your body.
4. CHEMOTHERAPY
• Aggressive form of chemical drug therapy meant to destroy rapidly growing cells in the
body
• It has the ability to damage DNA and interfere with cell division
• Chemotherapy is designed to kill cells that divide rapidly
• Usually given systematically can affect both normal and cancer cells

CHEMOTHERAPEUTIC AGENTS
• CELL CYCLE SPECIFIC-cytotoxic during a specific cell cycle
• CELL CYCLE NON SPECIFIC-cytotoxic during the entire cell cycle
1. ALKYLATING AGENTS
- the first alkylating agents were derived from nitrogen mustards
-Nitrogen Mustards were used in WW1 as chemical warfare agents (mustard gas) causing
blistering of the skin( vesicant)
-it was later found to be very effective in treating cancer
- Cell cycle nonspecific that damage DNA
-they are vesicants causing blistering of the skin, these agents can be very damaging if they are
not properly administered
 A, NITROGEN MUSTARDS
• CYCLOPHOSPHAMIDE
• CHLORAMBUCIL
• MECHLEOTHAMINE
B. PLATINUM ANALOGS
• CISPLATIN
-DOC: Testicular Cancer
• CARBOPLATN
• OXAPLATIN
2. ANTIMETABOLITES
• -Interfere with the DNA and RNA production
• -S phase Cell Cycle Specific- they interfere with the Sphase of the cell cycle
A. METHOTREXATE
• FOLIC ACID antagonist that binds to dehydrofolate reductase
• Interferes with DNA and RNA synthesis by preventing nucleoside production
B. PURINE ANTAGONIST
• -Interferes with DNA and RNA synthesis by preventing nucleoside production
EXAMPLES:
MERCATOPURINE
THIOGUANINE
C. PYRIMIDINE ANTAGONIST
-Interferes with DNA and RNA synthesis by preventing nucleoside production
EXAMPLE:
FLUOROURACIL( 5-FU)
DOC: Colorectal Cancer
3. PLANT ALKALOIDS
A. TAXANES-produced by yew tress, interfere with microtubules and are mitotic inhibitors
- M phase cell cycle specific
EXAMPLES:
-PACLITAXEL(TAXOL)
 -DOCITAXEL(TAXOTERE)

B. VINCA ALKALOIDS
-binds to tubulin and causes mitosis to stop
-M phase cell cycle specific
EXAMPLE:
1. VINCRISTINE
2. VINBLASTINE
-From periwinkle plant
4. ANTI TUMOR ANTIBIOTICS
A. ANTHRACYCLINES- a type of antibiotic that comes from Streptomyces bacteria,
used to treat many types of cancer
-damages DNA during all phases of cell cycle
- they are too toxic to use for bacterial infections
EXAMPLES:
DOXORUBICIN
EPIRUBICIN
IDARUBICIN
B. BLEOMYCIN- is a glycopeptide antibiotic produced by bacterium Streptomyces
verticillus
-do not only interferes with DNA synthesis and damages DNA and is especially
active during G2 phase
-G2 phase cell cycle specific
5. BONE MARROW TRANSPLANT
• is a procedure that infuses healthy blood stem cells into your body to replace
your damaged or diseased bone marrow. A bone marrow transplant is also called
a stem cell transplant.
• A stem cell transplant involves destroying any unhealthy blood cells and
replacing them with stem cells removed from the blood or bone marrow

5 Main Stages of Bone Marrow Transplant

• Tests and examinations – to assess your general level of health
• Harvesting – the process of obtaining the stem cells to be used in the transplant,
either from you or a donor
• Conditioning – treatment with chemotherapy and/or radiotherapy to prepare
your body for the transplant
• Transplanting the stem cells
• Recovery