Cancer Chemotherapy and Pain Management PDF

Cancer Chemotherapy and Pain Management AAAT, PharmD Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD I...

Cancer Chemotherapy and Pain Management AAAT, PharmD Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Introduction to Cancer Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Lesson Objectives Define Cancer Discuss the process of cancer development Identify different factors that can cause cancer Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD What is Cancer? Cancer is a large group of diseases that can start in almost any organ or tissue of the body when abnormal cells grow uncontrollably, go beyond their usual boundaries to invade adjoining parts of the body and/or spread to other organs. A neoplasm and malignant tumour are other common names for cancer (World Health Organization, 2024). Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Cancer Cancerous tumors spread into, or invade, nearby tissues and can travel to distant places in the body to form new tumors - metastasis Cancerous tumors may also be called malignant tumors. Many cancers form solid tumors, but cancers of the blood, such as leukemias, generally do not. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Cancer The four most common cancers are prostate, breast, lung, and colorectal cancer. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Epidemiology In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States (Siegel et al., 2023). Lung cancer in women decreased at one half the pace of men (1.1% vs. 2.6% annually) from 2015 through 2019, and breast and uterine corpus cancers continued to increase, as did liver cancer and melanoma, both of which stabilized in men aged 50 years and older and declined in younger men. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Epidemiology Cancer incidence increased for prostate cancer by 3% annually from 2014 through 2019 after two decades of decline, translating to an additional 99,000 new cases; otherwise, however, incidence trends were more favorable in men compared to women Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Estimated New Cancer Cases (2024) Estimated Cancer Deaths 2024 Role of Pharmacist in Chemotherapy Thorough knowledge of antineoplastic drug pharmacology and pharmacokinetics is essential to prevent and to manage drug- induced toxicities Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Cancer Cells Cancer cells differ from normal cells in many ways: Grow in the absence of signals telling them to grow. Normal cells only grow when they receive such signals. Ignore signals and normal process in the body such as Apoptosis. Invade into nearby areas and spread to other areas of the body. Normal cells stop growing when they encounter other cells, and most normal cells do not move around the body Cancer cells can instrct blood vessels to grow toward tumors. These blood vessels supply tumors with oxygen and nutrients and remove waste products from tumors. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Cancer Cells Cancer cells differ from normal cells in many ways: The immune system normally eliminates damaged or abnormal cells. trick the immune system into helping cancer cells stay alive and grow. For instance, some cancer cells convince immune cells to protect the tumor instead of attacking it. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Cancer cells vs. Normal cells Cancer cells accumulate multiple changes in their chromosomes, such as duplications and deletions of chromosome parts. Some cancer cells have double the normal number of chromosomes Cancer cells rely on different kinds of nutrients than normal cells: The can make energy from nutrients in a different way than most normal cells. This lets cancer cells grow more quickly Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Categories of Cancer 1. Hematologic- blood 1. Leukemia 2. Lymphoma 3. Multiple Myeloma 2. Solid Tumor - any part of the body, organs, or tissues. 1. Most common 1. Breast 2. Prostate 3. Lung 4. Colorectal Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Benign vs. Malignant Benign Tumors - Non cancerous. Rarely cause serious problems or threaten life unless they occur in a vital organ or grow very large and press on nearby tissues. Grow slowly and stay in one place. Once removed by surgery, benign tumours don’t usually come back (recur). Benign tumours usually stay non-cancerous, except in very rare cases. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Benign vs. Malignant Malignant Tumors - Cancerous Cancer cells have a larger nucleus that looks different from a normal cell’s nucleus, and cancer cells behave, grow and function quite differently from normal cells. They grow in an uncontrolled, abnormal way and can grow into (invade) nearby tissues, blood vessels or lymphatic vessels. They can interfere with body functions and become life-threatening. Can break off and spread to distant locations in the body (metastasize). Cancer that spreads from its original location (the primary tumor) to a new part of the body is called metastatic cancer. Can come back (recur) after they are removed. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Main Features of Benign and Malignant Tumors Classifications of Cancer 1. Carcinomas are characterized by cells that cover internal and external parts of the body such as lung, breast, and colon cancer. 2. Sarcomas are characterized by cells that are located in bone, cartilage, fat, connective tissue, muscle, and other supportive tissues. 3. Lymphomas are cancers that begin in the lymph nodes and immune system tissues. 4. Leukemias are cancers that begin in the bone marrow and often accumulate in the bloodstream. 