MRI vs CT scan 25 - 35 min Non-ionizing Radiation (RF) Muscles, Ligament, Tissue Vs 5 min Ionizing Radiation Bones & Organs

MRI 25 - 35 min Non-ionizing Radiation (RF) Muscles, Ligament, Tissue CT 5 min Ionizing Radiation Bones & Organs

Care Of The Child With Cancer Flashcards by Jade Ring

Childhood cancer vs Adult

Cancer usually affects…

Kids: Tissue

Adults: Organs

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Childhood cancer vs Adult

Histological type

Kids:

Embryonic, leukemia, lymphoma

Adults:

Epithelial in origin

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Childhood cancer vs Adult

Most common sites…

Kids:

Blood, lymph, brain, bone, muscle, kidney

Adults:

Breast, Lung, Bowel, Bladder, Prostate

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Childhood cancer vs Adult

Cancer prevention…

Kids:

Little known

Adults:

80% preventable

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Childhood cancer vs Adult

Metastasis….

Kids:

Metastasis often present

Adults:

Less often present

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Childhood cancer vs Adult

Responsiveness to treatment…

Kids:

Very responsive

Adults:

Less responsive

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Normal cells cycle

G0
G1…
S….
G2….
M…..

G1: Protein is made
S: chromosomes copies
G2: Just before splitting
M: Mitosis

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Normal cells have differentiation and inhibition. Cancer cells don’t

Describe….

Differentiation is abilty to perform a specific task. Lung cells, tissue, muscle.

Inhibition ensure cell grow when need and stop when not. Contact inhibition / apoptosis

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Loss of normal growth control

Lack of contact inhibition

Avoid apoptosis (cell death)

May produce their own blood supply (angiogenesis)

Can evade the immune system

Describes which type of cells…

Neoplastic cells

Benign or Malignant

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Diagnostics to view cancer (4)

CT 3d with / without contrast

MRI Magnet & Radiofrecuencia used to veiw

Bone scan: IV administration of radioactive tracer absorbed by the bone & excreted quickly No Special Care Afterwards

PET scan

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MRI vs CT scan

25 - 35 min

Non-ionizing Radiation (RF)

Muscles, Ligament, Tissue

5 min

Ionizing Radiation

Bones & Organs

MRI
25 - 35 min

Non-ionizing Radiation (RF)

Muscles, Ligament, Tissue

5 min

Ionizing Radiation

Bones & Organs

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CT vs PET scan

Hard & Soft tissues

Radiation Doesn’t stay in body

Pass X-ray through body create images

Detect / Monitor Cancer, Heart, Brain function

Small amount of Radiation remains in body

Detects cancer earlier than other test

CT
Hard & Soft tissues

Radiation Doesn’t stay in body

Pass X-ray through body create images

PET Scan

Detect / Monitor Cancer, Heart, Brain function

Small amount of Radiation remains in body

Detects cancer earlier than other test

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Lab test for Ped Cancer

a-fetoprotein….

Elevated Hodgkin lymphoma and others

Can help determine tumor burden

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Lab test for Ped Cancer

Urine Catecholamines

Elevated in neuroblastoma

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Lab test for Ped Cancer

CBC…

Determines abnormalities in blood cells seen in cancer

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Cancer staging criteria…

(T) Tumor
(N) Lymph
(M) Metastasis

0 = no growth

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Chemo adminstion

Why is an implanted port performed over a central venous catheter…

Long term access

Lower risk of infection due to being located under the skin

Can be used for blood draws, meds, IV fluids , transfusion

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Are Central line associated blood stream infections CLABSI a Pediatric Quality Indicator?

Yes

Patient Safety
Specif mortality rates
Utilization rates
Reduce unnecessary admission

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How is ped chemo dose determined…

Body surface area

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Give chemo drugs Nurse Safety…(6)

Never prepare chemo drugs outside of a chemo hood.

Wear proper PPE (double gloves, gown, face shield if needed).

