Oncologic Disorders (Exam 2)
Classification of tumor grade
*Depends on what type of cancer* Gx: grade cannot be assessed, undetermined G1: Well differentiated, low grade, grows slowly G2: Moderately differentiated, intermediate G3: Poorly differentiated, grows rapidly, high grade G4: Undifferentiated
What does hospice care focus on?
- Focuses on "relief from pain", terminal illness - Typically in person's home - Cost is an issue (Norman B.) -quality of life -palliation of symptoms -psychosocial/spiritual care
Q: A nurse is providing teaching to a client about preventing skin cancer. Which of the following client statements indicates a need for further teaching?
-"eating high fiber diet can reduce risk for developing skin cancer" REDUCE RISK FOR COLON CANCER
Skin Cancer: Squamous Cell Carcinoma
-Approx. 4000 deaths annually -Invasive carcinoma mets 4-8% of cases -Rough, thickened, scaly tumor that may be asymptomatic or may bleed. Border may be more inflamed than BCC
Q: During a routine physical examination, a nurse observes a 1-cm (0.4-in) lesion on a client's chest. The lesion is raised and flesh-colored with pearly white borders. The nurse should recognize that this finding is suggestive of which of the following types of skin cancer?
-Basal cell carcinoma •A basal cell tumor usually begins as a small, waxy nodule with rolled, translucent, pearly borders. Telangiectatic vessels can also be present. As a basal cell tumor grows, it can undergo central ulceration.
Common Side Effects and Interventions to Counteract
-Bone marrow suppression: Neutropenia and leukopenia (WBC <1000mm) -Anemia Hgb <10 -Thrombocytopenia: administer platelets, oprelvekin*stimulates bone marrow for platelets. Implement bleeding precautions, avoid aspirin -Allopecia, N/V, GI issues -Elevated uric acid, crystal and urate stone formation -Mucositis- cells of mouth and GI lining damage
Prophylactic vaccines prevent disease
-Cervarix-HPV type 16 & 18 female only -Gardasil-HPV 6,11, 16, 18 both male & female -Gardasil-9-(9) HPVs includes: cervical, anal, vaginal, & vulvar cancers as well as genital warts.
Q: A nurse is caring for a client who is receiving radiation therapy to treat lung cancer. Which of the following actions should the nurse take?
-Observe for signs of infection. •Radiation therapy to sites containing bone marrow (such as the sternum) can lower the WBC count (leukopenia), thus increasing the client's risk for infection. Screening the client for signs of infection is essential at this time.
Skin Cancer: Melanoma
-Only 2% of cancer but most lethal -Any age but average 57 -Nevus, dark, red, or blue, or mixed, irregular shape, associated with itching, rapid growth, or bleeding. -Lower extremities in women, & head, neck, trunk of men
What are the tertiary prevention for skin cancer?
-Relieving pain & discomfort -Reducing anxiety -Care after surgical procedure -Care after radiation -Care with chemotherapy
What are the secondary intervention for skin cancer?
-Screening -see physician regarding any "ugly duckling" -excisional vs incisional/punch/saucerization biopsy -fine needle aspiration
Tumor Staging and Grading
-Staging: determines the size of the tumor, the existence of local invasion, lymph node involvement, and distant metastasis -Tumor, nodes, metastasis (TNM): Refer to Chart 15-3 -Grading: pathologic classification of tumor cells: I-IV -Grade: microscopic (degree of differentiates
What are the primary intervention for skin cancer?
-Teaching -Teach ABCDE-asymmetry, border, color, diameter, evolving -Teach preventative-sunblock, decrease sun time, assessing own skin/moles, etc.
