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MEDICAL TREATMENTS CHEMOTHERAPY Definition Cytoxic Agents For Powered By Docstoc
					1. FOREWORD
Chemotherapy and Radiotherapy are commonly used in the treatments of a
wide range of illnesses associated with cancer.
The difficulties encountered by the embalmer when attempting to embalm a
case that has been subjected to Chemotherapy and Radiotherapy are very
complex and varied in nature.
The chemotherapy and radiotherapy treatments create an environment that
warrants specific care and attention and the illnesses that call for these
treatments provide their own share of challenges to the practicing embalmer.

   Chemotherapy is the treatment of infections and other disease with
   chemical agents that are designed to destroy cancer cells on a selective
   Cytoxic Agents.
   The pharmacologic compound (cytoxic) agents used in cancer treatments
   generally function in the same manner as ionising radiation. This means
   that the cytoxic agents do not kill the cancer cells but they impair the
   ability of the cancer cells to replicate. They do so by interfering with acid
   activities associated with cell division.

   For this reason the question of uncontrolled
   contamination towards close contact workers becomes
   a safety issue and certain protocols have been
   implemented to safeguard persons likely to become
   affected by excessive radiation exposure.
Chemotherapeutic agents are drugs and they cause cellular and tissue
changes within the body.
The drug induced changes may be relatively minor in nature but when the
drugs cause major changes, serious problems with the preservational
effectiveness of the embalming chemicals can occur.
Major changes could include the decreased permeability of the cell
membranes and the retention of nitrogenous wastes in the body systems
and structures.
When the permeability of the cell membrane becomes decreased it’s much
more difficult for the preservative to come into contact with the cell protein
and subsequently cell and tissue decomposition will continue to develop.
The nitrogenous waste build up within the body contains ammonia and
this will further hamper preservation by neutralising the formaldehyde.
The liver, which is the body’s main detoxification organ will attempt to
change the drug to an innocuous form however with prolonged exposure
the hepatic enzymes will not be able to keep up and serious damage may
occur to this organ.
This may lead to liver failure and jaundice.
Eventually the heart, the blood vessels, the skin, the kidneys and lungs
will also have their function ability impaired to the point where the
distribution and effectiveness of the embalming solution may become
severely compromised.
As chemotherapy reaches all parts of the body, not just the cancer cells,
all parts of the body may experience side effects that will have direct
influence on the strength and technique of the embalming.
It is not just the physical presence of the cytoxic agent that causes
problems but more so the physiological effects that they cause to the body
that will have a direct influence upon the embalming.
Side Effects
Common side effects of chemotherapy that may have an influence upon
the embalming processes may include;
Loose and easy detachable hair.
      Extreme care must be implemented when washing, drying, styling
      or otherwise handling the hair as the hair can easily become
      detached. In many instances the hair has thinned or disappeared
      prior to death and it may become necessary to tone residual hair to
      blend with artificial hairpieces or wigs.
      Reduced ability of the blood to clot
      With reduced ability of the blood to clot there may be many surface
      bruises and discolorations that need bleaching and cosmetology.
      With large areas of bruising it is good practice to hypodermic
      preservative in and around the area to ensure good localised
        Increased likelihood of
        opportunistic infections
      Chemotherapy effects white blood cells and reduce the ability of
      the living body to fight against infections.
      It is common for chemotherapy patients to be on various types of
      antibiotics and any drug administered to the body will not just add
      toxins requiring additional preservative, but also have direct effect
      on body changes.
      Antibiotics become lodged into the cell membrane and they have an
      affinity with metallic ions.
      This chelating process attracts the body’s abundant supply of
      calcium ions that in turn encapsulates the cell membrane
      Shingles will leave vesicular eruptions on the surface of the skin
      that will be prone to secondary infections. These areas are
      unsightly and specialised cosmetic treatments may be necessary to
      overcome the appearance.
Yellowing of tissues is counteracted by higher strength special
purpose fluids that meet with the increased demand for
preservative. An additional dye may be added to the arterial fluid
which will aid in masking discoloration. External applications of
cosmetics are usually necessary to optimise final presentation.
Purpura and Petechia
Purpura is an extravascular bruise upon the surface of the skin due
to fragile capillaries.
The purpuras can vary greatly in size and can lead to embalming
problems in a variety of ways.

Pupuras and petechia will not clear with arterial injection and they
tend to enlarge with additional fluid during the embalming.
Eventually the skin layers will separate into the condition known as
desquamation ( skin slip).
If the purpuras have ruptured, it is recommended that the loose skin
be removed and surface packs of phenol be applied to these
locations. The phenol bleaches the discolorations while drying and
cauterising broken surfaces.
A stronger arterial fluid should be used at a lower flow rate and if
possible these areas should be injected separately from the rest of
the body.
For larger and more difficult areas of purpura with skin slip, a
surface pack of embalming Gel, (Syngel) may be applied for a
period of time.
After the embalming and when these areas are completely dry they
may be restored and cosmetised.
These areas of skin will always be weak and additional care should
be taken so as not to worsen the skin slip while massaging or
              If the areas of concern are non viewing areas it is good practice to
              cover them with waterproof wrapping to avoid possible leakage and
              staining into clothing.


