Cancer Chemotherapy - دانشگاه علوم پزشکی ...

Cancer Chemotherapy - دانشگاه علوم پزشکی ...

Cancer Chemotherapy Dr.Azarm The goal of cancer treatment is eradication of cancer

If not possible shifts to palliation ,amelioration and preservation of quality of life Dr.Azarm

Surgery Radiotherapy Chemotherapy

Biologic therapy Dr.Azarm Diagnosis Pathology Tumor markers ; germ cell tumors ,

Dr.Azarm Staging Clinical Pathologic

Dr.Azarm Surgery Curative Palliative Radiation

Ionization and excitation of atoms and bombs that kills cells Cell killing ,nausea , vomiting ,fatigue , somnolence Late effect ;fibrosis and gliosis Skin and mucosal reactions are accentuated by other modalities like chemotherapy

Acute response , subacute response , late response Definitive , adjuvant , palliative Chemotherapy Chemotherapy

Clinically detectable tumor : 1 10 9cell =1 cm Mechanism of drugs : apoptosis , pproliferation control , affect maturation , angiogenesis ,

Chemotherapy for what ?? Cure malignancies or improve survival Palliate symptoms Organ preserving Types of chemotherapy

Adjuvant Neoadjuvant Palliative Type of administration Oral IV

Intracavitary Intravenous Vein selection Irritant : without necrosis ,BCNU ,cisplatin ,dacarbazine , etoposide , vinca alkaloids Vesicant : necrosis , antrscyclines ,

dactinomycine , nitrogen mustard Complications of chemotherapy Myelosuppression Gastrointestinal toxicity : nausea and vomiting , mucositis , diarrhea

Abnormal renal function : cisplatin , MTX Hepatotoxicity : vinca alkaloids , antracyclines Specific toxicity Alkylating agents : carcinogen , busulfan ; irreversible myelosuppression

chlorambucil ; the least toxic alkylating agent cyclophosphamide ; hemorrhagic cystitis , bladder carcinoma ,alopecia ,aspermia , amenorrhea , Ifosfamide ; hemorrhagic cystitis ,alopecia cisplatin ; renal insufficiency ,neuropathy ,ototoxicity , severe nausea and vomiting carboplatin ;

Specific toxicity Antimetabolites ; cytosar ; cerebellar toxicity ,conjuctivitis 5-FU ; mucositis , diarrhea , capecitabine ( xeloda ) : diarrhea , handfoot syndrome MTX ; mucositis , impaired renal function ,

myelosuppression , Specific toxicity Antitumor antibiotics ; bleomycin ; pulmonary fibrosis , anaphylaxis , anthracyclines ; cardiotoxicity , allopecia

Specific toxicity Mitotic spindle agents ; vincristin , vinblastin ; neuropathy taxane ; hypersensitivity , alopecia , peripheral neuropathy

Specific toxicity Topoisomerase inhibitors ; etoposide ,irinotecan Specific toxicity Tyrosin kinase inhibitors ; gefitinib ( Iressa )

imatinib ( gleevec ) Specific toxicity Monoclonal antibodies ; relative selectivity for tumor ,cytokine release syndrome ( fevfr , hypotension , bronchospasm ) ,

Rituximab , Trastuzumab , Alemtuzumab ,Bevacizumab Growth factors Erythropoetin G-csf Plt growth factor

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