Tuesday, 1 October 2013

Altretamine (Hexamethylmelamine, HXM, HMM, Hexalen) For the Treatment of Cancer

Description
Altretamine is chemotherapy given for the treatment of ovarian cancer.  Do not use if you are taking an MAO inhibitor or Cimetidine (Tagamet).

How It Is Given
It is taken by mouth, for 2 –3 weeks per month.

Common Side Effects
  • Nausea, vomiting, loss of appetite
  • Numbness or tingling in hands and feet
  • Reduced blood counts 1 to 2 weeks after treatment

Less Common Side Effects
  • Inflammation of the bladder.
  • Skin rash.
  • Liver changes may occur.
  • Diarrhea and abdominal cramps.
  • Confusion, agitation, nervousness (most often subsides when drug is stopped).
  • Kidney changes may occur.
  • Hair loss may occur, but is will regrow.  The texture of the hair may change.

Call Your Health Care Provider if
  • You become confused or agitated.
  • You are not able to take your medicine because of an upset stomach.
  • You develop a rash.

Special Concerns
  • Blood  and urine tests will be done to check your liver and kidney function.

Alopecia (Hair Loss)

Will I lose my hair?

Chemotherapy works by killing fast growing cancer cells.  It also affects some fast growing normal cells such as hair, skin, and intestinal cells.  Many chemotherapy drugs cause hair loss.  Ask your doctor or nurse if the drugs and dosages you are getting are likely to cause hair loss.  Some treatments can cause loss of hair from places other than your head.  You may lose hair from your eyebrows, eyelashes, underarms, and pubic hair.

When will I lose my hair?

Hair loss can begin as early as the second or third week after the first treatment, although you may not completely lose your hair until after the second cycle.  Hair loss can be sudden or slow.  You may lose some or all of your hair, or it may just become thin.  Your hair will not fall out all at once; it most often falls out in clumps.  To manage this more simply, some people elect to cut their hair shorter or to shave their heads altogether.

Will my hair grow back?

Yes, the hair loss from treatment does not last.  Hair can grow back 3 - 6 months after treatment.  Your hair may grow back a different color or texture. 

What can I do before or while my hair grows back?

While you are waiting for your hair to grow back, you have options to cover your head, if you choose to use them.  Wigs, turbans, scarves, and caps are options for keeping your head warm.  If you know your hair is going to fall out, you may want to plan ahead and get a wig that matches your current style or color.  You may also think about having your own hair cut and made into a wig.  This is more expensive and takes more time.  While you are going through hair loss, you will want to avoid dyes and permanents which can be harsh.  You may need to switch to gentle shampoos.  Use sunscreen and a head cover to protect your head from the sun.


The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited. 

Allopurinol (Zyloprim, Lopurin or Aloprim) Used in combination with chemotherapy For the Treatment of Cancer

Description
This drug is not chemotherapy, but it is often used in many different types of treatments to prevent uric acid from causing damage to the kidneys or gout.  Uric acid is released in the blood stream when cancer cells break down.

How It Is Given
It is taken by mouth once daily with food.  Drink a lot of fluids when you are taking this medicine.

Common Side Effects
  • Skin rash

Less Common Side Effects
  • Nausea
  • Diarrhea
  • Itching
  • Reduced blood counts may occur

Call Your Health Care Provider if

  • Painful urination
  • Blood in urine
  • Eye irritation
  • Swelling of mouth and/or lips

After Your Breast Cancer Consultation in Radiation Oncology

At this point, you may be feeling overwhelmed, scared, confused, and a wide range of other emotions.  We hope that your visit helped dispel some of those fears.  You will next need to decide which type of breast radiation treatment is right for you.

Radiation Therapy

The purpose of radiation is to kill any of the cancer cells that remain after surgery.  It may lessen the chance of breast cancer returning.  Below are the two methods of treating breast cancer using radiation.  We believe them to be equal in effectiveness.


How it is given
Treatment Schedule
Side Effects
Benefits
External Beam Radiation
High intensity x-rays are directed at the whole breast.
Once a day (15 minutes) for 4 to 6 weeks.
Skin reaction (like a sunburn).

Fatigue.
Less invasive.

Used for many years.
Breast Brachytherapy
Catheter(s) are placed into the breast in and around the area where the tumor was located.  A radiation substance is instilled through the catheters during the treatments.
Twice a day (45 – 60 minute sessions) for 5 days.
Mild to moderate discomfort from the catheter(s) (these are left in place throughout the treatment period).

Minimal skin reaction.
Radiation is given closer to the cancer, sparing healthy tissue.

Faster recovery.

When you have made your decision, please call your radiation oncology doctor.  If you choose either type of therapy, it will require a CT scan done in Radiation Oncology.

A CT scan is a type of x-ray.  A CT scan done in Radiation Oncology is used for treatment planning.  This type of CT is looked at only by persons within the department.  This type of scan is not used to diagnose disease.

Before the scan:

If you are pregnant, or think you might be pregnant, tell us before the scan is done.  This is to reduce the risk to your baby of being exposed to radiation. Your doctor will order a urine pregnancy test if you are of childbearing age (10-55 years of age) or have not gone through menopause.

Let us know if being in confined spaces is difficult for you.  We can give you medicine to help you relax.  If you take this type of medicine for the scan, you will need someone to drive you home.  You should not drive or use dangerous equipment for 24 hours.

You may eat and drink liquids up until the scan.  You may want to avoid a large meal right before the scan as you will by lying on your back. You will not receive contrast.

We will ask you to remove some of your clothing for the scan.  For women who are having a CT scan to plan breast radiation, this includes clothing that covers the upper body (i.e. shirt and bra).  You will be given a hospital gown, robe, towel, and/or blanket to use.