5. Adenomas are cancers that arise in the thyroid, the pituitary gland, the adrenal gland, and other glandular tissues. Cancers are often referred to by terms that contain a prefix related to the cell type in which the cancer originated and a suffix such as -sarcoma, -carcinoma, or just -oma. Common prefixes include Adeno- = gland Melano- = pigment cell Chondro- = cartilage Myelo- = bone marrow Erythro- = red blood cell Myo- = muscle Hemangio- = blood vessels Osteo- = bone Hepato- = liver Uro- = bladder Lipo- = fat Retino- = eye Lympho- = white blood cell Neuro- = brain Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Spread of Cancer In order to spread, some cells from the primary cancer must break away, travel to another part of the body and start growing there. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Spread of Cancer Local Spread - directly into nearby body tissues Through blood circulation - detached from the primary cancer Through the wall of a blood vessel then into the bloodstream Through the Lymphatic system Travels in the circulating lymph fluid until it gets stuck in the small channels inside a lymph node. There it begins to grow into a secondary cancer. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Types of Genes that Cause Cancer “Drivers” of cancer Proto-oncogenes Tumor suppressor genes DNA repair genes Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Seven warning signs of Cancer C-A-U-T-I-O-N Change in bowel or bladder habits A sore that does not heal Unusual bleeding or discharge Thickening or lump in the breast, testicles, or elsewhere Indigestion or difficulty swallowing Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore Nagging cough or hoarseness Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Diagnosis of Cancer Early detection of cancer can greatly improve the odds of successful treatment and survival. Imaging techniques such as X-rays, CT scans, MRI scans, PET scans, and ultrasound scans are used regularly in order to detect where a tumor is located and what organs may be affected by it. Biopsy Threadlike “False Feet” Are a Common Feature of Cancerous Cells. Specific Laboratory test Prostate specific antigen - High levels in prostate cancer Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Risk Factors Age - >65 year old Habits - Smoking, Heavy alcoholic drinker Family History - gene mutation Health Condition - e.g ulcerative colitis Environment - exposure to chemicals Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Defense Mechanisms DNA Repair Anti-growth signalling Apoptosis - programmed cell death Senescence important tumor suppressor that should prevent the proliferation of seriously damaged cells Immune System Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Diagnosis of Cancer The definitive diagnosis of cancer relies on the procurement of a sample of the tissue or cells suspected of malignancy and pathologic assessment of this sample. Samples can be obtained by numerous methods: Biopsy Is the Only Sure Way to Diagnose Cancer. Biopsy is the removal and microscopic examination of tissue. Fine-needle aspiration Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Light Microscope Image Shows Cancerous Cells in Breast Tissue Diagnosis of Cancer Blood Tests Can Detect Chemical Indications of Cancer Tumor markers Produced by particular types of cancer cells Produced by certain cells in response to cancer Detected by blood tests - HCG: human chorionic gonadotropin - PSA: prostate- specific antigen Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Diagnosis of Cancer Medical Imaging Can Reveal the Site and Size of Tumors MRI(magnetic resonance imaging): reveals tumors obscured by bon X-rays Ultrasound CT(computerized tomography) Radioactive Tracers Also Can Reveal Cancer Tumors Staging and Work-up Tumors should be staged to determine the extent of disease before any definitive treatment is initated. Staging provides information on prognosis and guide treatment selection. After treatment is implemented, the staging, work- up is usually repeated to evaluate the effectiveness of the treatment. Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Staging and Work-up The most commonly applied staging system for solid tumors is the TNM classification, where: T=tumor N=node M=metastases A numerical value is assigned to each letter to indicate the size or extent of disease Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Staging and Work-up The designated rating for tumor describes the size of the primary mass and ranges from T1 to T4. Nodes are described in terms of the extent and quality of nodal involvement (N0 to N3). Metastases are generally scored depending on their presence or absence (M0 or M1) Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Management Cancer treatments have different objectives, such as: Cure Primary Treatment - completely remove the cancer from your body or kill the cancer cells Primary cancer treatment for the most common cancers is surgery Radiation therapy or chemotherapy, Adjuvant Therapy chemotherapy, radiation therapy and hormone therapy Palliative treatment - Relieve side effects of treatment Ex. Medications may relieve signs and symptoms such as pain and shortness of breath Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD Cancer Treatment Surgery - removal of cancerous tumor Chemotherapy - Drugs to kill cancer cells Radiation Therapy - high-powered energy beams, such as X-rays, to kill cancer cells Stem cell transplant Biological therapy - Biological therapy uses the body's immune system to fight cancer Hormone therapy - e.g breast cancer and prostate cancer (removing excess hormone that may cause breast cancer and prostate cancer. Targeted drug therapy Clinical Trial Cancer Chemotherapy and Pain Management University of Immaculate Conception Clinical Pharmacy AAAT, PharmD