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Encyclopedia > Chemotherapeutics

Chemotherapy is the use of chemical substances to treat disease. In its modern-day use, it refers primarily to cytotoxic drugs used to treat cancer. Cytotoxicity is the quality of being poisonous to cells. ... When normal cells are damaged beyond repair, they are eliminated by apoptosis. ...


In its non-oncological use, the term may also refer to antibiotics (antibacterial chemotherapy). In that sense, the first modern chemotherapeutic agent was Paul Ehrlich's arsphenamine, an arsenic compound discovered in 1909 and used to treat syphilis. This was later followed by sulfonamides discovered by Domagk and penicillin G discovered by Alexander Fleming. Oncology is the medical subspecialty dealing with the study and treatment of cancer. ... An antibiotic is a drug that kills or slows the growth of bacteria. ... Paul Ehrlich Paul Ehrlich (March 14, 1854 – August 20, 1915) was a German scientist who won the 1908 Nobel Prize in Physiology or Medicine. ... Arsphenamine is a drug that was used to treat syphilis and trypanosomiasis. ... 1909 (MCMIX) was a common year starting on Friday (see link for calendar). ... Syphilis is a sexually transmitted infection (STI) that is caused by a spirochaete bacterium, Treponema pallidum. ... In chemistry, the sulfonamide functional group is -S(=O)2-NH2, a sulfone group connected to an amine group. ... Gerhard Johannes Paul Domagk (October 30, 1895 - April 24, 1964) was a German pathologist and bacteriologist and Nobel laureate. ... Penicillin nucleus Penicillin refers to a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ... Alexander Fleming Sir Alexander Fleming (August 6, 1881 – March 11, 1955) was a British biologist and pharmacologist. ...


Other uses of cytostatic chemotherapy agents (including the ones mentioned below) are the treatment of autoimmune diseases such as multiple sclerosis and rheumatoid arthritis, the treatment of some chronic viral infections such as Hepatitis, and the suppression of transplant rejections (see immunosuppression and DMARDs). Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ... Hepatitis is a gastroenterological disease, featuring inflammation of the liver. ... Transplant rejection occurs when the immune system of the recipient of an transplant attacks the transplanted organ or tissue. ... Immunosuppression is the medical suppression of the immune system. ... Disease-modifying antirheumatic drugs is a category of drugs used in many autoimmune diseases to slow down disease progression. ...

Contents


History

Main article: History of cancer chemotherapy

The era of chemotherapy began in the 1940s with the first uses of nitrogen mustards and folic acid inhibitors. Cancer drug development since then has exploded into a multi-billion dollar industry. The targeted-therapy revolution has arrived, but the principles and limitations of chemotherapy discovered by the early researchers still apply. The era of chemotherapy began in the 1940s with the first uses of nitrogen mustards and folic acid antagonist drugs. ... The nitrogen mustards are cytotoxic chemotherapy agents similar to mustard gas. ... Folic acid and folate (the anion form) are forms of a water-soluble B vitamin. ... When normal cells are damaged beyond repair, they are eliminated by apoptosis. ...


Principles

Cancer is the uncontrolled growth of cells due to damage to DNA (mutations) and, occasionally, due to an inherited propensity to develop certain tumours. Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body - in other words, the body attacks its own cells. In contrast, transplant rejection happens because a normal healthy human immune system can distinguish foreign tissues and attempts to destroy them. Also the reverse situation, called graft-versus-host disease, may take place. When normal cells are damaged beyond repair, they are eliminated by apoptosis. ... Cells in culture, stained for keratin (red) and DNA (green). ... The general structure of a section of DNA Deoxyribonucleic acid (DNA) is a nucleic acid —usually in the form of a double helix— that contains the genetic instructions specifying the biological development of all cellular forms of life, and most viruses. ... In biology, mutations are changes to the genetic material (usually DNA or RNA). ... A genetic disorder, or genetic disease is a disease caused by abnormal expression of one or more genes in a person causing a clinical phenotype. ... Tumor (American English) or tumour (British English) originally means swelling, and is sometimes still used with that meaning. ... Autoimmune diseases arise from an overactive immune response of the body against substances and tissues normally present in the body. ... Transplant rejection occurs when the immune system of the recipient of an transplant attacks the transplanted organ or tissue. ... Graft-versus-host disease is a common complication of allogeneic bone marrow transplantation. ...


Broadly, most chemotherapeutic drugs work by impairing mitosis (cell division), effectively targeting fast-dividing cells. As these drugs cause damage to cells they are termed cytotoxic. Some drugs cause cells to undergo apoptosis (so-called "cell suicide"). Light micrograph of a newt kidney cell in early anaphase of mitosis. ... This article or section does not cite its references or sources. ... A cell undergoing apoptosis. ...


Unfortunately, scientists have yet to be able to locate specific features of malignant and immune cells that would make them uniquely targetable (barring some recent examples, such as the Philadelphia chromosome as targeted by imatinib). This means that other fast dividing cells such as those responsible for hair growth and for replacement of the intestinal epithelium (lining) are also affected. However, some drugs have a better side-effect profile than others, enabling doctors to adjust treatment regimens to the advantage of patients in certain situations. Philadelphia chromosome or Philadelphia translocation is a specific genetic, chromosomal abnormality that is associated with chronic myelogenous leukemia (CML) and involves an exchange of material between chromosomes 9 and 22. ... Imatinib is a drug used to treat certain types of cancer. ... Young Girl Fixing her Hair, by Sophie Gengembre Anderson Hair is a filamentous outgrowth from the skin, found mainly in mammals. ... The intestine is the portion of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ... In zootomy, epithelium is a tissue composed of a layer of cells. ... Adverse effect, in medicine, is an abnormal, harmful, undesired and/or unintended side-effect, although not necessarily unexpected, which is obtained as the result of a therapy or other medical intervention, such as drug/chemotherapy, physical therapy, surgery, medical procedure, use of a medical device, etc. ...