A photo of your face will be taken for your chart for identification purposes.



During the scan:

You will lie on a narrow table.  The table will move in and out of the opening of the scanner.  It takes about 30-60 minutes to complete the scan. A lot of this time is used for getting you into the right position.

The scan itself takes only a few minutes. During the scan, you will be alone in the room.  We will be able to see you through a window. We will be able to hear you through a speaker.  You will need to hold still during the scan.  Most often you will be on your back for the scan, however, you may be asked to lie on your stomach too.  You may be asked to have your arms resting above your head.  You may also be asked to “take a deep breath and hold” during part of the scan.  In most cases there is no pain or discomfort during the scan.  If you need something, or have any problems during the scan, just speak up as we will be listening for any concerns.

The radiation therapist will place approximately four ink marks or small tattoos on your skin.  Please do not remove any marks at home, unless you are told that you may do so. 

After the scan:

External Beam Radiation – Following the CT scan, you may be given an appointment for your first treatment.

Breast Brachytherapy – Following the CT scan, you will meet with your doctor to determine if you are a candidate for breast brachytherapy and you will receive education about the breast brachytherapy procedure with the nurse coordinator. We will proceed to schedule your catheter placement and treatments.

If you have any questions or concerns, please call Radiation Oncology at
(608) 263-8500 between the hours of 8:00 am and 5:00 pm, Monday through Friday.

After Care for Breast Core Biopsy

Radiologist who performed the procedure:_______________________

If you have questions or concerns about your care, please call the Breast Center at (608) 266-6400, Monday through Friday, 8:00 a.m. to 4:30 p.m.  After hours and weekends, this number will be answered by the paging operator.  Ask for the radiologist on call.  If you live out of the area, you may call 1-800-323-8942.

 If you took an anti-anxiety medicine before this procedure, do NOT drive for 6 hours.  Do NOT drink alcohol, take muscle relaxants, or mood-altering medicines for 24 hours.

1. Results  Your biopsy results should be ready in 3-4 working days.  Your doctor or the Breast Center staff will call you to discuss your results.  

2. Care of the site 
  • Apply ice to the area for 20-30 minutes at least 3 times the day of the biopsy and then as needed.  This will help to reduce swelling and pain.
  • It is recommended that you wear a supportive bra for 24-48 hours.  A sports bra or other comfortable bra works well.
  • A gauze bandage will be placed over the biopsy site for protection.  You may remove the gauze bandage the next day.  The thin strips of tape or steri-strips placed over the biopsy site will loosen and come off on their own in about a week.  If they are still in place after a week, you may gently peel them off.
  • You may shower the next morning.  Do not soak in a bath or pool for 48 hours. 
3. Signs of infection  If any of these symptoms occur, call the Breast Center or your doctor.
 
  • Temperature over 100.4  F for two readings taken 4 hours apart
  • Significant swelling, firmness, or warmth
  • Increased redness
  • Pus around the site
  • Heavy bleeding from the site
4. Comfort  You may have some discomfort and bruising.  It should go away in about a week.  If you need something for discomfort, you may take Tylenol  for the first 24 hours if you do not have liver problems.  You may resume taking aspirin or ibuprofen 24 hours after the biopsy (if no signs of bleeding) or as directed by your doctor.

5. Activity  Avoid vigorous arm movements and heavy lifting for the first 24 hours.  You may resume your normal routine the next day or as directed by your doctor.


6. Blood Thinners  If you take Coumadin® , aspirin, or other blood thinners, you may resume these 24 hours after the biopsy (if no signs of bleeding) or as directed by your doctor.

Abraxis (Abraxane) for the treatment of cancer

Abraxis is chemotherapy given for treatment of cancer.  It is a form of taxane without the proteins that cause allergic reactions.

How It Is Given
Injections are given into the vein given over 30 minutes every three weeks.

Common Side Effects
  • Decreased white blood cell count (ANC)
  • Hair loss (alopecia)
  • Numbness and tingling (neuropathy), which may increase with each treatment
  • Increase or decrease in heart rates (ECG abnormalities)
  • Muscle and joint pain – most often 2-3 days after treatment
  • Increased weakness and decreased strength

Less Common Side Effects
  • Nausea and/or vomiting
  • Diarrhea
  • Mouth sores (mucositis)
  • Anemia

Special Concerns
  • Abraxane should not be given if your neutrophil count (ANC) is less than 1,500.  Blood counts will be monitored.
  • Avoid pregnancy while receiving treatment.
  • Do not father a child while receiving treatment.

When to Call Your Health Care Provider

  • Fever of 100.8°F or greater
  • Muscle and joint pain that are not relieved by Tylenol®
  • Increased numbness and tingling in hands and feet

6-Mercaptopurine (6-MP, Purinethol) For the Treatment of Cancer

Description
6-Mercaptopurine is chemotherapy given for the treatment of all acute lymphoblastic leukemia.

How It Is Given
It is taken by mouth most often as a single daily dose, or for a set number of days per month.  It is best taken on an empty stomach which means 1 hour before or 2 hours after meals.

Common Side Effects
  • Reduced blood counts

Less Common Side Effects
  • Mouth sores
  • Loose, frequent stools
  • Fever
  • Nausea and vomiting
  • Skin rash
  • Kidney changes may occur
  • Liver changes may occur
  • Decreased appetite

Call Your Health Care Provider if You Develop
  • Fever greater than 100.8° F
  • Trouble urinating or burning with urination
  • Nausea or vomiting not controlled by medicine

Special Concerns
  • Allopurinol should be stopped before taking 6-MP.
  • Blood tests will be taken to check your liver and kidney function.