Lippincott NursingCenter Pocket Card - May 2021

Cancer Treatment Strategies

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Cancer Treatment Strategies

Cancer is a complex process that can affect any organ within the body. Great progress has been made in the treatment of cancer and there are now a multitude of strategies that can be employed. This pocket card provides a general overview to help you understand the various therapeutic options available to your patients.

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Surgery (American Cancer Society, 2019a; National Cancer Institute [NCI], n.d.)

Depending on the type of cancer and how advanced it is, surgery may be used to:

  • Diagnose cancer via biopsy
  • Stage cancer: detect how much cancer is present and if it has spread; helps determine treatment strategy
  • Cure: if the cancer has not spread, surgery may be used to remove the entire tumor
  • Debulk the tumor: partial tumor removal if excision of the entire tumor is not possible or may affect a vital organ
  • Palliative: to relieve pain or pressure or correct a problem that causes discomfort or disability
  • Supportive: procedures are performed that help patients get other types of treatments (i.e., insertion of vascular access device)
  • Restorative or reconstructive: improves the patient’s appearance or restore the function of an organ after cancer surgery
  • Preventive or prophylactic: removes tissue that will likely become cancerous, even if there are no signs of cancer at the time of surgery
Types of surgery include:
  • Open surgery – one large incision of the skin to remove tumors
  • Minimally invasive surgery – laparascopes and other instruments are inserted through small incisions to find and remove tumors
  • Cryosurgery – extreme cold (liquid nitrogen or argon gas) is used to destroy abnormal tissue; used to treat early-stage skin cancer, retinoblastoma, precancerous growths on skin and cervix
  • Laser – beams of light used to cut tissue or shrink growths; may treat basal cell carcinoma, cervical tissue changes, vaginal, esophageal, and non-small cell lung cancer
  • Hyperthermia – high temperatures may damage cancer cells or make them vulnerable to radiation and chemotherapy
  • Photodynamic therapy – combines drugs that react to certain types of light to kill cancer cells; used to treat or relieve symptoms caused by skin cancer, mycosis fungoides, and non-small cell lung cancer

Radiation Therapy (NCI, n.d.)

High dose radiation (particles or waves) such as x-rays, gamma rays, electron beams, or protons, kill cancer cells by disrupting the cell’s DNA. Effects of radiation may take days or weeks. Radiation may be used to:
  • Cure or shrink cancer
  • Slow cancer growth
  • Prevent recurrence
  • Ease cancer symptoms (palliative treatment)
Radiation may be used alone or with other treatments such as surgery, chemotherapy and immunotherapy. In combination with surgery, the timing of radiation is an important part of treatment:
  • Before surgery – radiation may shrink the size of the tumor so it can be removed by surgery.
  • During surgery – radiation is directed to the tumor avoiding normal tissue.
  • After surgery – radiation is used to kill cancer cells that were not removed during surgery.
Two types of radiation:
  • External beam radiation therapy – localized treatment to a specific area of the body usually performed on an outpatient basis
  • Internal radiation therapy – radiation is placed within the body.
    • Brachytherapy – radiation in solid forms (seeds, ribbons or capsules) are placed within the body close to or within the tumor.
    • Systemic therapy – radiation in liquid form is administered by mouth, intravenous (IV) or via injection; radiation travels within the body to all tissues; body fluids such as urine, sweat, and saliva will give off radiation for some time after treatment.
      • Radioactive iodine (I-131) - used to treat thyroid cancer
      • Radionuclide therapy (molecular radiotherapy) – used to treat advanced prostate cancer

Chemotherapy (American Cancer Society, 2019b; NCI, n.d.)                                                    

Chemotherapy is a systemic treatment that stops or slows the growth of cancer cells that have metastasized to parts of the body far from the primary tumor. Goals of treatment with chemotherapy include:
  • Curative
  • Control growth and prevent metastasis
  • Palliative
Chemotherapy is also often used in combination with other therapies as neoadjuvant chemotherapy (to shrink tumors before surgery or radiation) or as adjuvant chemotherapy (to kill cancer cells that were not removed with surgery or radiation).
 
Chemotherapy may be administered by the following routes:
  • Oral – pills, capsules, liquids
  • Intravenous (IV)
  • Injection – intramuscular or subcutaneous
  • Intrathecal – injection into spinal canal or subarachnoid space into the cerebrospinal fluid (CSF)
  • Intraperitoneal (IP) – administered directly into the peritoneal cavity
  • Intra-arterial (IA) – injected directly into the artery
  • Topical – application of cream onto the skin
Dosing may be calculated based on weight or body surface area and will be affected by:
  • Age (reduce dose for elderly)
  • Nutritional status
  • Obesity
  • Concurrent medications
  • Radiation therapy
  • Blood cell counts
  • Liver or kidney disease
Additional factors that help determine the recommended chemotherapy (American Cancer Society, 2019b):
  • Type and subtype of cancer
  • Stage of cancer
  • Results of other tests such as biomarkers
  • Prior cancer treatments

