Chemotherapy

Aims of Chemotherapy

  1. Cure
  2. Prevention (of recurrence)
  3. Shrink tumours

Types

  1. Primary
  2. Neoadjuvant - before surgery (eg shrink breast cancer)
  3. Adjuvant - after surgery to gain control of primary disease
  4. Palliative

Considerations

  1. Chemosensitivity
  2. Stage
  3. Grade
  4. Patient's health

Principles of treatment

  • Adjusted according to weight and height
  • Body surface area estimated and cycles given at intervals to allow the body normal tissue to recover
  • High dose chemotherapy indicated in otherwise fit patients where cure may be achieved (choriocarcinoma, leukaemia) - but can cause profound toxic effects on bone marrow [possible to use stem cells support now]

Classification of Cytoxic agents

  1. Alkylating agents - impair function of enzymes to form DNA: chlorambucil / cyclophosphamide
  2. Anti-metabolites - irreversibly interrupt DNA: Methotrexate / 5FU
  3. Vinca alkaloids - inhibit microtubule function: vincristine / vinblastine
  4. Anti-mitotic agents: cause damage by production of free radicals

[Hormone manipulation in breast cancer]