Cancer Management
-Tx is based on specifics and not started unless it has been diagnosed confirmed and staging and grading are done. -Tx: usurgery, radiation, chemo, HSCT, hyperthermia, & targeted therapy -Cure: if complete eradication -Control: prolonged survival and containment -Palliation: Relief of sx and improve quality of life, Hospice
Carcinogenic Agents and Factors
-Virus & bacteria: 11%, own DNA = cell division, new cells carry viral DNA and lack normal controls. HPV, HBV, etc. -Physical agents: sunlight, radiation, chronic irritation, chemicals, asbestos—clothing, sunscreens, occupation, rec habits, environ variables humidity, altitude, latitude all play a role -Chemical agents: Tobacco, asbestos -Genetic/familial factors: Extra or too few chromosomes, breast/ovarian -Lifestyle factors: Diet, obesity, inactivity, ETOH is high risk for mouth, throat, breast, liver colon -Hormonal agents: Estrogen/progesterone that are linked to breasts
Chemotherapy
-agents to destroy in attempt to destroy cancer cells by interfering with the replication -its used primarily to treat systemic disease rather than local lesions -combined with sx/ rx -20%-90% destruction of cells-actively proliferating sells are most sensitive to chemotherapy -Cell cycle-replication of cells
Chemotherapy drugs
Alkylating agents: mechlorethamine, cyclophosphamide, cisplatin. Antimetabolite: fluorouracil, methotrexate Antibiotics: doxorubicin hydrochloride, bleomycin, dactinomycin Antimiotics: Vincristine, vinblastine Hormones: estrogen, progesterone, tamoxifen citrate, paclitaxel Biological modifiers: epoetin alfa, filgrastim
Intervention for elevated Uric acid
Allopurinol, increase fluid intake
Nursing care of pt with cancer
Alopecia-temporary or permanent begins 2-3 weeks after start of chemo.
Oncologic Emergencies - TLS: GI
Anorexia, nausea, vomiting, abdominal cramps, diarrhea, increased bowel sounds
Q: After radiation treatment, a client reports dryness, redness, and scaling of his skin occurring within the designated radiation treatment markings. The nurse should instruct the client to take which of the following actions?
Apply hydrating lotions •The nurse should instruct the client to gently apply hydrating lotions that do not contain metal, alcohol, or perfume.
Manifestation of Malignant Disease: Skin Cancer
A—Asymmetry B—border irregularity C—color variation D--diameter
Interventions for Mucositis
Administer oxygen, iron rich foods Monitor CBC, administer PRBC as needed Administer erythropoietin and epoetin alfa to inc RBCs Freq mouth assessment & care, soft tooth brush, gentle brushing, rinse mouth with peroxide/H20, saline rinse Apply ice caps, use gentle shampoo, hats, scarves, and sunscreen Refer to American Cancer Society that provides wigs and supportive services
Interventions for Thrombocytopenia
Administer platelets, oprelvekin *Stimulates bone marrow to produce platelets* Implement bleeding precautions, avoid aspirin
Mode of growth
Benign: Tumor grows by expansion and does not infiltrate the surrounding tissues; usually encapsulated. Malignant: Grows at the periphery and overcomes contact inhibition to invade and infiltrate surrounding tissues
Cell
Benign: Well differentiated cells resemble normal cells of the tissue from which the tumor originated. Malignant: Cells are undifferentiated and may bear little resemblance to the normal cells of the tissue from which they arose.
What is the patient high risk for before engraftment of the new narrow?
Death from sepsis and bleeding-close monitoring of visitors for illness or recent vaccines is a must
Monoclonal Antibodies (MoAB)
Destroy cancer cells and spare normal cells Inject tumor cells-mice-B cell lymphocytes-combined with cancer cell that has ability to grow indefinitely producing more antibodies. Combo of spleen cells/cancer cells=hybridoma Mouse+human-chimeric MoABSs All human-human MoABs these have greater immunologic properties and less likely to cause allergic reactions.
Diagnosis of Cancer
Determine presence, extent of tumor Identify possible disease metastasis Evaluate functions of involved and uninvolved body systems and organs Obtain tissue and cells for analysis, including evaluation of tumor stage and grade
Cognitive affect chemotherapy toxicity
Difficulty remembering dates, facial recognition, inability to follow directions, easily distracted, negative effects on all functional aspects.
Providing care during tx for HSCT
During infusion: VS, O2 sat, adverse: fever, chills, SOB, CP, N/V, ↓↑BP, ↑HR, anxiety, taste chgs reaction to (DMSO) N/V, chills, dyspnea, cardiac dysrhythmias, low BP.