Dispose of waste properly in chemotherapy-approved containers.

Receive training before handling chemo drugs.

Report any spills or exposures immediately.

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Chemo decreases the number of circulating….

Neutrophils

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What is used in chemo to increase number of neutrophils…

Granulocyte colony stimulating factors

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Intervention for a chemo patient exposed to chicken pox…

Varicella zoster immuno globulin (VZIG) With in 72hrs

Possible Antibiotic prophylaxis due to 2ndary opportunistic infections

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Neutropenic precautions for chemo patient…

Visitors wash hands before & after
No raw / undercooked foods/veg
No live plants or flowers
Don’t visit if sick

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Prevent hemorrhage Avoid rectal anything Avoid IM / LP if possible ____ dressing after bone marrow aspiration Acetaminophen instead of NSAID

Pressure dressing

With radiated skin use moisturizer & topical creams for itchiness....

True

Sepsis Cause: Neutropenia from bone marrow suppression. 4 SS..... ANC.... Clotting time / platelet count... Ph state...

SS Fever / Low body temperature Resp distress Poor perfusion Alt LOC ANC <500 Clotting time Increased/ Platelets Decreased Metabolic acidosis

Oncology Emergencies Tumor lysis syndrome SS NVD & Anorexia Lethargy Increased HR & BP Low urine output Alt LOC Describe (Hyper / Hypo) Uricemia Kalemia Phosphatemia Calcemia Oxygen level

HyperUricemia HyperKalemia HyperPhosphatemia HypoCalcemia Hypoxia

Tumor lysis syndrome NVD & Anorexia Lethargy Increased HR & BP Low urine output Alt LOC HyperUricemia HyperKalemia HyperPhosphatemia HypoCalcemia Hypoxia Give this medication several days prior to chemotherapy.... Fluid maintenance... Give sodium bicarbonate

Allopurinol Double fluid maintenance

Typhilitis (Neutropenic Enterocolitis) Inflammation of GI tract with Induction phase of leukemia chemotherapy Fever?.... NV Diarrhea or Constipation.... KUB why.... Diet... Broad-spectrum antibiotics

Fever Yes Blood diarrhea KUB for possible illeus Diet: NPO / IV nutrition

What causes Superior Vena Cava Syndrome....

Compression by NHL or other mediastinal mass (Neuroblastoma)

Superior Vena Cava Syndrome Dyspnea/ Cyanosis Large cervical lymph nodes Wheeze / Diminished breath sounds Diagnostic CT shows mediastinal mass / Pleural Effusion Treatment...

Intubation & ventilation Surgical removal of mass

Cushings triad.... Seen with increased ICP Why....

Bradycardia – abnormally slow heart rate Hypertension with widening pulse pressure – elevated systolic BP with a large gap between systolic and diastolic pressures Irregular respirations – often Cheyne-Stokes or other abnormal breathing patterns Why: As ICP raises it pushes on brain stem associated with vital functions. The changes reflects brain attempt to maintain cerebral perfusion pressure (CPP) in the face of rising ICP.

HA Morning vomiting Alt LOC Cushings triad Seizure Infants: Increases Head Circumference Describe problema... Interventions....

Increased ICP due to tumor Frequent neurological assessment Limit fluids Dexamethasone Anticonvulsants Tumor resection, radiation, chemotherapy

Obstruction causes by neuroblastoma filling a large portion of ab cavity...

Massive Hepatomegaly

Massive Hepatomegaly Distended ab Resp distress, hypoxia Poor perfusion Tachycardia/low BP Interventions....

Tumor resection/bulking Mech ventilation Inotropic support NG decompression Blood transfusion

Stem cells in bone marrow produce immature abnormal functioning WBC...

Leukemia

______ is a cancer of the blood-forming tissues, including the bone marrow and lymphatic system, leading to the Overproduction of immature white blood cells (blasts). These abnormal cells crowd out healthy blood cells, causing Anemia, Infection risk, and Bleeding.