Chemotherapy may involve the oral ingestion of a radioactive element
(radioisotope) which eventually passes through the patient’s system.
When a patient receives oral unsealed radioactive substances they must be
isolated during the half life of the radioisotope to prevent radiation exposure to
other persons in close contact.
Safe management of body wastes such as faeces and urine becomes a matter of
Bandages and other surgical wrappings also need to be managed in a way that
prevents radioactive exposure to the care provider.

The danger to the embalmer can occur when the patient dies prior to the half life
of the radioisotope and he is called to transfer and embalm the remains.


Radiotherapy is the treatment of disease by using x-rays or gamma rays, usually
from a cobalt source, to deter the proliferation of malignant cells.

Radiation therapy works by preventing cells from growing and dividing by
impairing the DNA synthesis.
The rays are concentrated to specific regions where the presence of tumour cells
exist and any normal cells inadvertently affected are able to quickly recover.

   With an excess of moisture in the body cavities and tissues, the
   preservative will be subjected to a higher than usual secondary dilution.
   The body tissues will swell to an unnatural appearance and there will be an
   increased possibility of skin slip. Leakage may also be a problem and the
   remains will develop unpleasant odours.
   The most serious concern lies in the fact that the excess fluid may contain
   waste products that the kidneys have not been able to excrete (urine), and
   these poisons will quickly cause tissue decomposition that               resist
   standard strength preservatives.
   Edema cases provide an ideal moisture environment for bacterial growth.
   It is advisable to use multipoint injection methods with edema cases and
   the additional incision sites      become useful as drainage outlets for
   intercellular fluid (pitting odema).
   Elevation encourages a gravitational flow towards these openings and the
   embalmer can assist the movement of excess fluid by massaging in these
   A high strength, high index fluid is best and in severe cases a waterless
   injection may be considered.
   Thorough cavity aspiration is important and if possible re-aspirate after 24
   hours and use at least 2 bottles of high firming cavity fluid to reinject these
   If a restricted cervical injection method is used the operator can avoid
   dehydrating the head by mixing a separate fluid with a restorative co
   injection chemical.
   Pre-injection fluids for edemic cases should be avoided and if fluid
   reduction leaves wrinkles a tissue reducer will aid in removing them.
Radiation therapy can cause anorexia and this presents emaciation due to
protein loss. (Atrophy)
Using a lower index solution containing restorative co injection towards
the head is beneficial and it may become necessary to hypodermic tissue
builder to fine tune the facial features.
A recent photo of the deceased may assist in identifying a more normal

Diarrhoea and Vomiting
Diarrhoea and vomiting are common side effects to radiotherapy and this
can cause dehydration of all tissues.
A pre-injection is best for dehydrated cases followed by a low to medium
index preservative fluid.
This will lessen the likelihood of further dehydration occurring without
compromising preservation.

Radiation Burns
Radiotherapy can cause skin
reactions during or after treatments.
A common reaction is the appearance of reddened areas, not unlike
sunburn, called radiation burns. The effect can be that the skin can be very
dry and shedding and peeling can occur. If this is the case the areas in
question may brown off after embalming, giving the appearance of razor
burn and these areas will require cosmetic repair. If blisters are evident
they will need to be opened and drained with a surface pack of cavity fluid
or syngel applied in an effort to preserve and dry these areas prior to
cosmetology. This is especially true if the areas are in viewable locations.

       The natural pigments of the skin can become very dark and require
       cosmetology if they fail to lighten after arterial injection.

Radioactive implants
A radioactive implant is a small container holding a radioactive isotope that is
imbedded into tissues for the purpose of interstitial radiotherapy.
The implants may be seeled in capsules, wires, tubes or needles, and they are
inserted directly into a tumour or body cavity.
These methods of radiation therapy must be assessed using the half life
protocols before casual contact is made by care providers as the implant may
transmit rays to outside the human body.
With relatively low emission rates it is generally considered safe for care
providers, including embalmers, as long as the implants are not opened or
otherwise tampered with.
All chemotherapy and radiotherapy treatments are administered by trained
professionals who have legal responsibilities to ensure other health care
professionals, including embalmers, can identify with and implement safe
practices when working within a radioactive environment.
If a patient dies, the isotope administrator will determine the risk factors of
contamination by a complex means of evaluating which particular isotope has
been used and of what strength for how long.
If necessary they will remove any hazardous materials prior to releasing the body
for autopsy or funeral preparation.
If the radioactive remains cannot be controlled to safe exposure limits then the
remains will not be released until the correct number of half days have elapsed.
Any remains that may still constitute a risk to the embalmer will have a label
attached identifying the radionuclide and its activity at the time of death.
In these situations the embalmer will need to consult the radiation safety officer
at the hospital where the treatment was given and gain specialised advice on how
to further eliminate the risk of unsafe exposure.

There are very few embalming cases beyond the competent embalmer’s

Optimum results for chemotherapy and radiotherapy embalming cases are
achieved by using stronger preservatives and special purpose fluids along with
thorough cavity work and detailed surface treatments.

Radiation exposure levels are routinely depleted by hospital safety officers before
releasing the remains to Funeral Directors with labelling attached to advise when
any other precautions are necessary prior to embalming.

Chemotherapy and radiotherapy cases can be safely handled by adopting
established protocols and employing good embalming techniques throughout the
entire procedure.

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