As chemotherapy affects cell division, tumours with high growth fractions (such as acute myelogenous leukemia and the lymphomas, including Hodgkin's disease) are more sensitive to chemotherapy, as a larger proportion of the targeted cells are undergoing cell division at any time. Acute myelogenous leukemia (AML), also known as acute myeloid leukemia, is a cancer of the myeloid line of blood cells. ... Lymphoma is a variety of cancer that originates in the lymphatic system. ... This article or section does not cite its references or sources. ...


Chemotherapeutic drugs affect "younger" tumours (i.e. less differentiated) more effectively, because at a higher grade of differentiation, the propensity to growth usually decreases. Near the center of some solid tumours, cell division has effectively ceased, making them insensitive to chemotherapy. Another problem with solid tumours is the fact that the chemotherapeutic agent often does not reach the core of the tumour. Solutions to this problem include radiation therapy (both brachytherapy and teletherapy) and surgery. Clinac 2100 C accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Sealed source radiotherapy or brachytherapy or endocurietherapy is the application of radiation from close range and is used for techniques where the radioactive source is placed inside the area requiring treatment. ... External beam radiotherapy otherwise known as teletherapy, is the mostfrequently used form of radiotherapy. ... A thoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center, November 1990. ...


Types

The majority of chemotherapeutic drugs can be divided in to: alkylating agents, antimetabolites, anthracyclines, plant alkaloids, topoisomerase inhibitors, and antitumour agents. All of these drugs affect cell division or DNA synthesis and function in some way. Alkylating agents are so named because of their ability to add alkyl groups to many electronegative groups under conditions present in cells. ... An antimetabolite is a chemical with a similar structural to a substance (a metabolite) required for normal biochemical reactions, yet different enough to interfere with the normal functions of cells, including cell division. ... Anthracycline - Wikipedia, the free encyclopedia /**/ @import /skins-1. ... An alkaloid is a nitrogenous organic molecule that has a pharmacological effect on humans and animals. ... Topoisomerases (type I: EC 5. ... This article or section does not cite its references or sources. ... The general structure of a section of DNA Deoxyribonucleic acid (DNA) is a nucleic acid —usually in the form of a double helix— that contains the genetic instructions specifying the biological development of all cellular forms of life, and most viruses. ...


Some newer agents don't directly interfere with DNA. These include the new tyrosine kinase inhibitor imatinib mesylate (Gleevec® or Glivec®), which directly targets a molecular abnormality in certain types of cancer (chronic myelogenous leukemia, gastrointestinal stromal tumors). Tyrosine kinases are a subclass of protein kinase, see there for the principles of protein phosphorylation A tyrosine kinase (EC 2. ... Imatinib is a drug used to treat certain types of cancer. ... Chronic myelogenous leukemia or Chronic myeloid leukaemia (CML) is a form of chronic leukemia characterized by increased production of myeloid cells in the bone marrow. ... Endoscopic image of GIST in fundus of stomach, seen on retroflexion. ...


In addition, some drugs may be used which modulate tumour cell behaviour without directly attacking those cells. Hormone treatments fall into this category of adjuvant therapies.


Where available, Anatomical Therapeutic Chemical Classification System codes are provided for the major categories. The Anatomical Therapeutic Chemical Classification System is used for the classification of drugs. ...


Alkylating agents (L01A)

See main article: alkylating agent A section of the Anatomical Therapeutic Chemical Classification System. ... Alkylating agents are so named because of their ability to add alkyl groups to many electronegative groups under conditions present in cells. ...


Alkylating agents are so named because of their ability to add alkyl groups to many electronegative groups under conditions present in cells. It has been suggested that this article or section be merged with electronegativity. ...


Anti-metabolites (L01B)

See main article: antimetabolite A section of the Anatomical Therapeutic Chemical Classification System. ... An antimetabolite is a chemical with a similar structural to a substance (a metabolite) required for normal biochemical reactions, yet different enough to interfere with the normal functions of cells, including cell division. ...


Anti-metabolites masquerade as purine ((azathioprine, mercaptopurine)) or pyrimidine - which become the building blocks of DNA. They prevent these substances becoming incorporated in to DNA during the "S" phase (of the cell cycle), stopping normal development and division. They also affect RNA synthesis. Due to their efficiency, these drugs are the most widely used cytostatics. An antimetabolite is a chemical with a similar structural to a substance (a metabolite) required for normal biochemical reactions, yet different enough to interfere with the normal functions of cells, including cell division. ... Purine is a heterocyclic aromatic organic compound, consisting of a pyrimidine ring fused to an imidazole ring. ... Mercaptopurine: chemical structure Mercaptopurine (also called 6-MP or by its brand name Purinethol®) is an immunosuppressive drug used to treat leukemia. ... Pyrimidine is a heterocyclic aromatic organic compound similar to benzene and pyridine, containing two nitrogen atoms at positions 1 and 3 of the six-member ring. ... The cell cycle, or cell-division cycle (CDC), is the cycle of events in a eukaryotic cell from one cell division to the next. ...


Plant alkaloids and terpenoids (L01C)

These alkaloids are derived from plants and block cell division by preventing microtubule function. Microtubules are vital for cell division and without them it can not occur. The main examples are vinca alkaloids and taxanes. A section of the Anatomical Therapeutic Chemical Classification System. ... An alkaloid is a nitrogenous organic molecule that has a pharmacological effect on humans and animals. ... Divisions Land plants (embryophytes) Non-vascular plants (bryophytes) Marchantiophyta - liverworts Anthocerotophyta - hornworts Bryophyta - mosses Vascular plants (tracheophytes) Lycopodiophyta - clubmosses Equisetophyta - horsetails Pteridophyta - true ferns Psilotophyta - whisk ferns Ophioglossophyta - adderstongues Seed plants (spermatophytes) †Pteridospermatophyta - seed ferns Pinophyta - conifers Cycadophyta - cycads Ginkgophyta - ginkgo Gnetophyta - gnetae Magnoliophyta - flowering plants Adiantum pedatum (a fern... Microtubules are protein structures found within cells, one of the components of the cytoskeleton. ... Species Vinca difformis Vinca herbacea Vinca major Vinca minor Periwinkle () is a genus of four species of evergreen subshrubs in the family Apocynaceae, native to Europe, northwest Africa and southwest Asia. ... The taxanes are a widely used class of chemotherapy drugs. ...


