Child w/ malignancy (Ch 22) Flashcards
which germ cell layer becomes connective tissue, muscle, bone, cartilage, kidneys, sex organs, blood, blood and lymph vessels and lymphoid organs
embryonic mesodermal germ layer
the embryonic mesodermal germ layer becomes?
connective tissue, muscle, bone, cartilage, kidneys, sex organs, blood, blood and lymph vessels and lymphoid organs
Most childhood cancers arise from which germ layer?
embryonic mesodermal germ layer
most adult cancers involve what type of tissue?
epithelial tissue
cancer of the epithelial tissue
carcinomas
carcinomas are cancers of which tissue type?
epithelial
In a majority of pediatric oncology cases, the tumor has metastasized at the time of diagnosis?
True
delayed diagnosis of cancer in children can be attributed to?
- nonspecificity of symptoms
- provider lack of experience and knowledge
most common types of childhood cancer?
- nonepithelial leukemia
- lymphoma
- sarcomas
- embryonal
most common types of adult cancer?
epithelial carcinoma
some S/S of childhood cancer?
- bone or abd pain
- mediastinal mass
- pale
- lethargy
- bruises easily
- petechiae
- weight loss
a small (1–2 mm) red or purple spot on the skin, caused by a minor bleed from broken capillary blood vessels
petechiae
the presence of pallor, ecchymoses and petechiae may indicate which type of cancer?
leukemia
Asymmetry of facial features may indicate which type of cancer?
retinoblastoma or nasopharyngeal rhabdomyosarcoma
enlarged, firm lymph nodes that are painful upon palpation and associated with weight loss, fever, and an abnormal chest x-ray may indicate which type of cancer?
a lymphoma such as Hodgkins lymphoma or NHL
What are the benefits of treating cancer by combining drugs that act different phases of the cell cycle?
- optimizes cell destruction
- reduces risk of developing a tolerance
- allows for smaller doses, reducing the potential for side effects from each drug
common side effects of chemotherapy in children?
- myelosuppression
- N/V
- diarrhea
- hair loss
- skin problems
suppression of bone marrow functions?
myelosuppression
Phases of chemo?
1) induction
2) consolidation
3) maintenance
4) observation
The phase of chemo where intensive therapy is given to kill enough cancerous cells to induce a remission?
induction
phase of chemo where remaining cancer cells are targeted?
consolidation
phase of chemo designated to provide less intensive txx to destroy any residual cancer cells?
maintenance
a child is consider to be a cancer survivor once they have been disease free for how long?
5 yrs
the side effects of chemo and radiation therapy result primarily from the destruction of which type of cells?
- rapidly dividing cells (mucous membranes, hair follicles and bone marrow)
Acute A/E’s of radiation therapy usually occur?
7-10 days after the start of tx and can last weeks to months after completion of therapy
general A/E’s of biotherapy?
- flulike symptoms
- fluid retention
- low-grade fevers
- bone pain
- chills
- rash
- neuropathic pain
Nursing interventions prior to initiation of biotherapy?
- obtain baseline vitals
- preemptive meds against A/E’s
abnormally low number of neutrophils?
neutropenia
Causes of weight loss in children with cancer?
- substances secreted by the tumor
- pain
- N/V
- stomatitis
- metabolic disturbances
- alterations in taste
Steroid use may cause?
- increased appetite
- weight gain
- fluid retention
Nutritional assessment of a child with cancer?
- daily weights
- I & O
- calorie counting
- labs (Na, K, albumin, Ca, Ma, glucose, protein)
diet for child on steroids?
- low Na (want to minimize fluid retention)
- low cal meals and snacks
period after chemo during which the immune cell count is at its lowest point?
nadir
nadir occurs how long after initiation of chemo?
7 - 10 days
this drug stimulates the bone marrow to repopulate granulocytes more quickly and efficiently, decreasing the duraion of neutropenia
G-CSF
Vaccines that can be administer to a child on chemo includes?
- diptheria-tetatnus-pertussis
- hep B
- inactivated poliovirus
- pneumococcal
- influenza
abnormally low platelet count?
thrombocytopenia
abnormal proliferation of WBC’s?
leukemia
What is the most common childhood cancer?
leukemia
most common type of leukemia in children?
Acute Lymphocytic Leukemia (ALL)
ALL originates/effects which type of cell?
B & T lymphoid cells (Blast cells)
Pathophysiology of ALL
leukemic cells proliferate and pack the bone marrow, interfering with hematopoiesis
ALL s/s?
- anemia
- neutropenia
- thrombocytopenia
- extramedullary disease
Common sites of extramedullary spread from leukemia?
CNS, testes, liver, kidneys and spleen
First diagnostic procedures needed for leukemia diagnosis?
CBC, lumbar puncture, bone marrow aspiration, and biopsy
Sanctuary sites (hiding spots) for leukemia?
- testes
- CSF
Risk factors associated with Acute Myeloid Leukemia?
-radiation exposure in utero, maternal smoking during pregnancy, hx of previous malignancy, trisomy 21, environmental factors
Low-grade tumor definition?
slow growing, contains a few mitotic cells, and show no evidence of necrosis or vascular proliferation
High-grade tumor definition
rapid growing, contain multiple mitotic cells and show evidence of necrosis and endothelial and vascular proliferation
tx of choice for children with a brain tumor?
surgical resection
two major types of lymphoma?
Hodgkins and Non-Hodgkins
Common organs affected by metastatic spread of lymphomas?
spleen, liver, bones, lungs and bone marrow
S/S of Hodgkins Lymphoma?
painless, firm movable nodes
- hepato and/or splenomegaly
- anorexia
- weight loss of > 10% within 6 months
- malaise and lethargy
- drenching night sweats
- fever of > 3 days
When possible, radiation therapy should be avoided until what age?
8 y/o
Peak incidence of NHL?
7 - 11 y/o
Wilms tumor affects which organ?
the kidney
