Childhood Cancer

Question 1

Retinoblastoma

Answer 1

congenital malignant tumor, arises from embryonic retinal cells
if 1 child has it siblings probably do too

Question 2

diagnosis of retinoblastoma

Answer 2

no red reflex
cats eye reflex is most common sign (think of what cat eyes look like when you shine a light in them)
strabismus- second most common sign
red, painful eye, often with glaucoma
blindness late sign

Question 3

treatment of retinoblastoma

Answer 3

based on stage and time of dx
early- irradiation and cryotherapy to preserve vision in affected eye
bilateral disease- attempt to preserve useful vision in least affected eye
advanced tumor- enucleation
chemotherapy
chemotherapy- some controversy

Question 4

prognosis of retinoblastoma

Answer 4

99% survival rate
tumor may spontaneously regress
concern with development of secondary tumors especially osteogenic sarcoma

Question 5

complications of retinoblastoma

Answer 5

spread to brain and opposite eye
metastasis to lymph nodes, bone, bone marrow, and liver
secondary tumors, most often sarcomas, occurring in children who have been tx for retinoblastomas

Question 6

post op care of retinoblastomas

Answer 6

large pressure dressing
dressing changes
sibling eye exams every 1-3 months for the first year

Question 7

rhabdomyosarcoma

Answer 7

highly malignant cells in muscle, tendon, bursa, fascia and fibrous connective tissue, lymphatic, or vascular tissue

Question 8

potential sites of rhabdomyosarcoma

Answer 8

head, neck, GU, extremities

symptoms may be vague and hard to dx

Question 9

rhabdomyosarcoma treatment

Answer 9

highly malignant and frequent metastasis
complete removal of tumor if possible
radiation therapy for most
chemo to shrink may proceed with radiation
long term chemo 1-2 years

Question 10

rhabdomyosarcoma prognosis

Answer 10

excellent in stage 1

poor if metastasis present during diagnosis

Question 11

Hodgkins

Answer 11

more prevalent in 15-19 yo
neoplastic disease originating in lymphoid system
often metastasizes to spleen, liver, bone marrow, lungs and other tissues

Question 12

how do you know its hodgkins?

Answer 12

presence of reed Sternberg cells

malignant B lymphocytes grow in lymph tissue

Question 13

etiology of hodgkins

Answer 13

unknown but has been linked to Epstein Barr virus

need lymph node bx to diagnose

Question 14

s/s of hodgkins

Answer 14

painless enlarged lymph nodes, fever, night sweats

Question 15

treatment of hodgkins

Answer 15

radiation

chemotherapy alone or with radiation

Question 16

prognosis of hodgkins

Answer 16

depends on stage, tumor bulk, classification

Question 17

why should hodgkins kids not drink alcohol?

Answer 17

significant pain in effected nodes after consumption

Question 18

complications for hodgkins

Answer 18

liver failure, secondary cancers, delayed puberty

Question 19

can kids younger than 2 receive radiation?

Answer 19

no

Question 20

signs and symptoms of brain tumors are

Answer 20

related to anatomic location, size, and child’s age

Question 21

diagnostic testing to confirm a brain tumor

Answer 21

MRI
CT
EEG
LP
histologic diagnosis via surgery

Question 22

presenting symptoms of a brain tumor

Answer 22

headache, vomiting, clusiness, unsteady gate, blurred vision, head tilt, seizures, moor abnormality, weakness, behavioral or personality changes, FTT, irritability, vital sign disturbances

Question 23

Therapeutic management of brain tumors

Answer 23

depends on type of tumor
surgery
radiotherapy after the age of 2
chemo
prognosis

Question 24

postop care of brain tumors

Answer 24

positioning- tissue can shift in brain after tumor removal be mindful of this. child should remain midline, flat until they are able to sit. Children are usually sedated for a few days afterwards.
if child is sedated make sure eyes are hydrated
reduce ICP
neck flexion
NPO
comfort measures

Question 25

neuroblastoma

Answer 25

most common malignant extracranial solid tumor of childhood and infancy develops in adrenal gland or retroperitoneal sympathetic chain (head, neck, chest, pelvis)