Leukemia

What are lymphoblasts Which problem are they associated with...

Immature WBC Leukemia

Type of chemo used for leukemia...

Intrathecal chemo

Signs and Symptoms.... Fatigue, pallor (from anemia) Fever, frequent infections (due to neutropenia) Easy bruising or bleeding (low platelets) Bone or joint pain Swollen lymph nodes Hepatosplenomegaly Unexplained weight loss

Leukemia

Most common form of childhood cancer...

Acute Lymphoblastic leukemia 3/4 of all childhood cancer

Direct etiology unknown for Actue Lymphobastic Leukemia. Prevalent 2 - 5 yrs, White, Boy General prognosis.... What can affect prognosis...

Good prognosis 70% response well to treatment High WBC count at diagnosis = decreased prognosis Also relapse is bad, mmmkay

Actue Lymphobastic Leukemia Affects all lymphoid progenitor. Explain...

Lymphoid Progenitor Cells (Lymph Stem Cells) Develop Into: B lymphocytes (B cells) – make antibodies for humoral immunity T lymphocytes (T cells) – regulate immune response and kill infected cells Natural Killer (NK) cells – destroy virus-infected or cancerous cells without prior sensitization These immature WBC (Lymphobasts) replace other blood cells leading to low RBC & Platelets

Actue Lymphobastic Leukemia Treatment....

Blood transfusion Pain control Bleeding precautions Chemotherapy (Stages) Induction Consolidation Maintenance

Acute Lymphobastic Leukemia Treatment: Blood transfusion Pain control Bleeding precautions Chemotherapy (Stages) Induction Consolidation Maintenance SS.....

Fever Infection Anemia Bleeding/bruising Ab/bone pain Nausea Anorexia HA

Acute Myelogenous Leukemia Affects Myeloblasts proliferate (which produce which cells).... Most common in <2 yrs More resistant to therapy Phases of chemo therapy include .... Treatment may require bone marrow transplant esp if relapse occurs

Granulocytes (Eosinophils, basophils, neutrophils) Induction & consolidation phase 6 - 9 months

Acute Myelogenous Leukemia Affects Myeloblasts proliferate produce Granulocytes (Eosinophils, basophils, neutrophils) Most common in... More resistant to therapy May require _____ if relapse occurs.

<2 & adolescentes, Hispanic, previous chemo, Downs syndrome Bone marrow transplant if relapse occurs

Most common solid tumor in children & 2nd most common next to leukemia...

Brain cancer

Brain Cancer Fast growing, invasive, highly malignant Located in cerebellum

Medulloblastoma

Medulloblastoma Describe... Location....

Fast growing, invasive, highly malignant Cerebellum

Brain Cancer Aggressive, slow growing/ hard to resection, resistance to Chemotherapy Can impact Cranial Nerve function Location: Brain stem (Pons / Medulla)

Brainstem Glioma

Brainstem Glioma Describe... Location...

Aggressive, slow growing/ hard to resection, resistance to Chemotherapy Can impact Cranial Nerve function Location: Brain stem (Pons / Medulla)

Brain Cancer Speed of growth varies Can cause hydrocephalus, helps with early detection Location: fourth floor of ventricle

Ependyoma

Ependyoma Describe... Location...

Brain Cancer Speed of growth varies Can cause hydrocephalus, helps with early detection Location: fourth floor of ventricle

Brain Cancer Slow growth Ranges from grade I - IV Location: cerebellum, thalamus, hypothalamus, cerebral Hemisphere

Astrocytoma

Astrocytoma Describe... Location...

Brain Cancer Slow growth Ranges from grade I - IV Location: cerebellum, thalamus, hypothalamus, cerebral Hemisphere

How to get Definitive Diagnosis of brain cancer...

Biopsy

Use of CT, PET ,MRI in brain cancer...