Vinca alkaloids (L01CA)

Vinca alkaloids bind to specific sites on tubulin, inhibiting the assembly of tubulin into microtubules (M phase of the cell cycle). They are derived from the Madagascar periwinkle, Catharanthus roseus (formerly known as Vinca rosea). The vinca alkaloids include: - A section of the Anatomical Therapeutic Chemical Classification System. ... Overview of the major events in mitosis In biology, mitosis is the process of chromosome segregation and nuclear division that follows replication of the genetic material in eukaryotic cells. ... The cell cycle, or cell-division cycle (CDC), is the cycle of events in a eukaryotic cell from one cell division to the next. ... Species Catharanthus coriaceus Catharanthus lanceus Catharanthus longifolius Catharanthus ovalis Catharanthus pusillus Catharanthus roseus Catharanthus scitulus Catharanthus trichophyllus Madagascar Periwinkle (Catharanthus) is a genus of eight species of herbaceous perennial plants, seven endemic to the island of Madagascar, the eighth, , from Sri Lanka. ...

Vincristine (Oncovin®) is an alkaloid from the Madagascar periwinkle (Catharanthus roseus, formerly Vinca rosea and hence its name). ... Vinblastine is a drug used to treat certain kinds of cancer, including Hodgkins lymphoma, non-small cell lung cancer and breast cancer or testicular cancer. ... Vinorelbine (Navelbine) is a chemotherapy drug that is given as a treatment for some types of cancer including breast cancer and non-small-cell lung cancer. ...

Podophyllotoxin (L01CB)

Podophyllotoxin is a plant-derived compound used to produce two other cytostatic drugs, etoposide and teniposide. They prevent the cell from entering the G1 phase (the start of DNA replication) and the replication of DNA (the S phase). The exact mechanism of its action still has to be elucidated. A section of the Anatomical Therapeutic Chemical Classification System. ... Podophyllin is a drug obtained from the rhizome of the American Mayapple (‘’Podophyllum peltatum’’), an herbaceous perennial belonging to the natural order Berberidaceae, indigenous in woods in Canada and the United States. ... Etoposide: chemical structure Etoposide phosphate (Eposin®, Etopophos®, Vepesid®, VP-16®) is an inhibitor of the enzyme topoisomerase II. It is used as a form of chemotherapy for malignancies such as lung cancer, testicular cancer, lymphoma, non-lymphocytic leukemia, and glioblastoma multiforme. ... Teniposide is a prescribed medication mainly used to treat childhood acute lymphocytic leukemia. ... The G1 phase is a period in the cell cycle during interphase, between mitosis and the S phase. ... DNA replication. ...


The substance has been primarily obtained from the American Mayapple (Podophyllum peltatum). Recently it has been discovered that a rare Himalayan Mayapple (Podophyllum hexandrum) contains it in a much greater quantity, but as the plant is endangered, its supply is limited. Studies have been conducted to isolate the genes involved in the substance's production, so that it could be obtained recombinantively. Binomial name Podophyllum peltatum L. The American Mayapple (Podophyllum peltatum) is a herbaceous perennial plant in the family Berberidaceae, native to the eastern part of North America. ... Binomial name Podophyllum hexandrum Royle The perennial herb Podophyllum hexandrum (syn. ... An autoluminograph from 1986 of a glowing transgenic tobacco plant bearing the luciferase gene of the firefly, illustrating the possibilities of genetic engineering. ...


Taxanes (L01CD)

Taxanes are derived from the Yew Tree. Paclitaxel is derived from the bark of the European Yew Tree while Docetaxel is derived from the pine needle of the Pacific Yew Tree Taxanes enhance stability of microtubules, preventing the separation of chromosomes during anaphase. Taxanes include: - A section of the Anatomical Therapeutic Chemical Classification System. ... Figure 1: Chromosome. ... A lung cell of a newt during early anaphase of mitosis. ...

Paclitaxel (Taxol®) is a drug used in the treatment of cancer. ... Docetaxel chemical structure Docetaxel is a chemotherapy drug used in the treatment of cancer. ...

Topoisomerase inhibitors (L01CB and L01XX)

Topoisomerases are essential enzymes that maintain the topology of DNA. Inhibition of type I or type II topoisomerases interferes with both transcription and replication of DNA by upsetting proper DNA supercoiling. A section of the Anatomical Therapeutic Chemical Classification System. ... A section of the Anatomical Therapeutic Chemical Classification System. ... Topoisomerases (type I: EC 5. ... Ribbon diagram of the enzyme TIM. TIM is catalytically perfect, meaning its conversion rate is limited, or nearly limited to its substrate diffusion rate. ... Topology (Greek topos, place and logos, study) is a branch of mathematics concerned with spatial properties preserved under bicontinuous deformation (stretching without tearing or gluing); these are the topological invariants. ... Transcription is the process through which a DNA sequence is enzymatically copied by an RNA polymerase to produce a complementary RNA. Or, in other words, the transfer of genetic information from DNA into RNA. In the case of protein-encoding DNA, transcription is the beginning of the process that ultimately... DNA replication. ... It has been suggested that this article or section be merged with Superhelix. ...

  • Examples of type II inhibitors include amsacrine, etoposide, etoposide phosphate, and teniposide. These are semisynthetic derivatives of epipodophyllotoxins, alkaloids naturally occurring in the root of mayapple (Podophyllum peltatum).

Irinotecan is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... Topotecan (Hycamtin®) is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... Etoposide: chemical structure Etoposide phosphate (Eposin®, Etopophos®, Vepesid®, VP-16®) is an inhibitor of the enzyme topoisomerase II. It is used as a form of chemotherapy for malignancies such as lung cancer, testicular cancer, lymphoma, non-lymphocytic leukemia, and glioblastoma multiforme. ... Etoposide phosphate (Eposin®, Etopophos®, Vepesid®, VP-16®) is an inhibitor of the enzyme topoisomerase II. It is used as a form of chemotherapy for malignancies such as lung cancer, testicular cancer, lymphoma, non-lymphocytic leukemia, and glioblastoma multiforme. ... Teniposide is a prescribed medication mainly used to treat childhood acute lymphocytic leukemia. ...

