Cancer Flashcards
1
Q
What is the difference btwn adult cancer & childhood cancer?
A
-
Pediatric cancers usually originate from primitive embryonal & neuroectodermal tissues
> this is why we see more leukemias, lymphomas, sarcomas, or central nercous system tumors - Common sites in children: blood, lymph, brain, bone, kidney, muscle
-
Adult cancers usually originate from epithelial cells
> this is why we see a lot of carcinomas - Common sites in adults: breast, lung, prostate, bowel, bladder
- Usually impacts tissues in children, organs in adults
-
Childhood cancer is rarely influenced by envir’t
> children usually respond well to cancer treatment
2
Q
Cancer - Epidemiology
A
- Genetic alteration leads to unrergulated cell proliferation
- Not necessarily hereditary
- Mutations in tumor suppressor gene
- Chromosome abnormalities contribute to development of cancer
- Immune system conditions may contribute to cancer
3
Q
Cancer - Treatment Modalities
pt 1
A
-
Multimodal Therapy
> combination of surgery, chemotherapy, radiation - Surgery
-
Chemotherpay
> primary form of treatment
> combination drug regimens
> IV infusion through venous access devices
> precautions; experienced & trained nurses
4
Q
Cancer - Treatment Modalities
pt 2
A
-
Radiotherapy
> in conjunction w/ chemo
> side effects r/t lethal damage to tissue -
Biologic response modifiers
> using body’s own immune system
> alter host’s immunologic mechanisms
> direct antitumor effect -
Blood or Marrow transplantation
> last line of defense
> used if high doses of chemo or replace dysfunctional marrow
> cells previously stored are given IV after conditioning regimen
5
Q
Nurse’s Role - Managing Side Effects of Treatment
gi
skin
urinary
bone marrow
A
Radiation & Chemotherapy
- Gastrointestinal
> anorexia: low appetite, weight loss
> n/v: antiemetics
> mucosal ulceration
> diarrhea
- Skin
> alopecia: chemo irritates all cell cycles, affects hair cells
> dry or moist desquamation (peeling skin)
> brusining
> sores
- Urinary bladder
> cystitis: pee out chemo, give in AM, frequent voiding
- Bone Marrow
> infection
> anemia
> hemorrhage
6
Q
Protecting the Child from Infection
A
-
Portective isolation
> private room
> mask & gown upon entry - Hand hygiene
- Strict aseptic technique
-
Monitor for infections closely
> urine, lungs, mucosa, wounds -
No live vaccines
> MMR, chickenpox (varicella), rotavirus - Avoid unnecessary procedures
-
Deep brreathing
> pin wheels - Limit # of caregivers
- Reduce exposure to envir’t organisms
7
Q
Managing Side Effects of Treatment
A
-
Steroid Effects
> can be distressful for older children
> crushingoid appearance: moon face, buffalo hump, weight gain
> avoid salt intake to reduce fluid retention
> loose-fitting clothes helpful
8
Q
Why Give Steroids?
