Cancer produces a major public health impact in developed countries. The American Cancer Society estimates that 1.5 million patients will be diagnosed with a new cancer each year in the U.S., with an estimated 1 million cases of skin cancer. In men, the most common cancers are prostate (25%), lung (15%), and colorectal cancers (10%). In women, the most common sites are breast (27%), lung (14%), and colorectal (10%).1 Cancer is also a major cause of death; in the U.S., cancer is the second leading cause of death, following heart disease. In 2009, lung cancer was the leading cause of cancer death in men (30%) and women (26%), followed by prostate (9%) and colorectal cancer (9%) in men, breast (15%) and colorectal cancer (9%) in women. Cancer treatment, depending on the type and stage of disease, utilizes chemotherapy, surgery, radiation, or combinations of the three. The chemotherapeutic armamentarium continues to expand, with the addition of new agents and the recognition of new toxicities.


Chemotherapeutic agents can be categorized into the following categories: alkylating agents, topoisomerase inhibitors, antimitotic agents, antimetabolites, hormonal agents, targeted therapies, and miscellaneous (Table 235.1-1). Toxicities commonly observed can result from the agents themselves, due to tumor breakdown, or due to interaction with the host.

Table Graphic Jump Location
Table 235.1-1 Chemotherapeutic Agent Classification 

Alkylating Agents


Alkylating agents are so named because they attach to an alkyl group in the guanine base of the DNA molecule (Table 235.1-2). This alkylation damages the DNA, preventing replication and cell division. Cancer cells proliferate faster and possess less capacity to correct DNA errors, so they are more sensitive than healthy cells to the damage caused by alkylation. However, normal cells that divide frequently, such as the intestinal epithelium and bone marrow, are susceptible to the alkylating agents. As with other agents that damage DNA, alkylating agents are carcinogenic. Alkylating agents are used to treat lung, breast, and ovarian cancer, sarcoma, as well as the hematologic malignancies of acute and chronic leukemia, lymphoma, ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessMedicine Full Site: One-Year Subscription

Connect to the full suite of AccessMedicine content and resources including more than 250 examination and procedural videos, patient safety modules, an extensive drug database, Q&A, Case Files, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessMedicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.