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Aims of Chemotherapy

1. Cure
2. Prevention (of recurrence)
3. Shrink tumours

Types

1. Primary
2. Neoadjuvant - before surgery (eg shrink breast cancer)
3. Adjuvant - after surgery to gain control of primary disease
4. Palliative

Considerations

1. Chemosensitivity
2. Stage
3. Grade
4. Patient's health

Principles of treatment

• Adjusted according to weight and height
• Body surface area estimated and cycles given at intervals to allow the body normal tissue to recover
• High dose chemotherapy indicated in otherwise fit patients where cure may be achieved (choriocarcinoma, leukaemia) - but can cause profound toxic effects on bone marrow [possible to use stem cells support now]

Classification of Cytoxic agents

1. Alkylating agents - impair function of enzymes to form DNA: chlorambucil / cyclophosphamide
2. Anti-metabolites - irreversibly interrupt DNA: Methotrexate / 5FU
3. Vinca alkaloids - inhibit microtubule function: vincristine / vinblastine
4. Anti-mitotic agents: cause damage by production of free radicals

[Hormone manipulation in breast cancer]