Toxicity of Radiation therapy
Early-skin & hair, oral mucosa, fatigue, general malaise, anorexia, impaired wound healing Late-fibrosis, atrophy, ulceration, and necrosis lungs, heart, CNS, etc. Late/chronic-dysphagia, incontinence, cognitive impairment, sexual dysfunction
Oncologic Emergencies - TLS: Cardiac
Elevated blood pressure, shortened QT complexes, widened QRS waves, altered T waves, dysrhythmias, cardiac arrest. High potassium - asystole; Low potassium - V tach
Q: Neoplasm can be classified as either benign or malignant. The following are characteristics of malignant tumor apart from:
Encapsulated •Benign: grows slowly, localized, encapsulated, well differentiated cells, no metastasis, not harmful to host. •Malignant: Grows rapidly, infiltrates surrounding tissues, not encapsulated, poorly differentiated, metastasis present, always harmful
Nursing care of pt with cancer
Promoting nutrition -Nutritional impairment-↓PRO, caloric intake, effects of cancer, SE of tx, emotions -Anorexia-alt in taste, "mouth blindness" -Malabsorption-impaired enzyme production, interference with both PRO & fats, may require central line if unable to take oral or enteral feeding. -Cancer-related anorexia-cachexia syndrome-↓ appetite ↑energy expenditure
Reconstructive sx
Following extensive surgery to improve function or cosmetic effect
Oncologic Emergencies - TLC: Other
Gout, malaise, pruritis
Oncologic Emergencies: Hypercalcemia
Hypercalcemia is a potentially life-threatening metabolic abnormality resulting when the calcium released from the bones is more than the kidneys can excrete or the bones can reabsorb. (polypeptide PTrP that mimics PTH)
Nursing care of pt with cancer
Radiation-associated impairment of skin integrity Radiation dermatitis-pain, irritation, pruritus, burning, skin sloughing, without drainage(dry) with drainage (wet) Nursing: maintenance of skin integrity (see chart 15-7), cleansing, promotion of comfort, pain reduction, prevention of additional trauma, prevention & management of infection, advise client to avoid rubbing or scratching as this will cause more irritation.
Q: A male client is in isolation after receiving an internal radioactive implant to treat cancer. Two hours later, the nurse discovers the implant in the bed linens. What should the nurse do first?
Pick up the implant with long-handled forceps and place it in a lead-lined container. If a radioactive implant becomes dislodged, the nurse should pick it up with long-handled forceps and place it in a lead-lined container, then notify the radiation therapy department immediately. The highest priority is to minimize radiation exposure for the client and the nurse; therefore, the nurse must not take any action that delays implant removal.
Q: Nurse Joy is caring for a client with an internal radiation implant. When caring for the client, the nurse should observe which of the following principles?
Pregnant people not allowed
What do chemotherapy drugs do?
Prevent cancer cells from multiplying all cause bone marrow depression
What to remember about radiation?
Remember radiation is tough on the body and systemic symptoms such as weakness & fatigue are the result of the tx not deterioration in condition
What to remember with surgical tx?
Remember to monitor all patients after surgery for the normal potential complications: airway issues, including atelectasis & pneumonia, infection, hemorrhage, VTE, F/E balance, organ dysfunction then look for things that are particular to the surgery performed, abdominal surgery—abd compartment syndrome, dehiscence, lung CA respiratory status, oxygenation)
Hospice
Should be referred in a timely fashion Comprehensive, multidisciplinary approach to care of patients with terminal illness, and their families
Therapeutic vaccines
Sipuleucel-T indicated for men with metastatic prostate cancer that is no longer responding to hormone therapy
Q: The male client is receiving external radiation to the neck for cancer of the larynx. The most likely side effect to be expected is:
Sore throat In general, only the area in the treatment field is affected by the radiation. Skin reactions, fatigue, nausea, and anorexia may occur with radiation to any site, whereas other side effects occur only when specific areas are involved in treatment.
Nursing care of pt with cancer
Stomatitis-inflammatory process of mouth and teeth characterized by changes in sensation, mild redness (erythema), and edema or, if severe, by painful ulcerations, bleeding, and secondary infection. Nursing: oral care practices, cavity assessment daily
What is the idea and most ideal and most frequent used method?
Surgical removal of entire cancer remains
Hyperthermia and HSCT
T>106.7F, damages tumor cells, also works in S phase so cells cannot repair themselves. Also makes cell membrane more permeable to chemo, pts & fam may be unfamiliar so will need explanations about the procedure, its goals, and its effects.
Q: Radiation protection is very important to implement when performing nursing procedures. When the nurse is not performing any nursing procedures what distance should be maintained from the client?
The distance of at least 3 feet / 0.9 or 1 meter should be maintained when a nurse is not performing any nursing procedures.
Diagnostic surgery
Tissue sample for histologic analysis of cells. Tumor or nodes
TNM?
