Cancer

Question 1

Cancer

Answer 1

The leading cause of disease related death in children
Overall survival rate 84%
Secondary cancers
Stress of chemo
Family Stress
Long term effects ( can affect growth and development )

Question 2

Cancer (causes, S/SX, Dx )

Answer 2

Causes: genetic mutations, immune system, chromosomal defects

S/SX: Pain, cachexia ( not wanting to eat ), anemia, infection, bruising (PLT not right), neurologic, palpable mass

DX: BIOPSY ( only way to definitively diagnose ), CBC, Lumbar puncture, MRI, CT, US, PET ( see if cancer metastasize )

Question 3

Cancer ( TX, and adverse effects )

Answer 3

TX: chemotherapy, radiation (use for local tumor ), surgery (can cut it out), biotherapy (uses body own defense ), stem cell or bone marrow transplant

Adverse effects: bone marrow suppression, infection risk r/t decreased WBC (FILGRASTIM), decreased RBC (EPOETIN), decreased PLT (OPRELVEKIN), or transfusions, nausea (ODANSTERONE), weight loss , mucositis (sores in mouth, painful ) - to help biotene mouth wash, constipation (POLYETHYLENE GLYCOL ), alopecia, body image, pain (OPIOIDS, NSAIDS )

Question 4

Neutropenic Precautions

Answer 4

• Low - microbial diet ( no raw fish, cheese, eggs, undercooked meat, if its not pasteurized they cant have it )
• No fresh fruits or veggies
• Wash hands and good hygiene
• Oral care
• avoiding live vaccine
• Avoiding crowds
• No fresh flowers/plants
• prophylactic antibiotics

Question 5

Tumor Lysis Syndrome (patho, s/sx, tx )

Answer 5

Patho: Dissolving or decomposing tumor
- High serum uric acid, hyperkalemia, hypocalcemia, hyponatremia
- Seen with lymphomas and ALL (acute lymphocytic leukemia )

S/SX: metabolic acidosis, cardiac dysrhythmias, renal failure

TX: ALLOPURINOL (to decrease uric acid), IV fluids to flush system, monitor labs

Question 6

Brain Tumors (Causes, S/SX, TX, Nursing )

Answer 6

Causes: results from other cancer, treatments, or idiopathic

S/SX: behavioral and neurologic changes ( N/V, vision/hearing changes, balance issues )

TX: Surgery, radiation (>5 years old ), chemo (will give right into CSF)

Nursing: infection risk, growth and development problems , can lead to: Arginine Vasopressin Deficiency ( diabetes insipidus )

Question 7

Neuroblastoma (patho, s/sx, nursing )

Answer 7

Patho: most common solid tumor outside cranium but follows the path of sympathetic nervous system
- prognosis depends on stage and age of child

S/SX: smooth, hard, nontender mass along sympathetic nervous system ( lump in chest / abdomen, bone pain, bruising around the eyes )
- weigth loss, and distention, fatigue, fever, irritability, bone pain

Nursing: can metastasize to lymph nodes –> bones, symtoms depends on tumor location, catch it before age 1 the better

Question 8

Wilims Tumor (Neuroblastoma)

( patho, S/SX, TX, Nursing )

Answer 8

Patho + S/SX: asymptomatic firm mass to one side of abdomen / back ( grows rapidly ), hypertension

TX: Kidney sparing surgery, chemo/radiation

Nursing: monitor I/O, DONT PALPATE THE ABDOMEN - light touch ( can make the tumor burst open–> metastasize )

Question 9

Osteosarcoma

Answer 9

Patho: Skeletal tumor (distal femur most common )

Cause: associated with radiation

S/SX: unilateral pain, swelling, limp, fractures

TX: surgery and chemo

Nursing: can metastasize to lung, kidneys, and brain

Question 10

Ewing Sarcoma (less common)
(Patho, S/SX, TX)

Answer 10

Patho: small round cell tumor in bone shaft
- seen in: pelvis, ribs, shoulder blades, legs, and arms

S/SX: Fractures, pain, swelling

TX: surgery, chemo, radiation

Question 11

Leukemia (patho, S/SX, DX, TX, )

Answer 11

Patho: the WBC are immature, they dont make it to the adult stage –> bone produces too many WBC. MOST COMMON CHILDHOOD CANCER

S/SX: infection that wont go away, anemia (decrease RBC), bleeding (decreased PLT )

DX: bone marrow biopsy - blast cells (immature WBC), lumbar puncture (can invade CNS), CBC (increased WBC, decreased RBC + PLT)

TX: chemo - 4 phases, bone marrow transplant, GVHD ( rash, increased liver enzymes )

Question 12

Lymphoma ( Hodgkin and Non- Hodgkin )

( patho, s/sx, dx, tx )

Answer 12

Patho: cancer in the lymph nodes
- Adolescents highest incidence

S/SX: nontender, firm lymph node (NOT GOOD), fever, night sweats, weight loss

DX: Lymph node biopsy ( Reed Sternberg cells )

TX: chemotherapy

Question 13

Rhabdomyosarcoma (patho, s/sx, nursing, tx )

Answer 13

Patho: soft tissue sarcoma (most common)

S/SX: symptoms depends on location - eye (strabismus ), GU tract (hematuria)

Nursing: difficult to dx, metastasis common

TX: surgery and chemo