Antitumour antibiotics (L01D)

See main article: antineoplastic A section of the Anatomical Therapeutic Chemical Classification System. ... herbs that have the specific action of inhibiting and combating the development of tumors. ...


The most important immunosuppressant from this group is dactinomycin, which is used to in kidney transplantations. Actinomycin is any of a class of polypeptide antibiotics isolated from soil bacteria of the genus Streptomyces. ...


Hormonal therapy

Several malignancies respond to hormonal therapy. Strictly speaking, this is not chemotherapy. Cancer arising from certain tissues, including the mammary and prostate glands, may be inhibited or stimulated by appropriate changes in hormone balance. This article needs cleanup. ...

Some other tumours are also hormone dependent, although the specific mechanism is still unclear. A steroid is a lipid characterized by a carbon skeleton with four fused rings. ... Dexamethasone is a synthetic member of the glucocorticoid class of hormones. ... Edema (BE: oedema, formerly known as dropsy) is swelling of any organ or tissue due to accumulation of excess fluid. ... Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. ... Finasteride (marketed as Proscar®, Propecia®, Fincar®, Finpecia®, Finax®, Finast®, Finara®, Prosteride®) is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. ... Testosterone is a steroid hormone from the androgen group. ... Dihydrotestosterone (DHT) is a biologically active metabolite of the hormone testosterone, formed primarily in the prostate gland, testes, hair follicles, and adrenal glands by the enzyme 5α-reductase by means of reducing the Δ4,5 double-bond. ... Breast cancer is cancer of breast tissue. ... Estrogens (also oestrogens) are a group of steroid compounds, named for their importance in the oestrus cycle, functioning as the primary female sex hormone. ... Progesterone is a C-21 steroid hormone involved in the female menstrual cycle, pregnancy (supports gestation) and embryogenesis of humans and other species. ... Aromatase inhibitors (AI) are a class of drugs used in the treatment of breast cancer in post- menopausal women. ... Tamoxifen is an oral selective estrogen receptor modulator which is used in breast cancer treatment, and is currently the worlds largest selling breast cancer treatment. ... Goserelin is an injectable luteinising hormone-releasing hormone analogue (LHRHa). ... Follicle stimulating hormone Follicle stimulating hormone (FSH) is a hormone synthesised and secreted by gonadotropes in the anterior pituitary gland. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... A hormone (from Greek horman - to set in motion) is a chemical messenger from one cell (or group of cells) to another. ...


Dosage

Dosage of chemotherapy can be difficult: if the dose is too low, it will be ineffective against the tumor, while at excessive doses the toxicity (side-effects, neutropenia) will be intolerable to the patient. This has led to the formation of detailed "dosing schemes" in most hospitals, which give guidance on the correct dose and adjustment in case of toxicity. In immunotherapy, they are in principle used in smaller dosages than in the treatment of malign diseases. It has been suggested that Agranulocytosis be merged into this article or section. ...


In most cases, the dose is adjusted for the patient's body surface area, a composite measure of weight and height that mathematically approximates the body volume. The BSA is usually calculated with a mathematical formula or a nomogram, rather than by direct measurement. In physiology and medicine, the body surface area (BSA) is the measured or calculated surface of a human body. ... A nomogram or nomograph is a graphical calculating device, a two-dimensional diagram designed to allow the approximate graphical computation of a function. ...


Delivery

Most chemotherapy is delivered intravenously, although there are a number of agents that can be administered orally (e.g. melphalan and gemcitabine). Depending on the patient, the cancer, the stage of cancer, the type of chemotherapy, and the dosage, IV chemotherapy may be given on either an inpatient or outpatient basis. For continuous, frequent or prolonged IV chemotherapy administration, various systems may be surgically inserted into the vasculature to maintain access. Commonly used systems are the Hickman line, the Port-a-Cath or the PICC line. These have a lower infection risk, are much less prone to phlebitis or extravasation, and abolish the need for repeated insertion of peripheral cannulae. In pharmacology and toxicology, a route of administration is the path by which a drug, fluid, poison or other substance is brought into contact with the body 1. ... An intravenous drip in a hospital Intravenous therapy or IV therapy is the administration of liquid substances directly into a vein. ... Melphalan chemical structure Melphalan hydrochloride ( Alkeran®) is a chemotherapy drug belonging to the class of alkylating agents. ... Gemcitabine is a nucleoside used as chemotherapy. ... A hospital today is an institution for professional health care provided by physicians and nurses. ... A hospital today is an institution for professional health care provided in part by physicians and nurses. ... A Hickman line in a leukemia patient. ... A Port-a-Cath® is a device for intravenous access in patients who require frequent or continuous administration of intravenous substances. ... A peripherally inserted central catheter (PICC or PICC line) is a form of intravenous access that can be used for a prolonged period of time, e. ... Phlebitis is an inflammation of a vein, usually in the legs. ...


Treatment schemes

There are a number of strategies in the administration of chemotherapeutic drugs used today. Chemotherapy may be given with a curative intent or it may aim to prolong life or to palliate symptoms.


Combined modality chemotherapy is the use of drugs with other cancer treatments, such as radiation therapy or surgery. Most cancers are now treated in this way. Combination chemotherapy is a similar practice which involves treating a patient with a number of different drugs simultaneously. The drugs differ in their mechanism and side effects. The biggest advantage is minimising the chances of resistance developing to any one agent. When normal cells are damaged beyond repair, they are eliminated by apoptosis. ... Clinac 2100 C accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... A thoracic surgeon performs a mitral valve replacement at the Fitzsimons Army Medical Center, November 1990. ...


In neoadjuvant chemotherapy (preoperative treatment) initial chemotherapy is aimed for shrinking the primary tumour, thereby rendering local therapy (surgery or radiotherapy) less destructive or more effective.


