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INTRODUCTION

According to the Centers for Disease Control and Prevention, cancer ranks second place as the leading cause of death in the United States1. Nearly 1.7 million cases were projected for the year of 2016 with an estimated 600,000 deaths caused by cancer in the United States. About 39.6% of all Americans will be diagnosed with cancer in their lifetime.

Cancer consists of more than 100 different diseases that are characterized by uncontrolled cellular growth, local tissue invasion, and distant metastases. Normal healthy cells are strictly regulated by a delicate balance between stimulatory and inhibitory signals. Normal cells are thought to become cancer cells when a physical, chemical or biological agent must have damaged the cells and cause a genetic alteration that is subsequently propagated during cell division. This eventually results in multiple alterations within the cell leading to unlimited growth, invasion, and metastases.

Diagnosis and staging of cancer provides treatment goals and allows healthcare providers to select the most appropriate therapy for cancer. The treatment goal may be cure, control, or palliation. An anticancer therapy typically includes a combination of anticancer medications, surgery, and radiation therapy.

ONCOLOGY CLINICAL PEARLS

To break it down into basics, we want to ensure you get the main takeaway points for chemotherapy2,3,4.

First, chemotherapy has many side effects (see figure 1 below). This is due to the difficulty of differentiating cancer cells from non-cancer cells. Most cytotoxic chemotherapies target rapidly dividing cells so many side effects seen are rapidly dividing cells that occur naturally such as hair growth, bone marrow, and lining of the GI tract and mucous membranes. This is where some of the respective side effects come in such as hair loss, anemia, nausea/vomiting, and sores/ulcers in the mouth and esophagus (mucositits).

Figure 1

Anti-Neoplastic Man

BMS = Bone marrow suppression; CNS = Central nervous system; GI = Gastrointestinal

*Other Anthracyclines (i.e. daunorubicin [Cerubidine®], epirubicin [Ellence®], etc.) can also cause cardiac toxicity

Chemotherapy can be divided into cell cycle specific and cell cycle non-specific. Most chemo agents are dosed based off a patient's body surface area (BSA) which is based on the meters squared (m2) of the surface area of the body, and most parenteral doses (IV, SubQ, IM, etc.) will be represented as mg/m2. The exception is carboplatin as it's dosed with the Calvert Formula and is based off the amount of exposure (AUC) and the kidney function (CrCl, Creatinine Clearance). Lastly, note that anthracyclines are bright red in color and similarly to rifampin may cause the urine, tears, secretions to be red in color.

Second, with recent advances in cancer we ...

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