- Chemotherapy
- Timing
- Neoadjuvant
- Prior to attempted resection
- Adjuvant
- Palliative
- Regimes
- Commonly combinations of drugs
- Cycles every 2-3/52 for 3-6/12
- Anaesthetic assessment
- Knowledge of drugs is needed
- Elicit side effects
- Bloods (FBC, U&E, LFT)
- Ix (ECG, Echo, CXR, PFTs, ABGs) may be required
- Drugs used
- Alkylation agents
- Attach an alkyl group to DNA so prevent replication
- Cisplatin, cyclophosphamide, chlorambucil
- Anti-metabolites
- Interfere with DNA synthesis and nucleotide metabolism
- Methotrexate, 5-fluorouracil
- Topo-isomerase inhibitors
- Inhibit topoisomerase which controls DNA structure
- Doxorubicin, daunorubicin, bleomycin
- Anti-microtubule agents
- Interfere with microtubules which help control mitosis
- Systems
- Respiratory
- Cyclophosphamide, bleomycin, doxorubicin
- Bleomycin is particularly toxic and can be exacerbated by oxygen therapy
- Infection
- Metastasis
- PE
- Fibrosis
- CVS
- Cisplatin, 5-fluorouracil, interferon
- Hypo/hyper-tension
- MI
- Arrhythmias
- Cardiomyopathy
- Pericardial effusion
- Pericarditis
- Long QT and Torsades
- Renal
- Cyclophosphamide, bleomycin, methotrexate
- Acute or chronic renal failure
- Haemorrhaging cystitis
- Nervous system
- Vincristine, cisplatin
- Neuropathy
- Seizures
- GI system
- Cisplatin
- Nausea/vomiting
- Diarrhoea with dehydration
- Mucositis
- Hepatic
- 5-flurouracil, cisplatin, vincristine
- Fatty liver
- Cholestasis
- Hepatocellular necrosis
- Haematological
- Most chemotherapy drugs
- Myelosupression
- Pancytopenia
- CEACCP
Link:ceaccp.oxfordjournals.org/content/early/2011/12/19/bjaceaccp.mkr055.full.pdf