Chapter 29: The Child With Cancer Textbook Flashcards
Define the following terms related to cancer
Apoptosis
Oncogenes
Tumor suppressor genes
What does apoptosis mean?
Death of cells
What does oncogenes mean?
Mutated gene that can turn into a / has the potential to turn into cancer cell
What is tumor suppressor genes?
Anti-oncogene
So helps prevent cancer cells from growing
Identify the cardinal symptoms of cancer in children
What are the cardinal symptoms of cancer in children? (8)
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 vomit
Sudden eye/vision changes
Excessive, rapid weight loss
Discuss the diagnostic evaluation of children suspected of having cancer, including the history, physical examination, laboratory testing, diagnostic procedures, diagnostic imaging and pathologic evaluation
Notes
Despite dramatic improvements in prognosis, cancer remains a life-threatening, life-altering illness that has a major impact on family life and places significant demands on family strength in coping with informational and support needs.
Nurses should base support of patients and their families on the premises that with clear communication and compassionate care, fear diminishes, hope emerges and the cancer journey feels less overwhelming.
Epidemiology incidence rates
Childhood cancer is rare
The incidence of specific types of childhood cancer varies according to demographic risk factors such as age,sex and race or ethnicity.
Males have a higher risk for cancer than females
Cancer incidence is higher in children from infancy to 4 years old
Mainly being neuroblastoma and retinoblastoma
&
15 to 19 years old being lymphoma and sarcoma
White children have an overall higher incidence of cancer compared to any other race
Etiology
Often most parents ask, how did my child get this and could it have been prevented?
Lifestyle related behaviors are the main factors adults end up with cancer yet there is no real environmental factor that shows a real connection that causes kids to have cancer.
However characteristics like (3) have been found to increase the risk of childhood cancer
Birth weight
Advanced parental age
Congenital anomalies
Etiology part2
Notes
Genomic technology is rapidly advancing understanding the biology of childhood cancer.
The value of this research is the ability to identify subsets of patients whose prognosis is associated with a particular genetic change & help develop new treatment approaches that are precisely tailored to that particular cancer molecular abnormality!!
Prevention
Knowledge of the risk factors that increase likelihood of cancer holds the promise to prevention.
What are some things health care professionals should educate parents specifically about protecting children from cancer that could be caused from outside/external factors? (2)
Second hand smoking / smoking
- lung cancer
- lung cancer is one of the leading cause of cancer death in adults
Exposure to sunlight & tanning
( excess radiation and not having sunscreen on )
- this could lead to skin cancer
Prevention
To provide early detection to other types of cancer, clinicians have historically recommended that your older patients, around adolescents do what ? Male vs female?
Testicular self-examination
Breast self-examination
What is the only vaccine out there that can prevent cancer and what type?
HPV
- cervical cancer
What type of test, usually recommended to females at the age of 21 to do to detect cancer?
Pap smear
( Papanicolaou smear )
What are diagnostic evaluation we might perform in order to evaluate a child with suspected of having cancer?
Complete health history
Review of system
Physical exemption
Laboratory test
Diagnostic imagining
Diagnostic procedures
- ( lumbar puncture, bone marrow aspirate, biopsy )
Surgical pathology
What are some laboratory tests that can help us diagnose and treat children with cancer?
CBC
Serum chemistries
Liver function test
Coagulation studies
Urinalysis
What are some diagnostic procedures we might do to help diagnosis patients with cancer?
LP
Bone marrow biopsy
What are some diagnostic imaging we might do for a patient who might have cancer?
CT scan
MRI
PET
Lastly what is the pathologic and molecular evaluation after all these diagnostic methods we can perform to help determine if a child has cancer or not?
This is also famously known as what as well?
So let’s use biopsy for example
You can take a piece of tissue for sampling in order for it be sent for various biologic or molecular studies that help define the patients risk of relapse or recurrence & allow health care team to adapt correctly
Targeted therapy because we are specifically finding one thing that’s wrong, typically from these exams and being able to identify that small thing that is causing that cancer & we will help have a patient focus care in treating that abnormality with specific treatment
Discuss the major modes of cancer therapy and their indications for use with children, including surgery, chemotherapy, radiotherapy, biologic response modifiers, and bone marrow transplantation
What is treatment modalities mean?
Forms of surgery or treatment that helps treat patients who have cancer
Examples being
Chemotherapy, biotherapy, blood or marrow transplant
What is the main goal behind surgery for cancer in children?
