Childhood Cancer Flashcards
- Bone Marrow Aspiration/Biopsy
Used to diagnose leukemia
- Nursing Responsibilities: Pain management, emotional support, sterile technique, monitoring for bleeding.
Lumbar Puncture
Checks for cancer cells in cerebrospinal fluid.
- Nursing Responsibilities: Positioning, sedation (if needed), monitoring for headache or bleeding.
CT, MRI, PET scans
Imaging for solid tumors.
- Nursing Responsibilities: IV contrast preparation, ensuring the child remains still (possible sedation).
Diagnostic Tests
Bone Marrow Aspiration
Lumbar Puncture
CT/MRI/PET
CBC w/differential
CBC w/Differential
Evaluates WBCs, RBCs, and platelets.
= Nursing Responsibilities: Monitor for infection, anemia, bleeding tendencies
Leukemia Types
- Most common childhood cancer
Types: Acute Lymphoblastic Leukemia (ALL) (most common) &
Acute Myelogenous Leukemia (AML).
Peak onset 2 to 3 years
Leukemia S/S
- Fever
- Petechiae, bruising, bleeding (low platelets)
- Fatigue, pallor (anemia)
- Bone pain (leukemic cell infiltration)
- Hepatosplenomegaly
- Frequent infections
Leukemia Diagnosis
- CBC: High WBC (>50,000 = worse prognosis), low RBCs, low platelets.
- Bone marrow biopsy: >25% blast cells.
- Lumbar puncture: Check for CNS involvement.
Leukemia Treatment
Chemotherapy in four phases:
1. Induction (goal = remission)
2. Consolidation
3. Delayed Intensification
4. Maintenance (2-3 years)
CNS prophylaxis: Intrathecal chemotherapy to prevent brain involvement.
Stem cell transplant (in high-risk cases).
Supportive care: Blood transfusions, infection control, anti-nausea meds.
Leukemia Complications
- Neutropenia → risk of infection
- Tumor Lysis Syndrome
- Bleeding due to thrombocytopenia
- Long-term effects: Secondary cancers, learning disabilities, endocrine issues
Leukemia Prognosis
- ALL survival rate = ~85%
- Worse prognosis if: WBC >50K, age <1 or >10, CNS involvement, T-cell leukemia.
Relapse rate 20%
Brain Tumors
- Second most common pediatric cancer.
- Most common types: Medulloblastoma, Astrocytoma, Ependymoma.
Brain Tumor S/S
- Morning headaches
- Nausea/vomiting
- Vision changes (blurred, double vision)
- Balance issues, dizziness
- Fatigue, seizures
Brain Tumor Diagnosis
- MRI/CT
- Lumbar puncture (if no increased ICP)
- Biopsy if accessible.
Brain Tumor Treatment
- Surgery: Goal is tumor removal.
- Radiation: Used in children >3 years.
- Chemotherapy: For younger children or in combination with surgery/radiation
Brain Tumor Post Op Complications
- Signs of increased ICP: Decreasing LOC, bradycardia, hypertension (Cushing’s Triad).
- Diabetes Insipidus: Excessive urination, dehydration.
- SIADH: Fluid retention, hyponatremia.
Wilms Tumor (Nephroblastoma)
- Kidney tumor, usually unilateral.
- Peak age: 2-3 years
High association with Beckwith/Wiedmann syndrome
Wilms Tumor (Nephroblastoma) S/S
- Painless abdominal mass (DO NOT PALPATE!) asymptomatic one side of midline
- Hypertension
- Hematuria (rare)
- Abdominal pain (uncommon)
Wilma Tumor (Nephroblastoma) - Diagnosis
- Abdominal ultrasound, CT/MRI.
- Lab tests: CBC, renal function (BUN/Creatinine).
Wilma Tumor (Nephroblastoma) - Treatment
- Nephrectomy (removal of affected kidney).
- Chemotherapy ± radiation.