Question 26

diagnosis of neuroblastoma

Answer 26

``` dx the younger the better radiology studies bone marrow IVP to determine renal involvement Metastasis may have already occurred before diagnoses ```

Question 27

therapeutic management of neuroblastoma

Answer 27

clinical staging to establish treatment plan surgery to remove tumor and obtain bx radiation to shrink tumor for removal chemotherapy bone marrow transplant or stem cell rescue

Question 28

Typical CBC of a leukemia kid

Answer 28

low RBC, HgB, Platelets High WBC Blasts high

Question 29

consequences of leukemia

Answer 29

anemia from decreased RBC infection from neutropenia bleeding tendencies from decreased platelet count spleen, liver, and lymph glands show marked infiltration, enlargement and fibrosis

Question 30

presenting symptoms of leukemia

Answer 30

``` fever pallor bleeding lethargy malaise anorexia large joint and bone pain ```

Question 31

Cardinal signs of bone marrow failure

Answer 31

petechiae frank bleeding joint/bone pain fatigue

Question 32

what does ANT stand for in leukemia

Answer 32

Anemia- low HgB neutropenia- risk of infections thrombocytopenia- bleeding

Question 33

how do you confirm the diagnosis of leukemia

Answer 33

bone marrow bx | bone marrow will show immature cells

Question 34

therapeutic management of leukemia

Answer 34

treatment for presenting symptoms combination chemotherapy cranial irradiation in some areas

Question 35

Ewing sarcoma

Answer 35

malignant bone tumor arises from marrow especially in femur, tibia, ulna, humerus, vertebrae, pelvis, scapula, ribs, skull high malignancy rate

Question 36

sign and symptoms of Ewing sarcoma

Answer 36

swelling and erythema at site. more likely o experience systemic symptoms (fever, spinal cord compression, respiratory distress)

Question 37

treatment of ewing sarcoma

Answer 37

radiation commonly first approach | chemotherapy as adjunct to radiation

Question 38

osteosarcoma

Answer 38

most frequent bone tumor in children peak age of incidence 15 years most primary tumor sites are in the metaphysis of long bones, especially legs can occur is distal femus, humerus, tibia, pelvis, jaw

Question 39

signs and symptoms of osteosarcoma

Answer 39

pain limp decreased ROM

Question 40

complications of osteosarcoma

Answer 40

metastasis to lungs or other bones | recurrence within 3 years

Question 41

therapeutic management of osteosarcoma

Answer 41

traditional approach- radical surgical resection or amputation of affected area limb-salvage procedures- resection of bone with prosthetic replacement of affected area chemotherapy accompanying surgical treatment

Question 42

nursing considerations for osteosarcoma

Answer 42

body image in adolescents support during concepts of amputation, surgical resection pain management phantom limb pain

Question 43

nursing care of child with cancer

Answer 43

side effects of treatment managed treatment complications prevented child and family coping skills supports quality of life help child and family adjust to chronic illness growth and development maintained during treament

Question 44

remission induced chemotherapy

Answer 44

rapid induction of complete remission, lasts 3-4 weeks, oral, steroids and IV chemotherapy

Question 45

consolidation (CNS prophylaxis)

Answer 45

strengthen remission | introduce CNS prophylaxis, intrathecal and IV administration

Question 46

intensification

Answer 46

destroy remaining or resistant cells

Question 47

maintenance

Answer 47

prevent relapse, treat metastasis

Question 48

signs of CNS involvement

Answer 48

``` headache persistent nausea or vomiting irritability dizziness seizures behavior and personality changes 6th cranial nerve palsy, abductus- lateral eye movement ```

Question 49

what to know about chemo

Answer 49

it kills healthy cells too

Question 50

short term side effects of chemo

Answer 50

``` immunosuppression infection myelosuppression nausea vomiting oral mucositis alopecia ```

Question 51

long term side effects of chemo

Answer 51

microdonita and missing teeth hearing and vision changes hematopoietic immunologic or gonadal dysfunction endocrine dysfunction various alterations of the cardiorespiratory, GI, GU development of secondary cancer as an adolescent or adult