Chapter 13: pediatric oncology Flashcards
Cancer is the #______ cause of death for children 0-14 in the US, but the 5 year survival is ______%
1st
84%
What are the 2 most common types of childhood cancer, each with 25% (broad)
- Brain/CNS
- Leukemia
What kind of cancer is Wilm’s tumor
Most common kidney malignancy in children, often presenting with a large abdominal mass and sometimes HTN
ESRD occurs with bilateral disease
T/F: Children are at greater risk for malnutrition during cancer treatment than adults
True, as their metabolic demands are higher as they’re need to gain weight/grow
These are 2 most common types of childhood cancers
- Acute Lymphoblastic Leukemia
(think ALL children’s hospital) - Acute Myeoloid Leukemia
These are 2 long-term side effects of ALL in children (maintenance and continuation phases)
- Obesity
- Reduced bone mineral density
This is considered “unhealthy weight” for children
< 5th percentile for BMI or > 85th percentile
T/F: Children with AML are especially prone to anorexia, weight loss, N/V, mucositis, and malnutrition d/t intensive chemotherapy regimens
True
(think M for malnourished & myopathy, L for large)
This is a late side effect of AML in children
Cardiomyopathy
_______ is a potential complication for children with posterior fossa, cerebellum, or brain stem tumors
Dysphagia
Long term complications of childhood CNS tumors
cognitive/motor deficits, weight gain, central adiposity, feeding difficulties
Radiotherapy to the brain may disrupt _______ & ______ cues, causing excessive energy intake
ghrelin & leptin cues
T/F: Significant weight loss may be a presenting symptom in hodgkins & non-hodgkins lymphomas
True
Medistinal radiation is often used for lymphomas and may cause abnormal function of the _____, ______, _______
Thyroid, heart, lung
Anthracycline chemotherapies of often used for childhood lymphoma and have ___________ risk
cardiovascular (cardiomyopathies)
T/F: Most childhood leukemias & lymphomas put survivors at risk for obesity, reduced strength, high fat/low muscle
True
________ is the most common solid tumor in children, often diagnosed (and less risky) in the first year of life
Neuroblastoma
Malnutrition at the time of dx of neuroblastoma is high, __________ (%)
20-50% though d/t the NIS, not hypermetabolic state
What are the 5 steps for ALL treatment in children?
- Remission induction
- Consolidation
- Interim Maintenance - sometimes this is the last phase
- Delayed intensification
- Maintenance/continuation
(Radiation Can Inhibit Daily Meals)
Describe Remission Induction phase
Lasts ~1 month, kills as many cancer cells as possible to bring WBC, RBC, Platelets to normal levels
Usually in the hospital
Explain Consolidation
Goal is to maintain remission and prevent relapse. This is more intense chemo than remission induction. It lasts several months.
Explain maintenance
This is lower chemo dose but goes on for longer periods of time
What is rhabdomyosarcoma
Soft tissue tumor that usually starts in the muscle and may occur in children, various parts throughout the body
Side effects depend on where treatment is given (often chemoradiation)
Which 2 common types of childhood cancer often benefits from MUAC?
Wilm’s tumor d/t large abdominal mass. This often causes anorexia/early satiety
Hepatoblastoma d/t abdominal tumor growth
These are the first & second most common BONE tumors in pediatric patients
- Osteosarcoma
- Ewing Sarcoma
__________ is a bone tumor that typically occurs during periods of rapid growth, with pain being the most common presenting symptom
Osteosarcoma
Ewing sarcoma is typically found in the ______ extremities, ______, & chest wall
Lower, pelvis, and chest wall
_________ is the most common liver malignancy in children
Hepatoblastoma
CAR T-cell therapy has been approved for pediatrics with relapsed or refractory __________
B-cell ALL
_________ is an approach to treating extensive peritoneal disease and involves administering heated chemotherapy agents directly into the peritoneal cavity
HIPEC
Hyperthermic Intraperitoneal Chemotherapy
T/F: HIPEC sometimes requires EN or PN
True, feeding tube is sometimes placed during the surgery
Name 4 common nutrition considerations of brain tumors
- Decreased appetite
- Taste changes
- Dysphagia
- Weight gain
Are pediatric patients with SOLID tumors at lower or higher risk for malnutrition at the time of diagnosis
Solid (but increases a lot w/ blood cancers during treatment)
Define Z score
Looks at standard deviations from the mean and used in pediatrics to determine malnutrition when only 1 datapoint is available
-1-1.9 (mild malnutrition)
-2-2.9 (moderate malnutrition
-3-3.9 (severe malnutrition)
T/F: Every child w/ cancer should be screened, assessed, and re-assessed by RD
True
This is the 1 validated screening tool for identifying children at risk for malnutrition
SCAN
(Screening for Childhood Cancer)
** >/= 3 of 10 points puts at risk for malnutrition
What are the criteria involved in the SCAN tool? (6)
Does this pt have a high risk cancer?
Is the child undergoing intensive treatment?
Does the pt have GI symptoms?
Has the pt had poor intake over the past week?
Has the patient had amy weight loss over the past month?
Does the patient show signs of undernutrition?I
Children with _______ & ______ cancer may have amputations, thus weight, BMI, and IBW must be adjusted
Osteosarcoma & Ewing Sarcoma
T/F: Predictive equations tend to overestimate energy needs in children
True
Thus use IC or adjust using clinical judgement
The ________ equation for pediatric critically ill patients should be used
WHO equation for REE
Explain growth charts, WHO versus CDC
WHO = 0-24 months
CDC = 2-20 years
Z score of >/= _____ for height should be investigated in pediatric population
+2
Z score of </= _____ for weight/BMI should be investiaged
1
The ______ (lab) indicates the body’s ability to fight infection and often how the pt feels/eats
Absolute Neutrophil Count (ANC)
This nutrient is often falsely ELEVATED d/t inflammation
Ferritin
Children with ______ syndrome are at increased risk for developing leukemia
Down’s Syndrome
Hepatosplenomegaly is common with ________
Leukemia
3 large solid tumors in children include
- Hepatoblasoma
- Neuroblastoma
- Wilm’s Tumor
Pediatric SGA has been validated for use in ________ pediatric patients
Hospitalized (not specifically oncology patients)
D/t calcium/vitamin D deficiencies, _______ is common in pediatric cancer survivors
Osteoporosis
Equation for adjusted body wt
Actual wt x 100 / (100% - % of ambutation)
*will be higher than the current wt
T/F: Activity factors for peds are slightly higher for males than females
False
Remember sedentary, low sedentary, active, very active
Energy equations may overestimate up to _______ kcal in pediatric cancer survivors
491 kcal/day
Protein goals for children
Use RDA (0.8-1.5 g/kg depending on the age, may need up to 150-200% of the RDA for illness, stress, infection, diarrhea
*1 g/kg + resistance training may help to build lean mass
T/F: Protein is metabolized if kcal intake is inadequate in the presence of stress
True
The ______ equation should be use for predicting fluid needs in children
Holliday-Segar
These 2 micronutrients are commonly deficient in pediatric cancer pts
Calcium & vitamin D
(thus high risk for osteoporosis)
Low vitamin D has been associated with _______ & ______ infections
C. diff & staphyloccocous
Vitamin D goal for pediatric cancer patients
> 30 ng/mL
3 appetite stimulants for peds
- Megace
- Dronabinol
- Cyproheptadine