Wilma Tumor (Nephroblastoma) - Complications
- Hypertension (from renin secretion).
- Metastasis to lungs (check for respiratory symptoms).
- Long-term renal function concerns
Osteosarcoma
- Bone cancer, often in long bones (femur, tibia, humerus).
- Peak age: Adolescence (13-17 years).
Osteosarcoma S/S
- Bone pain (worse at night)
- Limping
- Swelling at tumor site
- Pathologic fractures (rare)
High risk for lung metastasis 20%
Osteosarcoma Diagnosis
- X-ray (“sunburst” pattern).
- Bone biopsy.
- MRI, CT to check for metastases
Osteosarcoma - treatment
- Chemotherapy (before & after surgery).
- Limb-salvage surgery or amputation.
- Physical therapy & emotional support
Osteosarcoma - Complications
- Lung metastases.
- Limb loss impacting mobility/self-image.
- Chemo-related toxicity (cardiac, renal, infertility risks).
Lymphoma
- Hodgkin’s vs. Non-Hodgkin’s Lymphoma (NHL).
Lymphoma Risk Factors
- Hodgkin’s: Epstein-Barr Virus (EBV).
- NHL: Immunodeficiency, prior chemo/radiation.
Lymphoma Symptoms
- Painless lymphadenopathy
- Night sweats, fever
- Weight loss, fatigue
Lymphoma Diagnosis
- Lymph node biopsy.
- CT, PET scan (staging).
- Bone marrow biopsy (advanced cases).
Lymphoma Treatment
- Chemotherapy, radiation, possible stem cell transplant
Retinoblastoma
- Rare eye tumor in children <5 years.
- Genetic component (RB1 gene mutation).
Retinoblastoma - S/S
- Leukocoria (white reflex in pupil)
- Strabismus (crossed eyes)
- Vision loss (late sign)
Retinoblastoma - Treatment
- Enucleation (eye removal, in severe cases).
- Radiation or chemotherapy.
- Cryotherapy for small tumors.
Oncologic Emergencies
Febrile Neutropenia
Tumor Lysis Syndrome
Hyperleukocytosis
Febrile Neutropenia
Neutropenic fever = medical emergency.
Definition: Fever ≥100.4°F + ANC <500.
Febrile Neutropenia Treatment
- Immediate broad-spectrum IV antibiotics.
- Blood cultures before antibiotics.
- Strict infection precautions
Tumor Lysis Syndrome (TLS)
Occurs when cancer cells die to quickly
Tumor Lysis Syndrome (TLS) - LABS
- ↑ Potassium (hyperkalemia)
- ↑ Phosphate, ↓ Calcium (hypocalcemia)
- ↑ Uric acid (risk of kidney failure)
Tumor Lysis Syndrome TLS - High RISK
Leukemia
Lymphoma
Bulky Tumors
Tumor Lysis Syndrome (TLS) - Treatment
- Hydration, allopurinol (decrease uric acid).
- Electrolyte management
Hyperleukocytosis
Definition: WBC >100,000
Complication: Increased blood viscosity → Stroke, organ damage
Treatment: Chemotherapy, leukapheresis
Cancer Discharge Teaching
Infection Prevention
Home Care
Psychosocial Support
Infection Prevention Education
o Avoid sick contacts.
o Hand hygiene.
o No live vaccines during chemo.
Home Care Education
- Recognize signs of infection (fever, malaise)
- Manage chemotherapy side effects (nausea, mucositis).
Psychosocial Support Education
o Coping strategies.
o Support groups for parents and patients
Cancer Etiology
Genetic Basis - Wilms, Retinoblastoma, Neuroblastoma
Health promotion
Dental visits and vaccines
Problems of survival
Effects of therapy - surgery, radiations, chemo
Long term plans - family stress, outcome, money
frequent follow ups
S/E of cancer therapy
Pain
Infection
bleeding
N/V
Ulcers
Constipation
Alopecia
Steroid effects
