near the tumor for testing. Minimally invasive surgeries allow the surgeon to use a laparoscope to find and remove cancerous tissue. The advantages of minimally invasive procedures are smaller incisions and faster recovery time. The goal of surgery is often to remove the entire tumor, but there are cases when this is not possible. Debulking is the Chemotherapy Chemotherapy is the use of drugs to treat disease. In the case of cancer, the goal is to stop or slow the growth of cancer cells. There are more than 100 chemotherapy drugs in use either alone or in combination with other treatments. These drugs vary in their usefulness, side effects, and chemical composition. They can be used to cure certain forms of cancer and to lessen the probability that it will return. For other types of cancer, chemotherapy can shrink tumors that may be causing pain or pressure on surrounding tissues. Many chemotherapy agents work by interrupting the cell cycle, but they are not able to differentiate between normal reproducing cells and cancer cells. The American Cancer Society (2019) states that chemotherapy drugs can be divided into groups based on their chemical structure, how they work, and their interactions with other drugs. The latter is particularly important if more than one drug is needed for treatment. Some drugs belong to more than one group because they may act differently under certain circumstances. The two broad categories of chemotherapy drugs are non-specific agents and targeted therapies. Non-specific agents damage cells and limit their ability to reproduce; these agents often impact non-cancerous cells as well. Targeted therapies are tailored treatments that attack unique molecular characteristics of a tumor cell. Chemotherapy treatments are often delivered in six to eight cycles given every three weeks. Non-specific chemotherapy agents Alkylating agents work in all phases of the cell cycle by directly damaging the DNA of the cell to prevent it from reproducing. They are used to treat a variety of cancers, including sarcoma, multiple myeloma, leukemia, lymphoma, and Hodgkin disease. Their effect on the DNA can cause long-term damage to bone marrow and, in rare cases, lead to acute leukemia. Alkylating agents are divided into the following classes: ● Nitrogen mustards : Mechlorethamine, chlorambucil, cyclophosphamide, melphalan, and ifosfamide. ● Nitrosoureas : Streptozocin, lomustine, and carmustine. ● Alkyl sulfonates : Busulfan. ● Ethylenimines : Altretamine and thiotepa. ● Triazines : Dacarbazine and temozolomide. Antimetabolites disrupt both DNA and RNA growth by substituting during the cell cycle when the cell’s chromosomes are replicating. These agents are often used to treat forms of breast cancer, leukemia, ovarian cancer, and intestinal cancers. Examples of antimetabolites include the following: ● Capecitabine. ● Cytarabine. ● 5-flouroouracil. ● 6-mercaptopurine.
technique used to remove as much of the tumor as possible, when removing the entire tumor could damage organs or other healthy tissues. Surgery can also be used to ease symptoms by removing tumors that are causing pain or pressure on healthy structures including nerves. As with any surgery, patients could be at risk for increased pain or infection after the procedure. ● Doxorubicin. ● Daunorubicin. ● Idarubicin. Examples of anti-tumor antibiotics that are not anthracyclines include: ● Mitomycin-C. ● Bleomycin. ● Mitoxantrone. ● Actinomycin-D. Mitotic inhibitors interrupt cell reproduction primarily by stopping mitosis in the M phase of the cell cycle. However, they can cause cell damage in all phases by preventing enzymes from making necessary proteins. Examples of mitotic inhibitors include: ● Epothilones. ● Vinca alkaloids (vinblastine, vincristine, and vinorelbine). ● Estramustine. ● Taxanes. Topoisomerase inhibitors interfere with topoisomerases, enzymes that separate DNA strands before they are copied in S phase of the cell cycle. These drugs are used in the treatment of some forms of leukemia, lung, ovarian, gastrointestinal, and other cancers. There are two categories of topoisomerase inhibitors determined by the type of enzyme they impact: ● Topoisomerase I inhibitors:
○ Topotecan. ○ Irinotecan. ● Topoisomerase II inhibitors:
○ Teniposide. ○ Etoposide. ○ Mitoxantrone.
Corticosteroids are naturally-occurring hormones and hormone- like drugs that are used in several types of conditions. They are considered to be chemotherapy drugs when used in the treatment of cancer. Corticosteroids can help prevent severe allergic reactions when used before other chemotherapy agents. They may also help prevent nausea and vomiting caused by some forms of chemotherapy. Examples of corticosteroids include: ● Dexamethasone. ● Prednisone. ● Methylprednisolone. Targeted chemotherapy agents Targeted chemotherapy agents are a newer class of drugs with more specific methods for attacking cancer cells. They can attack cells that have an abnormal number of a certain gene or cells that have altered versions of certain genes. Differentiating agents can cause premature cancer cells to mature into normal cells. These agents are the focus of many research studies looking for new ways to treat cancer and prevent recurrence. Examples of targeted agents include: ● Bortezomib.
● Fludarabine. ● Floxuridine. ● Hydroxyurea. ● Methotrexate. ● Pemetrexed. ● Gemcitabine.
Anti-tumor antibiotics alter the DNA inside of cancer cells, preventing them from growing and replicating. A widely used type of anti-tumor antibiotic are anthracyclines. These drugs work in all phases of the cell cycle and they interfere with enzymes involved in the replication of DNA. There are lifetime dose limits for anthracyclines because permanent heart damage can result from high doses. Examples of anthracyclines include: ● Epirubicin.
● Gefitinib. ● Imatinib. ● Sunitinib. Examples of differentiating agents include: ● Tretinoin. ● Bexarotene. ● Retinoids. ● Arsenic trioxide.
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