Adjuvant chemotherapy (postoperative treatment) can be used when there is little evidence of cancer present, but there is risk of recurrence. This can help reduce chances of resistance developing if the tumour does develop. It is also useful in killing any cancerous cells which have spread to other parts of the body. This is often effective as the newly growing tumours are fast-dividing, and therefore very susceptible.


Palliative chemotherapy is given without curative intent, but simply to decrease tumor load and increase life expectancy. For these regimens, a better toxicity profile is generally expected.


Most chemotherapy regimens require that the patient is capable to undergo the treatment. Performance status is often used as a measure to determine whether a patient can receive chemotherapy, or whether dose reduction is required. In medicine (oncology and other fields), performance status is an attempt to quantify cancer patients general wellbeing. ...


Side-effects

The treatment can be physically exhausting for the patient. Current chemotherapeutic techniques have a range of side effects mainly affecting the fast-dividing cells of the body. Important common side-effects include (dependent on the agent):

Alopecia is a set of disorders ranging from male and female pattern alopecia (alopecia androgenetica), to alopecia areata, which involves the loss of some of the hair from the head, alopecia totalis, which involves the loss of all head hair, to the most extreme form, alopecia universalis, which involves the... For other uses, see Nausea (disambiguation). ... Vomiting (or emesis) is the forceful expulsion of the contents of ones stomach through the mouth. ... Diarrhea or diarrhoea (see spelling differences) is a condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; lit. ... Constipation or Irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to eliminate; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ... This article discusses the medical condition. ... The immune system is the system of specialized cells and organs that protect an organism from outside biological influences. ... Infection is also the title of an episode of the television series Babylon 5, and the English title of the Japanese film Kansen. ... Sepsis (in Greek Σήψις, putrefaction) is a serious medical condition caused by a severe infection. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... A Secondary neoplasm refers to any of a class of cancerous tumors that are either metastatic offshoots of a primary tumor, or apparently unrelated tumors that increase in frequency following certain cancer treatments, including chemotherapy and radiotherapy. ... Cardiotoxicity is the occurrence of heart muscle damage. ... Hepatotoxicity (from hepatic toxicity) is chemical-driven liver damage. ... Nephrotoxicity is a poisonous effect of some substances, both toxins and medication, on the kidney. ... Ototoxicity is damage of the ear (oto), specifically the cochlea or auditory nerve and sometimes the vestibulum, by a toxin (often medication). ...

Immunosuppression and myelosuppression

Virtually all chemotherapeutic regimens can cause depression of the immune system, often by paralysing the bone marrow and leading to a decrease of white blood cells, red blood cells and platelets. The latter two, when they occur, are improved with blood transfusion. Neutropenia (a decrease of the neutrophil granulocyte count below 0.5 x 109/litre) can be improved with synthetic G-CSF (granulocyte-colony stimulating factor, e.g. filgrastim, lenograstim, Neupogen®, Neulasta®.) The immune system is the system of specialized cells and organs that protect an organism from outside biological influences. ... Grays Anatomy illustration of cells in bone marrow. ... White blood cells (a. ... Human red blood cells Red blood cells are the most common type of blood cell and are the vertebrate bodys principal means of delivering oxygen from the lungs or gills to body tissues via the blood. ... A 250 ml bag of newly collected platelets. ... Blood transfusion is the taking of blood or blood-based products from one individual and inserting them into the circulatory system of another. ... It has been suggested that Agranulocytosis be merged into this article or section. ... Neutrophil granulocytes, generally referred to as neutrophils, are a class of white blood cells and are part of the immune system. ... The litre or liter (see spelling differences) is a unit of volume. ... Granulocyte-Colony Stimulating Factor (G-CSF) is a glycoprotein, growth factor or cytokine produced by a number of different tissues to stimulate the bone marrow to produce granulocytes. ... Granulocytes are a category of white blood cells, characterised by the fact that all types have differently staining granules in their cytoplasm on light microscopy. ...


In very severe myelosuppression, which occurs in some regimens, almost all the bone marrow stem cells (cells which produce white and red blood cells) are destroyed, meaning allogenic or autologous bone marrow cell transplants are necessary. (In autologous BMTs, cells are removed from the patient before the treatment, multiplied and then re-injected afterwards; in allogenic BMTs the source is a donor.) However, some patients still develop diseases because of this interference with bone marrow. Mouse embryonic stem cells. ... White Blood Cells is also the name of a White Stripes album. ... Human red blood cells Red blood cells are the most common type of blood cell and are the vertebrate bodys principal means of delivering oxygen from the lungs or gills to body tissues via the blood. ... In biology, autologous refers to cells, tissues or even proteins that are reimplanted in the same individual as they come from. ... Bone marrow transplantation (BMT) or hematopoietic stem cell transplantation (HSCT) is a medical procedure in the field of hematology and oncology that involves transplantation of hematopoietic stem cells (HSC). ...


Nausea and vomiting

Nausea and vomiting caused by chemotherapy; stomach upset may trigger a strong urge to vomit, or forcefully eliminate what is in the stomach.


Stimulation of the vomiting center results in the coordination of responses from the diaphragm, salivary glands, cranial nerves, and gastrointestinal muscles to produce the interruption of respiration and forced expulsion of stomach contents known as retching and vomiting. The vomiting center is stimulated directly by afferent input from the vagal and splanchnic nerves, the pharynx, the cerebral cortex, cholinergic and histamine stimulation from the vestibular system, and efferent input from the chemoreceptor trigger zone (CTZ). The CTZ is in the area postrema, outside the blood-brain barrier, and is thus susceptible to stimulation by substances present in the blood or cerebral spinal fluid. The neurotransmitters dopamine and serotonin stimulate the vomiting center indirectly via stimulation of the CTZ.


