Oncology Chemo Treatments PDF

**[ONCOLOGY:]** **[Multidisciplinary Team Approach to Head and Neck Cancer:]** **Maxillofacial** Surgeon **ENT** Surgeon **Plastic/reconstruction** Surgeon **Oncologist**: doctor who specialises in cancer treatments such as radiotherapy, chemotherapy, and targeted therapy **Clinical Nurse** sp...

**[ONCOLOGY:]** **[Multidisciplinary Team Approach to Head and Neck Cancer:]** **Maxillofacial** Surgeon **ENT** Surgeon **Plastic/reconstruction** Surgeon **Oncologist**: doctor who specialises in cancer treatments such as radiotherapy, chemotherapy, and targeted therapy **Clinical Nurse** specialist (MacMillan) **Radiologist** **Speech** and **Language** therapist -- prevent aspiration **Dietitian** **General** **dentist** **Restorative** **dentist** **Psychologist****Sputum****teeth** associated with **tumour** *[should be extracted]* - *[Wait]* **3 week**s prior RT - Minimum 10 days [**Dental Care** **DURING** **Radiotherapy**:] - **Smoking** and **alcohol** *[should be discouraged]* - Supportive care - **CHX** **Mouthwashes**, **Salina** **Mouthwashes**, **Lidocaine Gel** - **FUNGAL INFECTIONS**: nystatin/miconazole treatment - **Saliva Substitutes**: BioXtra, Saliveze etc [**Dental Care** **DURING** **Radiotherapy**:] - *[Excellent]* **OH** *[should continue]* - High Fluoride Supplementation - *[Extractions]* *[done]* in **Secondary Care** - Atraumatically as possible **[CHEMOTHERAPY:]** **Chemotherapy** *[is the use of]* **Anti-Cancer (Chemotherapeutic Agents)** drugs to *[treat]* ***cancer*** as part *[of a standardised]* **chemotherapy regimen**. It is *[rarely]* *[used]* for **Oral Squamous Cell Carcinoma.** **Chemotherapy** *[may be]* **Curative** or **Palliative** in nature. **Chemotherapy** **drugs** *[usually target the]* **G2** and **Mitosis** **Stages** of the **Cell Cycle.** The **Chemotherapy** *[selectively]* **kills** **TUMOUR CELLS** -- *[spares]* **Normal Tissues** (Quite hard in principle) **[TERMINOLOGY]** - *[If given after]* **Surgery**/**DXT** -- **ADJUVANT (DXT = Radiotherapy)** - **NEO-ADJUVANT** -- *[used as]* **Primary Treatment** for **Local Control = Chemotherapy** - **Primary treatment** in *[widespread]* **Disease** is known as **INDUCTION CHEMOTHERAPY** **[MELANOMA METASTASES]** Patient had an Oral Melanoma Cannon ball metastases can be seen Good example of a patient who would be fit for chemotherapy **[Growth Characteristics of Tumour Cells]** *[The **cell cycle** consists of :]* **G~0~** - stimulus **M** -- mitosis **G~1~** -- protein and RNA synthesis **G~0~** -- resting phase **S** -- DNA synthesis **G~2~** -- RNA synthesis **KINETIC CLASSIFICATION** **[Non-Phase Dependent]** Kills **Cells** **Exponentially** *[with]* **increasing dose** -- *[equally]* **Toxic** in **cycle** or **G~0~** **[Phase-Dependent]** Kills **Cells** at a **Lower Dose** *[but reach a plateau]* **kill** at *[higher doses]* because they are *[only]* *[effective]* in **Certain** **Part Of The** **Cycle** *[Examples]* of **Chemotherapy Drugs**: **[Phase-dependent]** **Methotrexate**: **Anti-Metabolite** - *[Inhibits]* **purine** and **pyrimidine** **synthesis** **Vinca alkaloids -- Anti-Mitotic** **[Non-Phase dependent]** **5-FU**: **Anti-Metabolite** **Alkylating Agents** **CHEMOTHERAPY \-\-\-\-\-\-\-\-\-\-\-- TYPES *(many!)