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• Chemotherapy


  The treatment of cancer using specific chemical agents or drugs that are destructive to malignant cells and tissues
• Chemotherapy


  The treatment of disease using chemical agents or drugs that are selectively toxic to the causative agent of the disease, such as a virus, bacterium, or other microorganism
• Cancer


  A group of more than one hundred different diseases

  
• Cancer


  • Uncontrolled cellular growth
  • Local tissue invasion
  • Distant metastasis

  
• According to the incidence, there are cancer epidemics

  
• According to the rate of death, there are cancer epidemics

  
• Role of pharmacist in carcinology

  • Industrial role for investigations of new drugs
  • Choice of drug regimen
  • Therapeutic drug monitoring
  • Monitoring of drug toxicity
  • Providing drug information related to anticancer drugs
  • Monitoring of patient with providing supportive care issues as: Nutritional support, Management of cancer induced pain, Management of anticancer induced nausea and vomiting, Management of anticancer induced anemia, etc
• Carcinogens


  • Chemical carcinogens (Aniline causes bladder cancer, Benzene causes leukemia, Hormones such as anabolic steroid and oral contraceptives)
  • Physical carcinogens (UV light)
  • Biological carcinogens (Epstein virus causes lymphoma, Hepatitis B virus causes hepato-cellular cancer, Human papilloma virus causes cervix and uterine carcinoma, Human herpes virus 8 (HHV8) causes Kaposi's sarcoma)

  
• Carcinogenesis


  1. Initiation (Exposure to carcinogen -> genetic damage -> if not repaired -> irreversible cell mutation or initiated cell)

  2. Promotion (Growth of mutated or initiated cells to form preneoplastic cells)

  3. Conversion (Mutated or initiated or preneoplastic cells -> cancerous cells)

  4. Progression (Cancerous cells -> proliferation or uncontrolled cell growth -> local tissue invasion -> metastasis)

  
• Carcinogenic genes


  • Oncogenes (Oncogenes developed from protoncogenes, Genetic alteration of protoncogenes results in activation of oncogenes which leads to dysregulation of normal cell growth with subsequent neoplasm formation, There is other types of Oncogenes which interfere with normal mechanism involved in programmed cell death or apoptosis, Apoptosis is controlled by Oncogenes and tumor suppressor gene. Over-expressionof Oncogenes may result in immortal cells with increased potential of malignancy)
  • Tumor suppressor genes (The normal function of these genes is to regulate and inhibit inappropriate cellular growth and proliferation, Tumor suppression genes loss, suppression or mutation results in loss of control over normal cell growth, the common examples of tumor suppressor genes are: Anti-tumor protein gene 53 (P53 gene) that regulates apoptosis, inhibit angiogenesis and induce DNA repair, Retinobastoma gene (RB1 gene) that is tumor suppressor protein which inhibit abnormal cell growth and disrupt cell cycle)
  • Anti-metastatic genes

  
• Tumor growth


  • Early stage (Tumor growth is exponential, Large portion of tumor cells is actively dividing and rapidly growing, Doubling time is very short, Tumor cells are highly dividing and small in size, they are sensitive and responsive to chemotherapy)
  • Late stage (Tumor growth is slow and tumor mass is large, Doubling time is long, Tumor are more resistant and less responsive to chemotherapy, Characterized by angiogenesis due to inability of blood and nutrient to diffuse throughout large tumor mass)

  
• Doubling time


  The time required for tumor to double its size
• The doubling time for most solid tumors is approximately 2 or 3 months except for Burkitt's lymphoma which has a doubling time of one day

  
• Burkitt's lymphoma


  A cancer of the lymphatic system (in particular, B lymphocytes), named after Denis Parsons Burkitt, a surgeon who first described the disease in 1956 while working in equatorial Africa
• Tumor burden


  It takes 109 cells (1 gram mass, 1 cm in diameter) in order for the tumor to be clinically detected either by palpitation or by radiography, Such tumor mass (109 cells, 1 gram mass, 1 cm in diameter) undergoes 30 doubling time, If such mass (1 gram mass, 1 cm in diameter) takes 10 additional doubling times, it reaches to 1 kg in size (1012 cells), A tumor has 1 kg mass (1012 cells) is considered lethal and never discovered all over its span, As the tumor grows beyond 109, the doubling time decline, Tumor burden relates to response to chemotherapy, as the tumor burden increase, the cancer cells become less responsive to chemotherapy

  
• Cell kill theory


  A certain percentage of cancer cells not a certain number will be killed with each course of chemotherapy, Tumor burden never reaches to absolute zero, Tumor consists of less than 104 cells can be eliminated by host immune system and this may lead to cure, Limitations: It assumes that all cancer cells are equally responsive, It neglects drug resistance, It assumed that metastasis doesn't occur

  
• Metastasis


  • Spread of cancer cells from primary tumor site into distant site, One metastasis is occurred, cure becomes very seldom, At least 60 ℅ of patients will have some form of metastasis at diagnosis, Occurs through Hematogenous spread and Lymph nodes

