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  • imageCarcinogenesis is a multistep process that includes initiation, promotion, conversion, and progression.

  • imageCancer cells demonstrate unique traits that distinguish them from normal cells. Cancer cells can stimulate their own growth, resist inhibitory signals, avoid programmed cell death, grow new blood vessels (angiogenesis), invade local tissues, and spread to distant sites (ie, metastases).

  • imageScreening programs are designed to detect cancers in asymptomatic people who are at risk of a specific cancer.

  • imageDiagnosis and staging informs the treatment goals and helps select the most appropriate anticancer therapy. The treatment goal may be cure, control, or palliation. The therapy may include a combination of surgery, radiation therapy, or systemic anticancer agents. Systemic anticancer agents include chemotherapy, targeted agents, and immunotherapy.

  • imageChemotherapy inhibits cancer growth by killing rapidly proliferating cells. These agents can be categorized as either cell-cycle phase-specific, targeting one specific phase of the cell cycle, or cell-cycle phase-nonspecific, targeting all proliferating cells regardless of their place in the cell cycle. Cell-cycle phase-specific chemotherapy is generally given more frequently or as a continuous infusion and cell-cycle phase-nonspecific chemotherapy is usually given less frequently.

  • imageSmall molecule targeted agents inhibit kinases or enzymes responsible for the activation of various proteins that form intracellular signaling cascades. These agents treat cancer by correcting a dysregulated signaling pathway.

  • imageBiologic therapies include cytokines, vaccines, growth factors, and monoclonal antibodies (mAbs) with most biologic therapies classified as mAbs. A mAb recognizes an antigen that is expressed preferentially on cancer cells or immune cells or targets growth factors responsible for cancer growth. These antibodies can also be used to deliver drugs, radioisotopes, or toxins to the antigen-expressing cells.

  • imageVarious factors can affect the response and toxicities a patient may experience with anticancer therapy. When determining the optimal therapy, the health professional should carefully consider patient-specific factors, tumor-specific factors, and treatment goals.

  • imageMyelosuppression is a common acute dose-limiting toxicity for chemotherapy agents. Common toxicities associated with small molecular and mAb-targeted agents are typically related to the interference with an intracellular signaling pathway or the alteration of the immune system and may occur several months after starting therapy.


Preclass Engaged Learning Activity


Fill in the blanks of the Cytotoxic Chemotherapy Table from the list of chemotherapy agents.

Chemotherapy Agents: cabazitaxel, bleomycin, gemcitabine, cisplatin, pemetrexed, ifosfamide, lenalidomide, topotecan, vinblastine, bortezomib, capecitabine, etoposide phosphate, temozolomide, doxorubicin, etoposide, pomalidomide, mercaptopurine, docetaxel, belinostat, oxaliplatin, epirubicin, carmustine, fluorouracil, vorinostat, vinorelbine, pentostatin, carfilzomib

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