1. CHEMOTHERAPY antineoplastic drug causing cell destruction by interfering with the celular fungtion and reproduction.

Chemotherapy may be administerd by oral, Intravenus, intramuscullar or subcutaneus. Intracavity and intrathecally. Types
Plant Alkaloids: These are made up from certain type of plants found in nature. The bark of Pacific Yew Tree is used to make taxanes while for making vinca alkaloids, the periwinkle plant is used. Taxanes and vinca alkaloids are also known as antimicrotubule agents. The podophyllotoxins are obtained from the May apple plants. Camptothecan analogs are obtained from the Asian Happy tree. Plant alkaloids attack the cells during various phases of division because they are cells cycle specific. There are some plant alkloids such as docetaxel, taxens and paclitaxel and some vinca alkaloids that include vinblastine, vincristine and virorelbine. Alkylating Agents: In the resting phase of the cell the alkylting agents are most active. These cells directly damage DNA and prevent reproduction of cancer cell. It is very important to treat the various kinds of cancer. Following are some alkylating agents used in chemotherapy treatment.

Alkylsulfonates: Busulfan Metal salts: Cispaltin, Carboplatin and Oxaliplatin. Ethylenimies: Hexamethylelmelamine and Thiotepa. Hydrazines and Triazines: Procarbazine, Altretamine, Dacarbazine and Temozolomide.

Mustard gas derivatives: Mechlorethamine, Chlorambucil, Cyclophosphamide, Ifosfamide and Melphalan.

Nitrosureas: Lomustine, Carustine, Streptozocin and Nitrosureas are unique and may cross blood brain barrier. These can also used to treat the brain tumors.

Anti-tumor Antibiotics: These are the natural products produced by soil fungus streptomyces. These cells are considered as cell cycle specific and act during multiple phase of cell cycle. Following are few types of anti-tumor antibiotics.

Chromomycins: Plicamycin and Dactinomycin. Anthracyclines: Mitoxantrone, Epirubicin, Doxorubicin, Idarubicin and Daunorubicin.

Miscellaneous: Bleomycin and Mitomycin.

Anthracyclines: Anthracyclines interfere with enzymes that are necessary for replication of DNA. Anthracyclines are cell cycle non specific and anti tumor antibiotic used to treat different kinds of cancer. The drugs like bleomycin, doxorubicin and mitomycin are examples of anthracyclines. Topoisomerase Inhibitors: These are various chemotherapy drugs that interfere with the action of toposiomerase enzymes. Topoisomerase enzymes also plays very important role in controlling the manipulation of DNA structure that is necessary for replication during chemotherapy treatment. There are few toposiomerase enzymes such as ironotecan, topotecan are included in topoisomerase I inhibitors and several enzymes like etoposide phosphate, amsacrine, etoposide and teniposide are included in topoisomerase II inhibitors.

Antimetabolities : Antimetabolities are similar to normal substances present in the cell. Antimetabolities are the drugs that interfere with growth of DNA and RNA. These are cell cycle specific and kill cancer cells in a specific phase of cell division. Antimetabolities are unable to divide when cells incorporate normal substances into the cellular metabolism. The antimetabolitities are classified according to substances with which they interfere.

Purine antagonist: 6-thioguanine and 6- Mercaptopurine Folic acid antagonist: Methotrexate. Pyrimidine antagonist: Foxuridine, Capecitabine, 5-fluorouracil, Cytarabine, and Gemcitabine.

Adenosine deaminase inhibitor: Nelarbine, Fludarabine, Cladribine, and Pentostain Mitotic Inhibitor.

The cell division of cancerous cell is inhibited by mitotic inhibitor. These inhibitors work during the mitosis phase of cycle. These cells also interfere with the production of enzymes and it is necessary for cell reproduction. Miscellaneous Antineoplastics :

Enzymes: Pegaspargase and Asparaginase. Ribonucleotide reductase inhibitor: Hydroxyurea. Adrenocortical steroid inhibitor: Mitotane Retinoids : Baxarotene, Isotretinoin, tretinoin (ATRA) Antimicrotubule agent: Estramustine.