  
• Tumor characteristics


  • Benign tumor (Non cancerous, Localized mass, Encapsulated mass, No tissue invasion, No metastasis to distant sites, No recurrence after ablation)
  • Malignant tumor (Cancerous genetically unstable cells, Cancer cells retain the properties of the original tissue, Anaplasia (cells lack the morphological characters), Tissue invasion i.e not localized, Metastasis to distant sites, Relapse after remission)

  
• Tumor origin


  • Epithelial tissue -> carcinoma
  • Connective tissue as blood or bone -> sarcoma
  • Glandular tissues -> adenocarcinoma
  • Nervous and , muscular tissues -> neuroblastoma

  
• Screening


  • Cancer is asymptomatic disease, Early detection of small mass makes it more easily to be cured, Small mass is more sensitive to chemotherapy than large mass

  
• Screening tests


  • Sigmoidscopy
  • Guiac test
  • Digital or finger rectal examination (DRE or FRE)
• Digital (finger) rectal examination (DRE or FRE)

  Done to check for problems with organs or other structures in the pelvis, such as checking for growths in or enlargement of the prostate gland in men, checking for problems in a woman's reproductive organs such as the uterus and ovaries, checking for hemorrhoids or growths, such as cancer, in the rectum
• Tumor markers


  • Prostate specific antigen (PSA)
  • CA 125 (cancer antigen)
  • CA19-9
  • Human Epidermal Growth Factor Receptor 2 (HER2)
  • CEA (carcino-embryonic antigen)
  • Alpha-Fetoprotein (AFP)
  • Hormones (Insulin production by islet cell tumor, Calcitonin by medullary thyroid carcinoma, Catecholamine by pheochromocytoma or tumor of adrenal gland, Elevation of ACTH (adrinocorticotropic and ADH (antidiuretic hormone) in case of lung cancers)
  • Enzymes (Acid Phosphatase, Neuron Specific Enolase (NSE))
• Prostate specific antigen (PSA)

  One of helpful tumor markers used for early detection or screening prostate cancer, Recommended for all men above 50 years old, Normal value in men is less than 4 ng/ml, Increased PSA concentration means increased risk for prostate cancer but not confirm prostate cancer as it increases with BPH and in patients with prostatitis, and also increases after DRE

  
• CEA (carcino-embryonic antigen)


  CEA protein is usually associated with cancers as Pancreatic cancer, Colon cancer, Lung cancer, Breast cancer, Ovarian cancer, The normal range for CEA in an adult non-smoker is < 3 ng/ml, The normal range for CEA in an adult smoker is ≤ 5 ng/ml
• Alpha-Fetoprotein (AFP)


  A normal fetal serum protein synthesized by the liver, yolk sac, and gastrointestinal tract, Of importance in screening and for primary diagnosing hepatocellular carcinoma, In healthy adults, less than 10 µg/L of AFP is found in the circulation, AFP is also elevated in Pregnancy, Benign liver disease (hepatitis, cirrhosis), Pancreatic cancer, Hepato-cellularcarcinoma
• Acid Phosphatase


  Found in high concentrations in the normal prostate as well as in primary and metastatic prostate cancers, May also originate from other tissues, The most sensitive immunological test for prostatic acid phosphatase is RIA
• Neuron Specific Enolase (NSE)

  Found only in brain and neuroendocrine tissue, Used as a marker for tumors of the central nervous system, neuroblastomas, Evaluated in lung cancer and neurobla
• Natural hormones


  • Insulin production by islet cell tumor
  • Calcitonin by medullary thyroid carcinoma
  • Catecholamine by pheochromocytoma or tumor of adrenal gland
• Ectopic hormones


  Hormones not associated with malignancy of its associated or secretory organs
• Ectopic hormones


  • Elevation of ACTH (adrinocorticotropic and ADH (antidiuretic hormone) in case of lung cancers
• Acid Phosphatase


  Enzyme found in high concentrations in the normal prostate as well as in primary and metastatic prostate cancers
• Acid Phosphatase may also originate from other tissues
• Immunological test for prostatic acid phosphatase

  RIA (Radioimmunoassay)
• Neuron Specific Enolase (NSE)

  Enzyme found only in brain and neuroendocrine tissue
• Uses of NSE


  • Marker for tumors of the central nervous system, neuroblastomas, lung cancer and neuroblastoma
• Galactosyl Transferase II


  In colon cancer its level correlated with the extent of disease and disease progression, in pancreatic cancer it was more sensitive and specific in distinguishing benign from malignant disease than other tests as AFP or CA 19-9 or CEA

  
• Monoclonal immunoglobulin


  Characteristic of myeloma
• Immunoglobulins


  Valuable in the staging and treatment of myeloma, the amount of immunoglobulin serving as an index of tumor volume

  
• Response to treatment is indicated by a fall in immunoglobulin production, whereas a rise points to relapse