Aims of Chemotherapy
- Cure
- Prevention (of recurrence)
- Shrink tumours
Types
- Primary
- Neoadjuvant - before surgery (eg shrink breast cancer)
- Adjuvant - after surgery to gain control of primary disease
- Palliative
Considerations
- Chemosensitivity
- Stage
- Grade
- 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
- Alkylating agents - impair function of enzymes to form DNA: chlorambucil / cyclophosphamide
- Anti-metabolites - irreversibly interrupt DNA: Methotrexate / 5FU
- Vinca alkaloids - inhibit microtubule function: vincristine / vinblastine
- Anti-mitotic agents: cause damage by production of free radicals