Tumor, node, metastasis
Gene Therapy
Tumor-directed-injected but difficult Active Immunotherapy- antitumor responses Adoptive immunotherapy- altered lymphocytes programed to cause tumor destruction
Manifestation of Malignant Disease
Weight loss Fatigue/weakness Pain (may not occur until late in the disease process) Nausea/anorexia
Tumor removal
Wide excision: Primary, nodes, structure, disfigurement Local excision: Our pt, sm mass
Types of HSCT (stem cell transplant)
•Allogeneic: From a donor other than the patient + ablative = kill bone narrow, any malignant cells, & help prevent rejection. •Autologous: From the pt •Syngeneic: identical twin •Myeloablative: High-dose chemotherapy/occ total-body irradiation •Nonmyeloablative: Mini transplants—doesn't completely destroy bone marrow cells
Classification of Chemotherapy Agents-mechanism of action
•Cell cycle-specific agents (S phase-interfere DNA and RNA synthesis) •Alkaloids-(M phase-halt mitotic spindle formation) •Cell cycle-non-specific agents (prolonged effect leading to damage or death) •Many treatments combine both to attack from different directions •Adjunct Chemo-protect normal cells
Cancer
•Disease process that begins when a cell is transformed by genetic mutation of cellular DNA •Metastasis: Abnormal cells invade surrounding tissue and gain access to lymph and blood vessels carrying them to other areas of the body •Malignant cancer cells: cells or processes that are characteristic of cancer •Benign cancer cells: cells that are not cancerous •Cancer is the second leading cause of death , 1 in 4 deaths caused by cancer. Leading causes in order of frequency and location are lung, prostate, and colorectal cancer in men and lung, breast, and colorectal cancer in women
Prevention
•Primary prevention: reducing the risks of disease through health promotion and risk reduction strategies •Secondary prevention: screening and early detection activities that seek to identify precancerous lesions and early stage cancer in individuals who lack signs and symptoms of cancer •Tertiary prevention: efforts focus on monitoring for and preventing recurrence of the primary cancer as well as screening for development of secondary malignancies in cancer survivors
Hypersensitivity reactions-associated with life-threatening outcomes
•Rash •Urticaria •Fever •Hypotension •Dyspnea •Wheezing,
Minimally Invasive
↓Blood loss, ↓wd infec/complications, ↓surg time/anesthesia, ↓PO pain, limited mobility, shorter recovery
Reproductive affect chemotherapy toxicity
↓sperm count, an-novation, advice to freeze sperm or ova, embryo etc. teratogenic need good birth control during and for a time after
Rate of growth
Benign: Slow Malignant: Variable/depends on level of differentiation; the more anaplastic the tumor, the faster.
Q: A nurse is planning care for a client who has immunosuppression following chemotherapy. Which of the following interventions should the nurse include in the plan of care?
-Limit the number of health care workers entering the room •The nurse should limit the number of health care workers entering the client's room to prevent possible overexposure to microorganisms that can lead to an infection.
Skin Cancer: Basal Cell Carcinoma
-No death -Small, waxy nodule with rolled borders, sometimes crusty -Surgical excision or cryotherapy, radiation, top chemo
Nursing care of patient undergoing radiation therapy
-promote healing, comfort and quality -assessment of skin, nutritional status, well being -protecting caregivers by, time, distance, and shielding, a private room, posting safety precautions, prohibiting visits from children and pregnant women *30 min/day *6ft distance from radiation source
Nursing care of pt with cancer
-relieve of pain -decrease fatigue -improving body self image -addressing sexuality-infertility consequence of cancer tx -assisting with grieving process- not all cancer is fatal
Cardiopulmonary affect chemotherapy toxicity
>70y/o, preexisting cardiac dx, HTN, Tobacco, renal damage, longer survival rate—monitor closely for cardiac & pulmonary toxicity, subtle ↑RR, dyspnea =resp distress
Interventions for anorexia, N/V, GI issues
Administer antiemetic prior to therapy; ondansetron, dolasetron Administer loperamide to manage diarrhea Encourage cool drinks, eat small, favorite meals high in potassium w/high calorie supplements, Avoid unpleasant odors. Provide soft, bland, high protein foods at room temp for stomatitis, use a straw for fluids Rinse mouth with topical anesthetic, may need top steroids and zinc supplements
Q: The ABCD method offers one way to assess skin lesions for possible skin cancer. What does the A stand for?
Asymmetry -border irregularity -color variation -diameter
Tissue distruction
Benign: No tissue damage unless its location interferes with blood flow Malignant: extensive damage to tissues, even cell damage
Intervention for Nuetropenia and leukopenia
Balanced diet Handwashing Limit visitors 0 fresh fruits/vegetables/ live plants Monitor for infection *high, sign of infection*
Q: A cervical radiation implant is placed in the client for treatment of cervical cancer. The nurse initiates what most appropriate activity order for this client?