The 5-HT3 inhibitors are the most effective antiemetics and constitute the single greatest advance in the management of nausea and vomiting in patients with cancer. These drugs are designed to block one or more of the signals that cause nausea and vomiting. The most sensitive signal during the first 24 hours after chemotherapy appears to be 5-HT3. Blocking the 5-HT3 signal is one approach to preventing acute emesis (vomiting), or emesis that is severe, but relatively short-lived. Approved 5-HT3 inhibitors include: dolasetron (Anzemet®), granisetron (Kytril®), and ondansetron (Zofran®). The newest 5-HT3 inhibitor, Aloxi® (palonosetron), has a distinct advantage over the other 5-HT3 inhibitors because, in addition to preventing acute nausea and vomiting, Aloxi® also prevents delayed nausea and vomiting, which occurs during the 2-5 days after treatment. Aloxi® is the only drug in its class that is approved by the FDA for the treatment of delayed nausea and vomiting.


Some studies[1] and patient groups claim that the use of cannabinoids derived from marijuana during chemotherapy greatly reduces the associated nausea and vomiting, and enables the patient to eat. Some synthetic derivatives of the active substance in marijuana (tetrahydrocannabinol or THC) such as Marinol may be practical for this application. Cannabinoids are a group of chemicals which activate the bodys cannabinoid receptors. ... Species Cannabis indica Cannabis ruderalis Cannabis sativa This is one of several related articles about cannabis. ... Tetrahydrocannabinol, also known as THC, Δ9-THC, Δ9-tetrahydrocannabinol (delta-9-tetrahydrocannabinol), Δ¹-tetrahydrocannabinol (using an older numbering scheme), or dronabinol, is the main psychoactive substance found in the Cannabis plant. ... Marinol. ...


Other side effects

In particularly large tumors, such as large lymphomas, some patients develop tumor lysis syndrome from the rapid breakdown of malignant cells. Although prophylaxis is available and is often initiated in patients with large tumors, this is a dangerous side-effect which can lead to death if left untreated. Lymphoma is a variety of cancer that originates in the lymphatic system. ... In medicine (oncology and hematology), tumor lysis syndrome is a complication of chemotherapy to particularly large tumors (e. ...


A proportion of patients reports fatigue or non-specific neurocognitive problems, such a inability to concentrate; this is colloquially referred to as "chemo brain" by patients' groups[2]


Chemotherapy may increase the risk of cardiovascular disease and occasionally leads to secondary cancer. It has been suggested that this article or section be merged with Coronary heart disease. ... When normal cells are damaged beyond repair, they are eliminated by apoptosis. ...


See also

When normal cells are damaged beyond repair, they are eliminated by apoptosis. ... Bold textMedia:Example. ... Experimental cancer treatments are medical therapies intended or claimed to treat cancer (see also tumor) by improving on, supplementing or replacing conventional methods (surgery, chemotherapy and radiation therapy). ... Chemotherapy regimens are often identified with acronyms, identifying the agents used in combination. ...

References

  1. ^ Tramer MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 2001;323:16-21. PMID 11440936.
  2. ^ Tannock IF, Ahles TA, Ganz PA, Van Dam FS. Cognitive impairment associated with chemotherapy for cancer: report of a workshop. J Clin Oncol 2004;22:2233-9. PMID 15169812.

Systematic reviews are named as the highest level of medical evidence, by evidence based medicine professionals. ... The British Medical Journal (BMJ) is a medical journal published weekly in the United Kingdom by the British Medical Association (BMA)which published its first issue in 1845. ...

External links

Chemotherapeutic agents edit - Chemotherapy regimens
Alkylating agents: Busulfan | Carboplatin | Chlorambucil | Cisplatin | Cyclophosphamide | Ifosfamide | Melphalan | Mechlorethamine | Oxaliplatin | Procarbazine | Uramustine
Antimetabolites: Azathioprine | Capecitabine | Cytarabine | Floxuridine | Fludarabine | Fluorouracil | Gemcitabine | Methotrexate | Pemetrexed
Plant alkaloids: Docetaxel | Etoposide | Paclitaxel | Vinblastine | Vincristine | (Vinorelbine)
Topoisomerase inhibitors: Irinotecan | Topotecan
Antitumour antibiotics: Bleomycin | Daunorubicin | Doxorubicin | Epirubicin | Hydroxyurea | Idarubicin | Mitomycin | Mitoxantrone
Tumors (and related structures), Cancer, and Oncology
Benign - Premalignant - Carcinoma in situ - Malignant