Targeted Therapy (NCI, 2021)

Targeted therapies are substances developed to inhibit cancer by impeding certain molecules (“targets”) that help cancer grow and spread. Also known as “molecularly targeted drugs,” “molecularly targeted therapies,” and “precision medicine,” these drugs differ from chemotherapy in that they attack specific molecules or proteins while chemotherapies affect both rapidly dividing normal and cancer cells. The treatments are either small-molecule drugs or monoclonal antibodies that work using a variety of mechanisms:
  • Help the immune system destroy cancer cells
  • Impede chemical signals that cause cancer cell growth
  • Prevent the formation of new blood vessels that supply cancer cells
  • Deliver toxic substances to kill cancer cells
  • Alter proteins in cancer cells resulting in cell death
  • Starve cancer of the hormones it needs to grow
Targeted treatments include hormone therapies, immunotherapies, signal transduction inhibitors, gene expression modulators, apoptosis inducers, angiogenesis inhibitors, and toxin molecules.

Hormone Therapy (NCI, 2021)
Hormone therapy is used primarily to treat cancers that depend on hormones to grow, such as prostate, breast, ovarian, and uterine cancers. Hormone therapy can be administered orally or by injection (subcutaneous or intramuscular) and may involve surgery to remove hormone-producing organs (i.e., ovaries in women or testicles in men).
There are two types of hormone therapy:
  • Block hormone production
  • Interfere with hormone effects
Like chemotherapy, hormone therapy is also often used in combination with other therapies as neoadjuvant treatment (to shrink tumors before surgery or radiation) or adjuvant treatment (to kill cancer cells that were not removed with surgery or radiation); and can also be used to treat cancer that returns or spreads to other parts of the body.
 
Common side effects of hormone therapy include hot flashes, loss of interest or inability to have intercourse, nausea, diarrhea, fatigue, and mood changes.

Immunotherapy (American Cancer Society, 2019c; NCI, 2021)
Immunotherapy employs an individual’s immune system to fight cancer either by stimulating the immune cells to work more effectively against cancer cells or by providing synthetic proteins that support the immune system. Also known as biologic therapy or biotherapy, these medications are administered by IV, oral, topical or intravesical (directly into the bladder) routes.
Types of immunotherapy include:
  • Checkpoint inhibitors – allow the T cells (white blood cells) to kill cancer cells; prevent cancer cells from avoiding the immune system
  • Adoptive cell transfer – improve the natural ability of T cells to fight cancer by growing T cells from the tumor itself
  • Cancer-specific vaccines – boost the immune system’s response to cancer cells
Signal Transduction Inhibitors (NCI, 2021)
Signal transduction inhibitors impede molecules that help cells react to signals from the environment. Cancer cells are stimulated to divide unceasingly without signals from external growth factors. Signal transduction inhibitors prevent this inappropriate signaling.

Gene Expression Modulators (NCI, 2021)
Cancer may develop from a gene that does not normally express in a cell; rather it mutates causing uncontrolled cell growth. Gene expression modulators change the way proteins participate in gene expression.

Apoptosis Inducers
Apoptosis is a process the body uses to get rid of nonessential or abnormal cells through programmed cell death. Some cancer cells can evade this mechanism. Apoptosis inducers provoke cancer cells to self-destruct.

Angiogenesis Inhibitors
Angiogenesis inhibitors target molecules that stimulate new blood vessel formation to tumors thus preventing further growth.

Monoclonal Antibodies
Monoclonal antibodies, created in the lab, deliver toxic substances (radioactive or poisonous chemical) causing cancer cell death. The toxin will not impact normal cells (cells lacking the antibody target).

Stem Cell Transplant (American Cancer Society, 2020)

Stem cell transplants (peripheral blood, bone marrow, and cord blood transplants) are used to treat patients with leukemia, lymphoma, neuroblastoma and multiple myeloma. This therapy replaces the stem cell components (white blood cells, red blood cells, platelets) within the bone marrow that may have been destroyed by cancer, chemotherapy and radiation.
Transplants can be:
  • Autologous – stem cells are donated by the patient
  • Allogeneic – stem cells are donated from another person
  • Syngeneic – stem cells come from an identical twin
In most cases, stem cell transplants do not fight cancer but instead help the body recover from the effects of chemotherapy and radiation. In some cases, allogeneic stem cell transplants may have a graft-versus-tumor effect causing white blood cells from the donor to attack cancer cells. However, allogeneic transplants may also cause graft-versus-host disease in which white blood cells from the donor attack the recipient’s normal cells. This may damage the skin, liver, intestines and other organs. Graft-versus-host disease can be treated with steroids or other immunosuppressant drugs. Additional side effects include bleeding and increased risk of infection.