Chapter 33: Caring for a Child with Cancer Flashcards
Cancer
a group of diseases in which there is out-of-control growth and spread of abnormal cells (anaplasia)
Anaplasia
out-of-control growth and spread of abnormal cells
-anaplastic cells resist normal growth controls
Neoplasm
abnormal cellular growth
- caused by one or a combination of three factors:
1. external or environmental stimuli
2. viruses that can alter the immune system and let the cancer grow
3. chromosomal and gene abnormalities
Growth and Development
child with cancer experiences alterations or lags in growth and development b/c of altered nutrition, fatigue, pain, social isolation, and complications from the disease process requiring frequent hospital admissions
>nursing care= geared toward minimizing the effects of the disease process on the child’s growth and development
Growth and Development: Nutrition
good nutrition is essential for the growing child to maintain growth and development
-child may experience altered nutrition, less than body requirements, b/c of the inability to ingest enough calories to meet the demands of the body and the disease process
>nurse= encourage child to eat small, frequent, high-calorie meals to meet the body’s increased metabolic needs; promote good oral hygiene to prevent complications of pharmacologic therapies
-enteral and parenteral nutrition implemented when needed
-nutritionist used to identify appropriate resources for the child
Growth and Development: Activity
normal activity supports self-esteem and self-knowledge
-nurse= encourage activity and play while allowing for adequate periods of rest b/c the child with cancer may fatigue easily
>quiet activities encouraged when the child has low levels of energy
-nurse assess the child’s pain and implement appropriate pain relief measures to encourage activity and play
Growth and Development: School
peer contact and schoolwork promote cognitive and social growth and development
-nurse= encourage the child to attend school, or see peers when unable to attend school, to avoid social isolation
>nurse should work closely with schoolteachers and child life workers to identify schoolwork needs and support reentry to school when appropriate
Pattern of Tumor Progression
tumor originates as a singe, transformed cell somewhere in the body
- that cell must undergo a long process of growth and development before it can form a tumor
- cell also undergoes countless divisions to form a mass that may be made up of a billion cells at the time of diagnosis
- tumor cells have very stringent constraints placed on them as they grow; each of the newly created cells must have a steady supply of nutrients to keep growing; while the tumor may not be directly next to a capillary, it may be close enough so that oxygen and nutrients can diffuse through tissue to tumor cells; if the tumor receives a continuous supply of nutrients and blood, it grows and invades surrounding tissue; once a tumor grows past its critical phase, it induces growth of new blood vessels into the tumor mass; it can then grow much more rapidly and produce a clinically detectable tumor
- if a tumor does not receive adequate blood supply and nutrients, it can die; a tumor lacking a sufficient blood supply can also remain dormant for years and not grow beyond a certain size
Cell Division
- normal cells divide in an orderly fashion through the four phases of cell division
- normal cells have a control mechanism that stops division when it is complete
- cancer cells have no control mechanism and keep dividing and replicating unchecked without stopping
Understanding Cancer
an oncogene is a gene found in a virus that has the ability to encourage a cell to become malignant
- a tumor is a mass of abnormally growing cells that is either benign (not cancerous), with slow and limited noninvasive growth, or malignant (cancerous), a progressively virulent growth
- cancerous growth are divided further into solid tumors (e.g. a brain tumor) and systemic cancers such as leukemia
Staging
describes the severity of the patient’s cancer; process of classifying tumors in relation to the degree of differentiation, possibility of responding to therapy, and prognosis
- Stage 0= indicates early cancer that is present only in the layer of cells in which it began
- Stage I, II, and III= indicate more extensive disease, greater tumor size, and/or spread of the cancer to nearby lymph nodes or adjacent organs
- Stage IV= cancer has spread to another organ(s)
Common Guidelines for Childhood Cancer Survivors
- height measured regularly
- pre-pubertal girls should be closely monitored for signs of early onset puberty
- patients who have evidence of impaired fertility should be referred to a specialist for ongoing assessment
- neck, spine, or brain radiotherapy may warrant ongoing thyroid function observation
- follow-up appointments
- give patients written summaries about their diagnosis, treatment, and possible late treatment side effects
- multidisciplinary team approach for ongoing care
Gene Therapy
complex and in the early stages of usage for cancer patients
-used to understand and treat the genetic mutations that cause disease
Immunotherapy
the concept of boosting immune cells to destroy cancer cells
>limited success b/c cancer cells tend to evolve, mutating to evade immune detection
Oncolytic Agent
growing area of gene therapy in which genetically engineered and altered viruses are used to target and destroy cancer cells while remaining innocuous to the rest of the body
Gene Transfer
insertion or transfer of a foreign gene into the cancer cell or surrounding tissue
-genes with a number of different functions have been proposed for this type of therapy
Roadmap
protocol or treatment plan that is “mapped out” to guide staff and families through the treatment course
Protocol
complete explanation of a treatment plan, includes background, drug dosages and timing, and protocol requirements such as tests and laboratory specimens
Clinical Trials
medical research studies conducted with volunteers
-each study is designed to answer scientific questions and to find new ways to treat cancer
Remission
the partial or complete disappearance of signs and symptoms of disease
- this does not mean “cancer free”
- there could still be cancer cells that are undetectable in the body; treatment will continue during this time
Extravasation
leaking of vesicants that can cause tissue damage surrounding the IV or central line insertion site; blistering, blanching, or excoriation may lead to ulceration and deep skin sloughing
Induction
chemotherapy given to achieve remission
Consolidation
chemotherapy given after induction to control microscopic disease
Maintenance
chemotherapy given on a long-term basis to maintain remission
Palliative Care
treatment given to relieve rather than cure symptoms caused by cancer
- supportive care services involved
- patient may still receive chemotherapy or radiation
Prevention of Common Childhood Cancer
- not always possible; early prevention is key
- x-rays and computed tomography (CT) scans are ordered more sparingly than in the past b/c limiting children’s exposure to radiation may prevent future risks of developing cancer
- cause of cancer is unknown; genetics, environmental factors, and viruses may play a part in the development of childhood cancer
C-A-U-T-I-O-N
help recognize the seven early signs of cancer
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in the breast, testicles, or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in size, color, shape, or thickness of wart, mole, or mouth sore
- Nagging cough or hoarseness
Signs of Cancer
C-A-U-T-I-O-N (early signs of cancer):
- Change in bowel or bladder habits
- A sore that does not heal
- Unusual bleeding or discharge
- Thickening or lump in breast, testicles, or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in size, color, shape, or thickness of wart, mole, or mouth sore
- Nagging cough or hoarseness
> other signs:
- persistent headaches
- unexplained loss of weight or loss of appetite
- chronic pain in bones or any other areas of the body
- persistent fatigue, nausea, or vomiting
- persistent low-grade fever, either constant or intermittent
- repeated infection