Topography: Anus - Bladder - Bone - Brain - Breast - Cervix - Colon/rectum - Duodenum - Endometrium - Esophagus - Eye - Gallbladder - Head/Neck - Liver - Larynx - Lung - Mouth - Pancreas - Penis - Prostate - Kidney - Ovaries - Skin - Stomach - Testicles - Thyroid Chemotherapy regimens are often identified with acronyms, identifying the agents used in combination. ... Alkylating agents are so named because of their ability to add alkyl groups to many electronegative groups under conditions present in cells. ... Busulfan is a chemotherapy drug that is an alkylating agent. ... Carboplatin is a chemotherapy drug used against some forms of cancer. ... Chlorambucil (marketed as Leukeran by GlaxoSmithKline) is a chemotherapy drug that has been mainly used in the treatment of chronic lymphocytic leukemia. ... Cisplatin or cis-diamminedichloroplatinum(II) (CDDP) is a platinum-based chemotherapy drug used to treat various types of cancers, including sarcomas, some carcinomas (e. ... Cyclophosphamide is a nitrogen mustard alkylating agent, used to treat various types of cancer and some autoimmune disorders. ... Ifosfamide (Mitoxana®) Ifosfamide (pronounced i fos fa mide) is chemotherapy that is given as a treatment for many different types of cancer. ... Melphalan chemical structure Melphalan hydrochloride ( Alkeran®) is a chemotherapy drug belonging to the class of alkylating agents. ... Mechloretamine: chemical structure Mechlorethamine also known as nitrogen mustard and HN2 and sold under the brand name Mustargen, is the first anticancer drug to be widely used clinically. ... Oxaliplatin - Wikipedia /**/ @import /w/skins-1. ... Procarbazine (Matulane® (US), Natulan (Canada)) is an antineoplastic chemotherapy drug for the treatment of Hodgkins lymphoma and certain brain cancers (such as Glioblastoma multiforme). ... Uracil mustard or uramustine is a chemotherapy drug which belongs to the class of alkylating agents. ... An antimetabolite is a chemical with a similar structural to a substance (a metabolite) required for normal biochemical reactions, yet different enough to interfere with the normal functions of cells, including cell division. ... Azathioprine is a chemotherapy drug, now rarely used for chemotherapy but more for immunosuppression in organ transplantation, autoimmune disease such as rheumatoid arthritis or inflammatory bowel disease such as Crohns disease. ... Capecitabine - Wikipedia /**/ @import /w/skins-1. ... Cytarabine is a shortened form of cytosine arabinoside, a commonly used chemotherapy agent used mainly in the treatment of leukemia and non-Hodgkin lymphoma. ... Floxuridine is an oncology drug that belongs to the class known as antimetabolites. ... Fludarabine is a chemotherapy drug used in the firstline treatment of chronic lymphocytic leukemia. ... Fluorouracil (5-FU) is a drug that is used in the treatment of cancer. ... Gemcitabine is a nucleoside used as chemotherapy. ... Methotrexate (rINN) (IPA: ), abbreviated MTX and formerly known as amethopterin, is an antimetabolite drug used in treatment of cancer and autoimmune diseases. ... Pemetrexed chemical structure Pemetrexed (brand name Alimta) is a chemotherapy drug. ... An alkaloid is a nitrogenous organic molecule that has a pharmacological effect on humans and animals. ... Docetaxel chemical structure Docetaxel is a chemotherapy drug used in the treatment of cancer. ... Etoposide: chemical structure Etoposide phosphate (Eposin®, Etopophos®, Vepesid®, VP-16®) is an inhibitor of the enzyme topoisomerase II. It is used as a form of chemotherapy for malignancies such as lung cancer, testicular cancer, lymphoma, non-lymphocytic leukemia, and glioblastoma multiforme. ... Paclitaxel (Taxol®) is a drug used in the treatment of cancer. ... Vinblastine is a drug used to treat certain kinds of cancer, including Hodgkins lymphoma, non-small cell lung cancer and breast cancer or testicular cancer. ... Vincristine (Oncovin®) is an alkaloid from the Madagascar periwinkle (Catharanthus roseus, formerly Vinca rosea and hence its name). ... Vinorelbine (Navelbine) is a chemotherapy drug that is given as a treatment for some types of cancer including breast cancer and non-small-cell lung cancer. ... Topoisomerases (type I: EC 5. ... Irinotecan is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... Topotecan (Hycamtin®) is a chemotherapy agent that is a topoisomerase 1 inhibitor. ... herbs that have the specific action of inhibiting and combating the development of tumors. ... Bleomycin is an anti-cancer agent. ... Daunorubicin is chemotherapy that is given as a treatment for some types of cancer. ... Doxorubicin or adriamycin is a DNA-interacting drug widely used in chemotherapy. ... Epirubicin is an anthracycline drug used for chemotherapy. ... Hydroxyurea chemical structure Hydroxyurea or hydroxycarbamide (rINN), (brand names include Hydrea®) is an antineoplastic drug used in hematological malignancies. ... Idarubicin chemical structure Idarubicin or 4-demethoxydaunorubicin is an anthracycline drug that is used in the treatment of cancer. ... Mitomycin or mitomycin C is a form of chemotherapy given intravenously to treat upper gastro-intestinal (e. ... Mitoxantrone belongs to the general group of medicines known as antineoplastics, specifically the anthracycline class. ... Tumor (American English) or tumour (British English) originally means swelling, and is sometimes still used with that meaning. ... When normal cells are damaged beyond repair, they are eliminated by apoptosis. ... Oncology is the medical subspecialty dealing with the study and treatment of cancer. ... Benign can refer to any medical condition which, untreated or with symptomatic therapy, will not become life-threatening. ... A premalignant condition is a disease, syndrome, or finding that, if left untreated, may lead to cancer. ... Carcinoma in situ is present when a tumor has been detected that has the characteristics of malignancy but has not invaded other tissues. ... In medicine, malignant is a clinical term that is used to describe a clinical course that progresses rapidly to death. ... Anal cancer is a distinct entity from the more common colorectal cancer. ... Bladder cancer refers to any of several types of malignant growths of the urinary bladder. ... Bone tumor is an inexact term, which can be used for both benign and malignant abnormal growths found in bone, but is most commonly used for primary tumors of bone, such as osteosarcoma (or osteoma). ... CT scan of brain showing brain cancer metastatic to left parietal lobe in the peri-ventricular area. ... Breast cancer is cancer of breast tissue. ... Cervical cancer is a malignancy of the cervix. ... Colorectal cancer, also called colon cancer or bowel cancer, includes cancerous growths in the colon, rectum and appendix. ... This article needs more context around or a better explanation of technical details to make it more accessible to general readers and technical readers outside the specialty, without removing technical details. ... Endometrial cancer involves cancerous growth of the endometrium (lining of the uterus). ... Esophageal cancer is malignancy of the esophagus. ... Cancers can affect the eye. ... Bold textA more uncommon cancer predominate in females, if found early on before symptoms, can be cured by removing Gallbladder, most often it is found after symptoms occur (abdominal pain, Jaundice) and has spread to other organs such as liver and the outlook at this point is poor. ... Head and neck cancers are malignant growths located in the oral cavity (mouth), nasal cavity, pharynx, larynx, thyroid, paranasal sinuses, salivary glands and lymph nodes of the upper neck. ... Hepatocellular carcinoma (HCC, also called hepatoma or liver cancer) is a primary malignancy (cancer) of the liver. ... Cancer of the larynx also may be called laryngeal cancer. ... Lung cancer is a cancer of the lungs characterized by the presence of malignant tumours. ... Oral cancer is any cancerous tissue growth located in the mouth. ... Pancreatic cancer (also called cancer of the pancreas) is represented by the growth of a malignant tumour within the small pancreas organ. ... Penile cancer is a malignant growth found on the skin or in the tissues of the penis, usually originating in the glans and/or foreskin. ... Prostate cancer is a disease in which cancer develops in the prostate, a gland in the male reproductive system. ... Renal cell carcinoma, also known by a gurnistical tumor, is the most common form of kidney cancer arising from the renal tubule. ... Ovarian cancer is a malignant ovarian neoplasm (an abnormal growth located on the ovaries). ... In medicine (dermatology), there are several different types of cancer referred to under the general label of skin cancer. ... Stomach cancer (also called gastric cancer) can develop in any part of the stomach and may spread throughout the stomach and to other organs, particularly the esophagus, small intestine. ... Testicular cancer is a type of cancer that develops in the testicles, a part of the male reproductive system. ...


