Book contents
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- The cancer multidisciplinary team
- Tumour types
- Principles of chemotherapy
- Radiotherapy in cancer treatment
- Palliative care
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Principles of chemotherapy
Published online by Cambridge University Press: 06 July 2010
- Frontmatter
- Contents
- List of contributors
- Foreword by Professor Lord Ara Darzi KBE
- Preface
- Section 1 Perioperative care
- Section 2 Surgical emergencies
- Section 3 Surgical disease
- Section 4 Surgical oncology
- The cancer multidisciplinary team
- Tumour types
- Principles of chemotherapy
- Radiotherapy in cancer treatment
- Palliative care
- Section 5 Practical procedures, investigations and operations
- Section 6 Radiology
- Section 7 Clinical examination
- Appendices
- Index
Summary
Chemotherapy is any pharmacological agent given with the intention of eradicating malignant cells, and can be given intravenously, orally and topically. It is the mainstay of treatment of germ cell tumours, lymphomas and leukaemias. It is also used with curative intent as an adjunct to surgery or radiotherapy (RTX) in many tumour types and with palliative intent in metastatic disease.
Systemic chemotherapy: definitions
Neoadjuvant: the use of chemotherapy prior to surgery or RTX to downstage tumour.
Adjuvant: the use of chemotherapy after surgery to eradicate micrometastases and improve overall survival.
Palliative: the use of chemotherapy to palliate symptoms and prolong the life of patients with metastatic disease.
Cytotoxic chemotherapy
Cytotoxic chemotherapy is relatively non-selective. It is not targeted to the tumour and damages normal cells as well as cancer cells. However, malignant cells are more sensitive to its effect because they do not have the same capacity for repair. Cytotoxic drugs predominately damage proliferating cells; malignant tumours are often rapidly growing and therefore susceptible to damage from cytotoxics. Rapidly proliferating normal tissues such as bone marrow and mucous membranes are also often affected, accounting for (some of) the common side-effects of myelosuppression and mucositis.
Cytotoxic chemotherapy drugs have a narrow therapeutic index. This means that the difference between maximum tolerated dose (MTD) and minimum effective dose (MED) tends to be small. Therefore great care is required when prescribing these drugs and patients need to be monitored carefully throughout treatment.
Mechanism of action of cytotoxics
Cytotoxics act at various stages of the cell cycle; different drugs work at different stages.
- Type
- Chapter
- Information
- Hospital SurgeryFoundations in Surgical Practice, pp. 575 - 579Publisher: Cambridge University PressPrint publication year: 2009