Purpose:

The main purpose of chemotherapy is to kill cancer cells. It is usually used to treat patients with cancer that has spread from the place in the body where it

started (metastasized). Chemotherapy destroys cancer cells anywhere in the body. It even kills cells that have broken off from the main tumor and traveled through the blood or lymph systems to other parts of the body. Chemotherapy can cure some types of cancer. In some cases, it is used to slow the growth of cancer cells or to keep the cancer from spreading to other parts of the body. When a cancer has been removed by surgery, chemotherapy may be used to keep the cancer from coming back (adjuvant therapy). Chemotherapy also can ease the symptoms of cancer, helping some patients to have a better quality of life.
PRECAUTIONS FOR AGENT PREPARATION (reconstitution and dilution): 1. All agent preparation must be performed in a ducted biosafety cabinet. 2. Wear chemotherapy gloves or double gloves of either surgical quality latex gloves or nitrile. Chemotherapy gloves provide the greatest protection. 3. Wear a protective gown that is lint-free, non-permeable with a solid front, long sleeves, and tight-fitting elastic or knit cuffs (gowns specifically designed for chemotherapeutic agents). 4. When double gloving, one glove should be placed under the gown cuff and one over. 5. The outer glove should be changed immediately if contaminated. Both gloves should be changed if the outer gloves is torn, punctured, or overtly contaminated with the drug (as in a spill) and every hour during preparation. 6. All potentially contaminated disposable items (gloves used in prep) must be placed in a plastic bag (while in the biosafety cabinet) and then in the chemotherapy waste container. Sharps should be disposed of in a sharps container specific for chemotherapy. This sharp container must be labeled as holding chemotherapy items. 7. Preparations should be performed over plastic backed absorbent pads. Dispose of as noted above, immediately upon contamination. 8. External surfaces of syringes should be wiped with a clean alcohol pad to remove any potential contamination. 9. Chemotherapeutic agents must be stored in an area labeled chemotherapeutic agents. 10. Chemotherapeutic agents must be transported in ziplock bags with chemo labels. 11. Leurlock syringes are recommended. 12. A Chemotherapeutic agent spill kit must be available. These can be purchased from University Stores (3-1980) or Drug Services (598-6058). 70% isopropyl alcohol is an acceptable decontaminant for these agents. 13. The ducted biosafety cabinet should be cleaned (70% isopropyl alcohol) upon completion of tasks. 14. Hands must be washed upon completion of tasks.

15. Excess chemotherapeutic agent, not used, must be disposed of in chemotherapy waste container. 16. Chemotherapy gloves, gowns and stickers can be purchased at Drug Services (5986058). 17. Consult with EH&S Environmental Programs at 616-5836 (or 685-2848) for disposal needs. PRECAUTION FOR AGENT ADMINISTRATION: 1. Wear double gloves (latex or nitrile) for all procedures involving chemotherapy administration. 2. Change gloves after each use, tear, puncture, medication spill, or after 30 minutes of wear for latex, 60 minutes for nitrile. 3. Wear protective gown with solid front at all time. 4. For situations where potential eye contact with chemotherapeutic agent exists, safety goggle or face shield should be used. 5. Use leurlock needles, if possible. 6. Dispose all waste material in the appropriate chemical waste container.

2. RADIOTHERAPY Also know as cobalt treatment, radiotherapy or irradiation. High energy rays are used to destroy cancer cells. It may be used before surgery to shrink the tumor or after surgery to destroy any cancer cell remaining locally that area. a. External Radiotherapy it is the use of high energy ionizing rays to treat cancer. It destroys the cells ability to grow and multiply. The patient are treated five days a week. They are not radioactive during or after treatment. b. Internal radiotherapy Iodine Therapy : radioactive iodine is administered orraly in cases of cancer thyroid in medical ward. Brancy Therapy : it is intracavity application of radiation for cancer cervix, cancer uterus in the female medical ward. Common side effects of radiation are unusual tiredness and skin reaction. It may also reduce the number of white blood cells. The type and degree of side effects depend on the area of the body being irradiated.

Purpose:

3. SURGERY Surgery is a local treatment. It is removal of tumor and surrounding still a safety margin of normal tissue. In some lymph nodes and lymphatic chanels are also removed to examine for the present of malignat cells. 4. HORMONE THERAPY Administration of hormone inhibits the growth of certain cancers for e.g. cancer of breast and cancer prostate etc. 5. IMMUNOTHERAPY Drug that enhance the body natural immune system to fight against abnormal cells, for example : cetuximab, mabthera, avastin etc