Morphology: Papilloma/carcinoma - Adenoma/adenocarcinoma - Soft tissue sarcoma - Melanoma - Fibroma/fibrosarcoma - Lipoma/liposarcoma - Leiomyoma/leiomyosarcoma - Rhabdomyoma/rhabdomyosarcoma - Mesothelioma - Angioma/angiosarcoma - Osteoma/osteosarcoma - Chondroma/chondrosarcoma - Glioma - Lymphoma/leukemia Human papillomavirus (HPV) is a virus which affects humans. ... In medicine, carcinoma is any cancer that arises from epithelial cells. ... Adenoma refers to a collection of growths (-oma) of glandular origin. ... In medicine, carcinoma is any cancer that arises from epithelial cells. ... Malignant (cancerous) tumors that develop in soft tissue are called sarcomas, a term that comes from a Greek word meaning fleshy growth. ... This article or section does not cite its references or sources. ... Fibroma. ... Fibrosarcoma (fibroblastic sarcoma) is a malignant tumor derived from fibrous connective tissue and characterized by immature proliferating fibroblasts or undifferentiated anaplastic spindle cells. ... A lipoma is a common, benign tumor composed of fatty tissue. ... This article needs to be cleaned up to conform to a higher standard of quality. ... A leiomyoma (plural is leiomyomata) is a benign smooth muscle neoplasm that is not premalignant. ... A sarcoma is a cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. ... A rhabdomyoma is a benign tumor of muscle. ... A rhabdomyosarcoma is a type of cancer, specifically a sarcoma (cancer of connective tissues), in which the cancer cells arise from skeletal muscle. ... Angiomas are benign tumors that are made up of small blood vessels. ... Angiosarcoma is a rare, malignant tumor consisting of endothelial and fibroblastic tissue that proliferates and eventually surrounds vascular channels. ... An osteoma is a new piece of bone growing on another piece, typically the skull. ... Osteosarcoma is a common primary bone cancer. ... A chondroma is a benign cartilaginous tumor, which is encapsulated with a lobular growing pattern. ... A chondrosarcoma is a cancer of the cartilage. ... A glioma is a type of primary central nervous system (CNS) tumor that arises from glial cells. ... Lymphoma is a variety of cancer that originates in the lymphatic system. ... Leukemia or leukaemia (see spelling differences) is a cancer of the blood or bone marrow characterized by an abnormal proliferation of blood cells, usually white blood cells (leukocytes). ...


Treatment: Chemotherapy - Radiation therapy - Immunotherapy - Experimental cancer treatment Clinac 2100 C accelerator Radiation therapy (or radiotherapy) is the medical use of ionizing radiation as part of cancer treatment to control malignant cells (not to be confused with radiology, the use of radiation in medical imaging and diagnosis). ... Cancer Immunotherapy is the use of the immune system to reject cancer. ... Experimental cancer treatments are medical therapies intended or claimed to treat cancer (see also tumor) by improving on, supplementing or replacing conventional methods (surgery, chemotherapy, radiation, and immunotherapy). ...


Related structures: Cyst - Dysplasia - Hamartoma - Neoplasia - Nodule - Polyp - Pseudocyst This is an article about cysts in the body. ... Dysplasia (latin for bad form) is an abnormality in the appearance of cells indicative of an early step towards transformation into a neoplasia. ... A hamartoma is an abnormal growth of normal cells. ... Neoplasia (literally: new growth) is abnormal, disorganized growth in a tissue or organ, usually forming a distinct mass. ... In medicine, a nodule refers to a small aggregation of cells. ... Polyp of sigmoid colon as revealed by colonoscopy. ... A pseudocyst is a pathological collection of fluid. ...


Misc: Tumor suppressor genes/oncogenes - Staging/grading - Carcinogenesis/metastasis - Carcinogen - Research - Paraneoplastic phenomenon - ICD-O - List of oncology-related terms A tumor suppressor gene is a gene that reduces the probability that a cell in a multicellular organism will turn into a tumor cell. ... An oncogene is a modified gene that increases the malignancy of a tumor cell. ... The stage of a cancer is a descriptor (usually numbers I to IV) of how much the cancer has spread. ... In pathology, Grading is a measure of the progress of tumors. ... Cancers are caused by a series of mutations. ... Metastasis (Greek: change of the state) is the spread of cancer from its primary site to other places in the body. ... In pathology, a carcinogen is any substance or agent that promotes cancer. ... Cancer research is the intense scientific effort to understand the development of cancer and identify potential therapies. ... A paraneoplastic phenomenon is a disease or symptom that is the consequence of the presence of cancer in the body, but is not due to the local presence of cancer cells. ... The International Classification of Diseases for Oncology (ICD-O) is a domain specific extension of the International Statistical Classification of Diseases and Related Health Problems for tumor diseases. ... This is a list of terms related to oncology. ...


  Results from FactBites:
 
Anti-Angiogenic Basis:Metronomic Chemo (6944 words)
In essence, chemotherapeutics are used as anti-angiogenic agents, therefore "redefining the target of chemotherapy", to cite Miller et al.23.
Chemotherapeutics do not specifically target tumour cells, but rather interfere with cell division, such as by inhibiting enzymes involved DNA replication or metabolism (for example, topoisomerases and thymidylate synthase), or microtubules.
Further experiments are required to determine whether other chemotherapeutics that can be orally administered on daily schedules for extended periods of time, such as the topoisomerase enzyme inhibitor etoposide (VP-16) or the alkylating agent temozolamide118, also have anti-angiogenic effects119 that contribute to their antitumour efficacy.
  More results at FactBites »

 
 

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