Child with Malignancy Flashcards
Cells growing and spreading in a disorderly, chaotic fashion.
Malignancy
the leading cause of cancer-related death in children?
Brain tumors
Most prevalent cancer in children?
Leukemia
Term for malignant soft tissue or bone cancer
Sarcoma
Common Presenting Signs & Symptoms of malignancy?
- Fever
- Pain
- Fatigue
- Headaches
- Lymphadenopathy (hard, rubber, immovable nodes)
- Pallor
- Purpura
- Weight loss
- Neurological changes
- Mass or swelling
the distorted and uncontrolled proliferation of white blood cells.
Leukemia
Formation and development of the various blood cells (red blood cells, leukocytes, and platelets)
Hematopoiesis
red blood cells, leukocytes, and platelets develop from which type of stem cell?
undifferentiated, pluripotent stem cell
Myeloid cells differentiate into?
Red blood cells, monocytes, granulocytes, and platelets
Lymphoid cells differentiate into?
B cells and T cells
Two major classifications of leukemia?
- Acute lymphcytic leukemia (ALL)
- Acute myelogenous leukemia (AML)
Most common classification of leukemia?
ALL
Peak age of onset for ALL?
- 4 years old
Malignant cell line involved in ALL?
the immature lymphocyte, the lymphoblast.
Most common type of leukemia in adults?
- AML
- frequency increase in late adolescence
Clinical Presentation of Leukemias?
- Anemia: malaise, fatigue, pallor
- Thrombocytopenia: gingival, cutaneous or nasal bleeding
- Neutropenia: fever, recurrent infections
- Hepatosplenomegaly, abdominal pain, nausea, vomiting
- Bone pain (23%)
- Lymphadenopathy
- Anorexia, weight loss
S/S of Anemia?
malaise, fatigue, pallor
S/S of Thrombocytopenia?
gingival, cutaneous or nasal bleeding
S/S of Neutropenia?
fever, recurrent infections
S/S of Hepatosplenomegaly?
abdominal pain, nausea, vomiting
Clinical Presentation of AML
- May present with life-threatening sepsis or hemorrhage
- Gingival hypertrophy
- Extramedullary infiltration
Extramedullary infiltrations?
- into the soft tissues and skin)
- Chloromas (myeloid sarcoma)
- Leukemia cutis (infiltration of leukemia cells under the skin approx 3%– colorless or slightly purple, “blueberry muffin” appearance
- infiltration of leukemia cells under the skin approx 3%
- colorless or slightly purple, “blueberry muffin” appearance
- Leukemia cutis
Gastrointestinal Potential Side Effects of CTX?
nausea, vomiting, diarrhea, constipation, impaired liver function, pancreatitis, anorexia, & electrolyte imbalances
Skin/mucosal Potential Side Effects of CTX?
mucositis, stomatitis, rashes, discoloration, increased sensitivity to sunlight, alopecia
Hematologic Potential Side Effects of CTX?
anemia, neutropenia, and thrombocytopenia
Immunosuppression
Other Potential Side Effects of CTX?
pulmonary, renal, neurological, or cardiac damage, possible sterility
Staff should wear appropriate protection to shield them from body & blood for how long after CTX has been completed?
48 hours
Common classifications of brain tumors?
- Astrocytomas
- Low-grade astrocytomas
- Anaplastic astrocytomas & glioblastoma multiforme
- Brainstem glioma
- Medulloblastoma
- Ependymoma
Craniopharyngioma
Brain tumor clinical presentations caused by increased ICP?
Headache, vomiting, ataxia, nystagmus, & diplopia
What symptoms are associated with brainstem involvement either from tumor or compression from tumor or hydrocephalus
Cranial nerve deficits
Supratentorial symptoms caused by brain tumors?
hemiparesis, seizures, visual changes, and intellectual problems.
Midline tumors in the hypothalamus/pituitary region present with?
visual changes, endocrine abnormalities, and increased ICP.
Tx of brain tumors?
- Primary treatment with maximal surgical resection being the goal.
- Radiation
- Chemotherapy
Most common intraabdominal and kidney tumor of childhood?
Wilms Tumor
- Nephroblastoma,
Most common presenting sign of Wilms tumor?
- swelling or mass within the abdominal area
- Firm, nontender, confined to one side, deep within the flank
Manifestations of Wilms Tumor?
swelling or mass within the abd, hematuria, anemia, hypertension, weight loss, fever
Tx of Wilms Tumor?
- surgical removal
- Children with localized tumors (Stage I and II) have 90% chance of cure with multimodal therapy
Postop concerns for Wilms Tumor removal patient?
- Monitor GI activity; bowel sounds, bowel movements, distention, and vomiting
- Observe for s/s of infection, especially during chemotherapy
Osteogenic Sarcoma
- Primary malignant tumor of bone
- Most common bone tumor & 6th most common malignancy in pediatrics
- Peak incidence is in the 2nd decade of life due to the rapid bone growth occurring during this time.
- Often occurs earlier in girls due to their earlier growth spurt
- more common in boys due to their larger bone volume.
Primary malignant tumor of bone?
Osteogenic Sarcoma
Most common sites for Osteogenic Sarcoma?
- long bones
- Distal femur (35%)
- Proximal tibia (17%)
- Proximal humerus (10%)
Clinical Presentation of OS
- Pain that is dull, aching, and constant and is often worse at night
- Average duration of pain is 3 months prior to diagnosis
- Pain is often attributed to trauma
- May or may not have soft tissue swelling
- May have altered gait or function of extremity
Most common metastatic site for OS?
Lungs
Surgical Tx’s for OS?
- Limb salvage procedure (implant or bone graft)
- Arthrodesis (joint fusion)
- Amputation
- Rotationplasty (ankle used as knee joint)
Risks of CTX in children?
- infection
- fluid volume deficit
- weight loss
- pain
- altered oral mucus membranes (ulcers, mucicitis)
- constipation