*** - **ALKYLATING AGENTS** - damage **DNA** to *[stop]* **reproduction** - **ANTIMETABOLITES** - **interfere** with **DNA** and **RNA** **growth** - **VINCA ALKALOIDS** - **stop** **cell division** - **ANTIMITOTIC ANTIBIOTICS** - **stop** **mitosis** - **OTHERS** - e.g. *[improving]* **Immune Response** (**Interferon**, **Monoclonal Antibodies, Alpha Interferon**) *[Routes]* of **ADMINISTRATION** - **Oral**, **I.M., I.V**., **Intrathecal** *(around spinal cord)* - **Long-Term** -- **catheters** are *[placed]* in the **Right Atrium**. "Hickman Lines (internal Jugular Vein)," "Portacath" - *[Sometimes]* a **Pump Mechanism** is *[inserted]* into the **Common Hepatic Artery** **[Complications -- Acute Toxicity]** **Local Toxicity** -- **tissue destruction** if injected out of vessel **Bone Marrow Toxicity** -- *[dose-limiting factor]* *[Patients]* need a *[regular]* **FBC** and **Differential White Cell Count - THEY MUST HAVE A FULL BLOOD COUNT** **GI Toxicity --** **nausea** and **vomiting** -- *[stimulation]* of **CT zone**, **Gut** and **Cerebral Cortex** **Methotrexate** -- **Mucositis** **Alopecia** \- *[Can be reduced]* by **Scalp Cooling** \- **Hair** **Loss** *[starts]* **18-21 days** *[after first injection]* \- *[Not]* all **Agents** *[cause it]* **[LONG-TERM TOXICITY]** **CARCINOGENESIS -** *[Long-term]* **Alkylating Agents** [can *lead*] *to* **Acute Leukaemia** **GONADAL DAMAGE - STERILITY** **SIDE EFFECTS \-\-\-\-\-\-\-\-\-\-\-- CHEMOTHERAPY** - **Anorexia** - **Backache** - **Oral mucositis** - **Infections** - **Nausea/vomiting** - **Oedema** - **Fatigue** - **Anaemia** - **Headaches** **[ORAL COMPLICATIONS:]** - *[Occur]* in **40% Of Patients** *[receiving]* **Chemotherapy** - **Mucositis**, **Dental** **Problems**, **Gum Problems**, **Swallowing Issues,** **Infections**, **Ulceration**, **Meucositis**, **Lip Cracking**, **Gingival** **Bleeding**, Xerostomia, **Dehydration**, **Abnormal Dental Developmen**t - **ORAL HYGIENE** *[important]* - *[Source]* of **Bacteraemia** - Team approach to care -- nursing, dentistry, dietetics, pain team - *[Loss]* of **Taste**: - *[Affects]* **Appetite, Nutrition** - *[Loss]* of **Taste** *[don't want to eat]* *[effects]* **Healing** - *[In turn, affects]* **Healing** - "*[Think]* of **Eating** as a job" - **Oral** **Supplements** or **Alternatives** *[may be required]* **Dental Aspects \-\-\-\-\-\-\-\-\-\-\-- CHEMOTHERAPY** **[ORAL MUCOSITIS: ]** - *[Develops]* around **7-14** days after *[initiation]* of - *[Due]* to **Rapidly** **Proliferating** **Mucosa** - Soft **Diet**, *[excellent]* **Oral Hygiene**, **Topical Lidocaine Gels** - **Folic** **Acid** *[supplementation]* may *[help]* with **Methotrexate Induced Mucositis** **[INFECTIONS:]** - *[Increased]* **risk** of **infections** - **Chemotherapy** *[suppresses]* the **Immune System** **BEFORE** **Chemotherapy**: - Excellent oral hygiene - Extractions to be done before hand - Beware of possible bleeding problems and predisposition to infection [**DURING** **Chemotherapy**:] - **Ulceration** *[caused]* by **METHOTREXATE** *[may respond to]* **TOPICAL FOLINIC ACID.** - **SUXAMETHONIUM (muscle relaxant)** *[may be]* *[increased]* **Toxicity** if **patients** *[taking]* **METHOTREXATE** - *[If prone]* to **Stomatitis** -- *[sucking]* **Ice Cubes** or **Cold Water** *[during]* the *[infusion]* *[can help]* -- *[particularly]* with **5-FU.** - **ESTABLISHED MUCOSITIS** - *[optimise]* **oral hygiene,** *[consider]* **Benzydamine Hydrochloride.** - **(Difllam liquid has alcohol in it which causes mouth to burn)** - **Candidiasis** -- **Fluconazole** - **HERPETIC INFECTIONS** - **acyclovir** **AFTER** **Chemotherapy**: - Increased susceptibility to infection and bleeding tendencies **[The Full Blood Count]** [**PLATELETS** -- ] **\>50x10^9^/litre** -- **Routine Management**. *[Some]* **patients** *[may have]* **Desmopressin/Platelets** to *[cover]* **Surgery** **\2x10^9^/litre** -- *[normal]* **management**. **\