See extent / part of brain impacted See borders as pre-surgical baseline

Treatment Brain Cancer Why might radiation not be used for a child <3 with brain cancer... Down side to chemotherapy... Can use hematopoietic stem cells

Toxic effect to developing brain Chemo is less effective due to blood brain barrier

Post op brain tumor Pain: May need narcotics (Around the clock or PRN bases on assessment) VS... Posistion will be decided by surgeon, usually...

Monitor hyperthermia/ Provide cooling blankets Usually flat after surgery <30°

Common extracranial solid tumor that arises from embryonic neural crest cells... Only found in children

Neuroblastoma

Neural crest cells often form the adrenal glands & sympathetic nervous system can form a Neuroblastoma. This type and location of cancer.... Only found in children.

Neuroblastoma

Often diagnosed in infants & toddlers this extracranial solid tumor often has metastsized when found in the adrenal glands or paravertebral sympathetic chain (chest or retroperitoneum)....

Neuroblastoma

Neuroblastoma Staging: Stage 1... All other stages this treatment... Stage IV... Stage IV-S....

Stage 1: Can be resected All other stages this treatment... Require chemo & radiation Stage IV: Metastasis to other sites including bone Stage IV-S: Metastasis to other sites (liver, lymph, skin, bone marrow) Not Bone

SS... 1ST sign swollen or asymmetrical abdomen. TUMOR FIXED AND IMMOBILE symptoms depende on where tumor lies Swollen/ bruising around eyes Paralysis if spine is compressed Bone pain Weight loss Bowel / bladder dysfunction

Neuroblastoma

Neuroblastoma SS... Most important/1st signs

1ST sign swollen or asymmetrical abdomen. TUMOR FIXED AND IMMOBILE symptoms depende on where tumor lies Swollen/ bruising around eyes Paralysis if spine is compressed Bone pain Weight loss Bowel / bladder dysfunction

Diagnostic labs CT / MRI Bone scan Bone marrow biopsy 24hr URINE COLLECTION: HOMOVANILIC ACID & VANILLYLMANDE Increased

Neuroblastoma

Neuroblastoma Treatment... Prognosis...

Surgery, radiation, chemotherapy for any stage >1 Stage 1-2 and 4S = 80 - 100% Stage 3 40%

Type of bone cancer that forms in the embryonic mesenchymal tissue...

Osteosarcoma

Osteosarcoma....

Type of bone cancer that forms in the embryonic mesenchymal tissue...

Common sites for Osteosarcoma .... Type of bone cancer that forms in the embryonic mesenchymal tissue

Long bones Distal femur, humerus, proximal tibia

Osteosarcoma Type of bone cancer that forms in the embryonic mesenchymal tissue... Clinical Manifestions...

Dull bone pain, limp, limited ROM, erythema, swelling. Mass may or may not be visible Metastasis to lungs / otro bones

Dull bone pain, limp, limited ROM, erythema, swelling. Mass may or may not be visible Metastasis to lungs or other bones Problem...

Osteosarcoma

Treatment for osteosarcoma is primarily radation...

False Radiation Doesn't Work Chemo & Surgery

Ewings Sarcoma Round xell tumor of the bones usually involving the diaphyseal (Shaft) portion of the....

long bones

Round cell tumor of the bones that usually affects the diaphyseal (shaft) portion of long bones...

Ewing's sarcoma

Most common sites Femur, Pelvis, Humerus, Tibia, Fabia Highly malignant: Lungs, bones, bone marrow Problem.....

Ewings Sarcoma

Ewing's Sarcoma Most common sites Femur, Pelvis, Humerus, Tibia, Fabia Highly malignant: Lungs, bones, bone marrow Clinical Manifestions....

Pain Swelling Erythema to soft tissue Fractures to bones Limp Increased Crp ESR WBC

Population: 5 - 20 yr Male Treatment: Excision of tumor Chemo Radiation- due to radiosensitivity Goal to save functional limb...