A
- Repress immune system
- Dcr inflammation
- Prevent bad reactions to chemo; anaphylaxis
- Help w/ n/v; incrs appetite
-
Negatives
> wt gain, irritation (mood), stretch marks, salt retention, incr BG, incr BP
9
Q
Preparation for Procedures
A
- Typically sedated
- Explanations according to age & development provided
- Emotional support
- Topical anesthetics before venipuctures & accessing implanted port
- Deeper infiltration of lidocaine used for bone marrow biopsy
10
Q
Health Promotion
A
- Children w/ cancer still need basic health care, can be overlooked w/ focus on cancer care
- Cognitive, physical, & neurologic status carefully monitored
-
Dental care
> fluoride & dental examinations, monitor for effects of irradiation
> may have delay in development of permanent teeth
11
Q
Health Promotion - Immunizations
A
- Live, attenuated viruses contraindicated
- Inactivated vaccines can be used
- Fam can receive some live vaccines
- Varicella dangerous to child, need varicella immune globulin
12
Q
Cardinal Symptoms of Childhood Cancer
A
- Unusual mass or swelling
- Unexplained paleness & loss of energy
- Sudden tendency to bruise
- Persistent localized pain or limping
- Prolonged unexplained fever/illness
- Frequent headaches, often w/ vomiting
- Sudden eye or vision changes
- Excessive rapid weight loss
13
Q
Osteosarcoma
A
-
Most common bone cancer in children
> 10-15yrs - Typically found in long bones (femur)
- Surgery, chemo, amputation
14
Q
Osteosarcoma - Symptoms
A
- Symps confused w/ growing pains
- Localized pain
- Palpable mass
- Limping
- Progressive limited ROM
15
Q
Brain Tumors
A
- Many types
- Most start in lower parts of brain
- Surgery, radiation, chemo
-
Post-surgical care
> biggest concern: how fluid has shifted in brain
16
Q
Brain Tumors - Symptoms
A
-
Headaches
> worse in AM
> afternoon headaches due to glucose or vision problems - Dizziness
- Balance problems
- Vision/hearing/speech problems
- Frequent vomiting
-
Seizures
> incrd ICP
17
Q
Neuroblastoma
A
- Arises from immature nerve cells in infants & young children (under 5)
- Often begins in adrenal glands
- More common in males
- Poor prognosis due to invasiveness
18
Q
Neuroblastoma - Symptoms
A
- Impaired ability to walk
- Changes in eyes
- Pain in various locations of body
- Diarrhea
- High BP
- Pubic hair very early
19
Q
Wilms Tumor (Neohproblastoma)
A
- Usually in 1 kidney
- Typically found in children 3-4yrs
-
Do NOT palpate abdomen
> risk of rupture & spread
20
Q
Wilms Tumor (Neohproblastoma) - Symptoms
A
- Swelling or lump in belly
- Urinary retention/hemturia
- Anemia
- Fever
- Pain
- Nausea
-
Poor appetite
more common in children w/ anomalies
21
Q
Hodgkin’s Lymphoma
A
- Starts in lymphocyte cells in immune system
- Affects lymph nodes, lymph tissue and then metastasized
- Good prognosis w/ radiation & chemo
-
Hodgkin Lymphoma
> rare in kids younger than 5 -
Non-Hodgkin’s Lymphoma
> no reed-sternberg cells
22
Q
Hodgkin’s Lymphoma - Symptoms
A
- Swollen lymph nodes in neck, armpit, or groin
- Weight loss
- Fever
- Sweats
- Non-productive cough
- Weakness
23
Q
Leukemias
A
- An unrestructed prolifeartion of immature WBCs in the blood-forming tissues of body
- Incring # of immature WBCs depresses bone marrow
- Liver & spleen are the most severely affected organs
24
Q
Acute Lymphoblastic Leukemia
A
-
Most common childhood cancer
> typically occurs btwn 2-4yrs, more common in males - Begins in bone marrow, spreads to blood, then organs
- Prognosis depends on various things including age of diagnosis, initial WBC count, type of cell involved, gender of child, & occurence
25
Q
Bone Marrow Dysfunction
A
- Proliferating cells dcr bone marrow production due to the competition for essential nutrients
-
3 primary consequences
> anemia: dcr in RBC
> infection: dcr in WBC
> bleeding: dcr in platelets - Bones weaken & are prone to fractures
- Bone pain from incrd pressure
-
S/S
> fever, pallor, fatigue, anorexia, hemorrhage, bone & joint pain
26
Q
Leukemia - Diagnostics
A
-
Based on hc & physical manifs
> minor infection does no disappear
> pale, listless, irritable, febrile, anorexia -
Peripheral blood smear
> immature leukocytes
> frequently low blood cell counts - Lumbar puncture to evaluate central nervous system involvement
- Gold Standard: Bone Marrow Aspiration
27
Q
Three Phases of Chemotherapy
A
-
Induction
> 4-5 wks, begins almost immediately -
Intensification (consolidation) Therapy
> to eradicate residual leukemic cells
> chemo given periodically over 6 months -
Maintenance Therapy
> to preserve remission
> wkly or monthly CBCs
> treatment usually stops after 2 or 3 yrs
> monitor for relapse
28
Q
Therapeutic Management of Leukemia
A
- Each relapse means poorer prognosis
-
Monitor for infection!
> major cause of death in immunosuppressed child -
Bone marrow transplantation
> used in both AML & ALL