Bed rest The client with a cervical radiation implant should be maintained on bed rest in the dorsal position to prevent movement of the radiation source. The head of the bed is elevated to a maximum of 10 to 15 degrees for comfort. The nurse avoids turning the client on the side. If turning is absolutely necessary, a pillow is placed between the knees and, with the body in straight alignment, the client is logrolled.
Ability to cause death
Benign: Does not cause death unless it interferes with vital functions Malignant: unless growth can be controlled, it causes death
General effects
Benign: Is usually a localized phenomenon that does not caused generalized effects unless its location interferes with vital functions Malignant: Often causes generalized effects, such as anemia, weakness, systemic inflammation, weight loss, and CACS
Metastasis
Benign: No spread Malignant: Gains access to the blood and lymphatic channels and metastasizes to other areas of the body or grows across body cavities such as the peritoneum
Neurologic affect chemotherapy toxicity
CNS, PNS, issues, numbness, tingling, burning, freezing pain, loss of deep tendon reflexes, and paralytic ileus. May go away after chemo is stopped or may linger for a while
Types of Cancer
Carcinoma--epithelial tissue (skin, GI tract lining, lung, breast, and uterus) Sarcoma--nonepithelial tissue (bone, muscle, fate, lymph system) Adenocarcinoma—glandular organs Leukemia—malignancy of blood forming cells Lymphoma—lymph tissue Multiple myeloma—plasma cells and affects bone Melanoma—skin pigmentation cells
Oncologic Emergencies-Spinal Cord Compression
Caused by metastases to epidural space and spinal cord Most often with cancers that metastasize to bone. 70% occur at the thoracic level prognosis depends on severity and rapidity of onset. nursing int: assess, pain control, care of normal SCI patient.
Prophylactic sx
Colectomy, Mastectomy, or oophorectomy
Hematopoietic Stem Cell Transplantation (HSCT)
Completely knocks out immune system prior to stem cells transplantation Used to treat several malignant and nonmalignant diseases
Oncologic Emergencies: Superior Vena Cava Syndrome (SVCS)
Compression or invasion of SVC by tumor or enlarged lymph nodes most often associated with lung CA Untreated may lead to cerebral anoxia (due to ↓O2 to brain) S/S ↑SOB, cough, hoarse, CP, Facial swelling, edema neck, hands, difficulty swallowing, stridor, dilated thoracic vessels. DX: clinical symptoms, CXR, CT MRI Medical: shrink tumor, chemo, anticoagulant or thrombolytic therapy, stents, supportive measures (oxygen, steroids, diuretics etc.)
What are the goals of chemotherapy?
Curative, control or palliative
Radiation therapy
Curative, control, or palliative External radiation-most common Internal radiation-implanted Brachytherapy-within or next to CA site
Manifestation of Malignant Disease
C—Changes in bowel or bladder habits A—A sore that does not heal U—Unusual bleeding or discharge T—Thickening or lumps in breast or elsewhere I—Indigestion or difficulty swallowing O—Obvious changes in wart or mole N—Nagging cough or hoarseness
Biopsy
Excisional: is used for small, easily accessible tumors of the skin, upper or lower gastrointestinal and upper respiratory tracts. Needle: Cells, cytologic Incisional: Mass is too large
Q: A female client with cancer is scheduled for radiation therapy. The nurse knows that radiation at any treatment site may cause a certain adverse effect. Therefore, the nurse should prepare the client to expect:
Fatigue Radiation therapy may cause fatigue, skin toxicities, and anorexia regardless of the treatment site. Hair loss, stomatitis, and vomiting are site-specific, not generalized, adverse effects of radiation therapy.
Oncologic Emergencies - TLS: Neurologic
Fatigue, weakness, memory loss, altered mental status, muscle cramps, tetany, paresthesia's (numbness and tingling), seizures
Oncologic Emergencies - TLC: Renal
Flank pain, oliguria, anuria, kidney injury, acidic urine pH
What do patients receive to prevent GVHD?