To remove the tumor and restore normal body functioning to the greatest extent possible
Typically for surgery, many children respond well to it when ?
The cancer is localized & encapsulated
( confined to the site of origin )
Generally, the best prognosis is directly related to _____of the tumor because that facilities surgical removal!
Early prognosis
What is radiation therapy?
Notes
( answer question then read this )
Technology has advanced so much that today, it’s been optimized to beneficial effects and minimized many of the undesirable side by sparing normal tissue
Relieve symptoms by shrinking the size of the tumor with a beam that’s aimed precisely at the tumor or abnormal tissue
However, ionizing radiation is cytotoxic in at least 3 different ways, which are?
Damaging the pyrimidine bases cytosine, thymine and uracil needed for the synthesis of nucleic acids
Causing single stranded breaks in DNA
Causing double helical strand breaks in these molecules
There are two forms of damage that can mainly occur from radiation which is?
Lethal damage - cell death
Sublethal damage - injuries to cells
When you think of this lethal and sublethal damage, what side effects do the patient might present when receiving radiation?
Gi upsets
( nausea & vomit )
Alopecia
( hair falling out )
Bone marrow suppression
Chemotherapy is the primary form of what typically in patients who have cancer?
Primary form of treatment
How does chemotherapy work?
By interfering with the function or production of nucleic acid, DNA/RNA
Why are there precautions in administering and handling chemotherapeutic agents?
Because these agents are Vesicants ( sclerosing agents ) that can cause severe cellular damage if even minute amounts of drug infiltrate surrounding tissue
Are we as new grad nurses be able to handle chemo drugs ?
No, only licensed nurses with that verification can because of how toxic it is
Notes
Chemotherapy drugs must be given through a free flowing IV line
Infusion must be immediately stop if any sign of infiltration are spotted
When a patient is receiving chemo with an known anaphylactic potential, like it’s a very common allergy in the chemo, the precautions are to be in the room/observe for at least an 1 hour after the infusion
- have emergency equipment readably available like your oxygen, epinephrine, corticosteroids, bag valve masks etc
What is biologic therapy?
Also known as biotherapy ?
Uses substances made from living organisms, or laboratory produced version of these substances to treat cancer
Lastly another approach is hematopoietic stem cell transplant, others wise known as your bone marrow transplant. What is it?
Truly how it sounds
Blood forming stem cells being given to a patient
What are the two types of HSCT?
( hematopoietic stem cell transplant )
Allogenic
Autologous
What is allogeneic HSCT?
Where cells are obtained from a family member or volunteer donor
What is autologous HSCT?
Cells previously stored from the patient are given back to the patient by IV infusion
What is the overall treatment or function of successful treatment for patients receiving either HSCT?
That the newly transfused cells will begin to produce functioning nonmalignant blood cells.
In essence the recipient accepts a new blood-forming organ
What are the two stem cells locations patients may end up using if they are getting autologous bone marrow transplantation ?
Peripheral stem cells
Steam cells from umbilical cord blood
Autologous transplants use the patients own marrow that was collected from where?
Disease free tissue
Frozen
Autologous bone marrow transplantation has been used to treat? (6)
Neuroblastoma
Hodgkin disease
Non Hodgkin lymphoma
Wilms tumor
Rhandomyosarcoma
Ewing sarcoma
What does apheresis mean?
Involves blood components removed from a patient, separated and then either returned to the bloodstream or replaced with donor blood products
Discuss the following life-threatening oncologic emergencies that may develop in children with cancer as a a result of malignancy or aggressive treatment of the malignancy ;
Tumor lysis syndrome
Hyperleukocytosis
Superior vena cava syndrome
Spinal cord compression
Disseminated Intravascular coagulation ( DIC )
What are the 4 pediatric oncologic emergencies?
Tumor lysis syndrome
Hyperleukocytosis
Superior vena cava syndrome
Spinal cord compression
Complication of therapy
Although great advances have been achieved through current modes of cancer therapy, the successes are not without consequences. Numerous acute side effects are commonly expected with chemotherapy or biotherapy and radiation. Several complications are less frequent but some are very serious
What is tumor lysis syndrome?
Metabolic abnormalities that are the direct result of rapid release of intracellular contents during the lysis of malignant crisis
What are the 4 metabolic abnormalities of tumor lysis syndrome?
Hyperuricemia
Hypocalcemia
Hyperphosphatemia
Hyperkalemia