Ewing's Scarcoma

Most common renal tumor Peak occupancy 3 - 4 yrs 90% survival rate

Wilms tumor

Painless hematuria Mass on 1 side of abdomen HTN Labs: CT / MRI Urinalysis: hematuria/ Leukocytes 24 hr urine collection (HVA or VMA not elevated) NO PALPATION OF ABDOMEN Describes....

Wilms tumor

Neuroblastoma vs Wilms Tumor Opsoclonus-myoclonus syndrome May cross brains midline Fixed & immobile Constitutional symptoms Common Vs WAGR syndrome & Beckwith-Wiedemann syndrome Not cross brains midline Maybe displaced Constitutional symptoms Not Common

Neuroblastoma Opsoclonus-myoclonus syndrome May cross brains midline Fixed & immobile Constitutional symptoms Common Wilms Tumor WAGR syndrome & Beckwith-Wiedemann syndrome Not cross brains midline Maybe displaced Constitutional symptoms Not Common

Highly malignant soft tissue tumor that arises from embryonic mesenchymal cells (Striated Muscle)

Rhabdomyosarcoma

Rhabdomyosarcoma Highly malignant soft tissue tumor that arises from embryonic mesenchymal cells (Striated Muscle) Most commonly occurs...

Head, Neck, GU tract, Abdominal, extremeties

Rhabdomyosarcoma is highly malignant and metastasizes through Venus/ Lymphatic system Most common sites of Metastasis...

Lungs

Rhabdomyosarcoma Highly malignant soft tissue tumor that arises from embryonic mesenchymal cells (Striated Muscle) Most common in these ages....

2 - 5 70% of cases <10yrs

Diagnosis of rhabdomyosarcoma...

PET/CT or MRI

Rhabdomyosarcoma Uses chemo, radiation, surgery to get rid of cancer & prevent relapse Prognosis w/o metastasis.... Prognosis with Metastasis....

W/O 60 - 80% With 40% have 3 year survival rate

Congenital highly malignant tumor from embryonic Retinal cells. Diagnosis at 1 - 2 years Rare after 6 yrs

Retinoblastoma

Retinoblastoma Non hereditary vs Hereditary Autosomal Dominate Unilateral or bilateral Vs Unilateral Advanced maternal age

Hereditary Autosomal Dominate Unilateral or bilateral Non hereditary Unilateral Advanced maternal age

Leukocoria aka Cats eye reflex is #1 presenting sign Strabismus (Cross eyed) 2nd most common Inflammation of eye HA / Vomiting Red painful eye with glaucoma Poor vision / blindness (late sign) Heterochromia: Different colored eyes

Retinoblastoma

Retinoblastoma Diagnosis...

Ophthalmic exam with sedation CT / MRI determine extent of tumor LP & bone marrow aspiration to determine Metastasis (Rare)

Photocoagulation Enumeration (Eye removal) Cryotherapy Laser Chemo Radiation Treatment for...

Retinoblastoma

Active chicken pox in a pt with neutropenic precautions will require....

Acyclovir

Use this topical for itching in a pt receiving radiation...

Hydroxyzine

How long can the maintenance phase of chemo associated with acute lymphoblastic leukemia last...

2 - 3 yrs

50% of brain tumors occur here in peds...

Posterior fossa

What is the first choice treatment fir brain cancer..

Surgery

Do u wake up a patent for Q2H neurochecks after postop brain surgery...

Yes

Post op brain cancer put pt on affect3d side to reduce chance of hemorrhage...

False. Avoid affected side

Most common sites for Osteosarcoma...

Knee area Distal femur & Proximal Tibia

This bone cancer that is resistant to radiation is most common during adolescente years, in white males...

Osteosarcoma

Opsoclonus-myoclonus is a rare neurological disorder where a person has: Opsoclonus: fast, uncontrolled, random eye movements in all directions (not rhythmic, very chaotic) Myoclonus: sudden, brief, jerky movements of muscles (like twitching or spasming) Is associated with....

Neuroblastoma Develops into Wilms tumor 60% of the time