Immunosuppresssant drugs, cyclosporine
Monitoring and Managing Potential Complications for cancer patients
Infection-monitor lab values, especially WBCs (but cannot be counted on to function normally), fever, monitor for sepsis. -ANC = (seg neutrophils[%] + bands [%]) X WBC count (cells/mm3) -Ex: (25% segs + 25% bands) X 6000 WBC cells/mm3 = 3000 ANC As ANC declines < 1500 cells/mm3 the risk of infection rises, ANC < 500 severe risk, -Nadar-lowest ANC following chemotherapy (growth factors to help prevent the old time lows) Septic shock-hospitalization and emergent treatment Bleeding, hemorrhage -Although laboratory test results confirm the diagnosis of thrombocytopenia, the patient who is developing thrombocytopenia may display early signs and symptoms.
Renal affect chemotherapy toxicity
Kidney damage r/t by products and ↑ uric acid. Hydration diuresis, allopurinol, monitor labs BUN, Cr, creatinine clearance, and electrolytes
Hematopoietic affect chemotherapy toxicity
Leukopenia, neutropenia, anemia, thrombocytopenia = ↑ infection & bleeding
Q: A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells?
Liver The liver is one of the five most common cancer metastasis sites. The others are the lymph nodes, lung, bone, and brain. The colon, reproductive tract, and WBCs are occasional metastasis sites.
Nursing care of pt with cancer
Malignant skin lesions (see chart 15-7)this chart is very inclusive of all things nursing and would be a great place to get exam questions from
Is constipation a side effect of radiation therapy?
No
Oncologic Emergencies: Hypercalcemia signs and symptom
S/S: Fatigue, weakness, confusion, decreased level of responsiveness, hyporeflexia, nausea, vomiting, constipation, ileus, polyuria (excessive urination), polydipsia (excessive thirst), dehydration, and dysrhythmias Medical: ID patient at risk, Educate, need to consume 2-4L/d and loop diuretics, unless contraindicated. Glucocorticoids (=$Ca absorption in gut) Antiemetics, ambulation,
Oncologic Emergencies-Spinal Cord Compression: Signs and Symptoms
S/S: inflammation, edema, venous stasis, back or neck pain along the dermatomal areas innervated by the affected nerve root, ↑pain with back movement, coughing, sneezing, or the Valsalva maneuver, neuro dysfunction (numbness, tingling, feelings of coldness in the affected area, inability to detect vibration, loss of positional sense) Motor loss ranging from subtle weakness to flaccid paralysis Bladder and/or bowel dysfunction depending on level of compression (above S2, overflow incontinence; from S3 to S5, flaccid sphincter tone and bowel incontinence).
Graft vs. Host Disease (GVHD)
Serious complication of bone marrow transplant (graft). Immune cells from the donor bone marrow attack the recipient's (host's) tissues. Occurs when the donor lymphocytes initiate an immune response against the recipient's tissues (skin, GI tract, liver) during the beginning of engraftment
Acute side effects of HSCT
alopecia, hemorrhagic cystitis, N/V, encephalopathy, pulmonary edema, acute kidney injury, F/E imbalances, severe mucositis.
Fatigue affect chemotherapy toxicity
an unusual, persistent, and subjective sense of tiredness
NI of Oncologic Emergencies-Spinal Cord Compression
assess, pain control, care of normal SCI patient.
Mangement in chemotherapy
assessing fluid and electrolytes, cog status, modifying risk for infection, administering chemo, prevention of n/v, managing fatigue, protecting other caregivers
GI affect chemotherapy toxiciy
chemotherapy induced n/v (CINV)
Cytokines
enhance or suppress the production and functioning of components of the immune system. *Interferons cytokines w/ antiviral, antitumor & immunomodulatory properties which includes: antiangiogenetic, direct destruction of tumor cells, inhibition of growth factors, and disruption of cell cycle.
What are the symptoms of GVHD?
mouth ulcers, abdominal pain, rash, thickness or yellow skin & eyes, diarrhea, nausea, abnormal taste, dry eyes, frequent infections or weight loss
Extravasation
non-vesicant Irritant Vesiant (inflammation/necrosis)
Extensive assessment for HSCT
phys. Ex, organ function test, psych eval, blood work, social support systems, financial/insurance resources, Informed consent, pt. educ.
Palliative sx
relieve symptoms, make the patient as comfortable as possible, and promote quality of life as defined by the patient and family.
Chronic Side effects of HSCT
sterility, pulmonary, cardiac, renal, neurologic, and hepatic dysfunction; osteoporosis, avascular bone necrosis, diabetes, and secondary malignancies
biological response modifiers
substances produced by normal cells that either directly block tumor growth or stimulate the immune system to fight cancer (2) -Non-specific biologic response modifiers -Monoclonal Antibodies (MoAB)