childhood cancer Flashcards
how does the development of cancer typically differ in children than adults?
- cancer arises from abnormal and unregulated cell growth, leading to crowding out of healthy cells
- in children the cell of origin is typically an immature cell (where as in adult it is typically mature cells making replication errors)
what are predisposing factors to childhood cancers?
- down syndrome, Li Fraumeni, Noonan’s Syndrome, NF1, p53 mutation
- with down syndrome AML is more common
- with p53 mutation increased risk of osteoblastoma, retinoblastoma
how prevalent is childhood cancer in Canada?
- there are about 950 cases a year in Canada and about 40 per year in Saskatchewan
- children make up less than 1% of all new cancer diagnosis in Canada
How is cancer in children diagnosed?
- depends on type of cancer
- first investigation is often a CBC (CBC often how leukemia is diagnosed)
- bone marrow aspiration and biopsy
- lumbar puncture
- imaging (x-ray, MRI, CT, ultrasound)
- surgical biopsy
- urine and blood samples for tumor markers
treatment options for cancers
- chemotherapy
- surgery
- radiation
- biotherapy
- allo or auto bone marrow transplant
- some treatments are appropriate for certain types of cancers while others are not*
what is the difference between allo and auto bone marrow transfers?
- both are a hemopoetic stemcell transplant (aka blood transfusion)
- allo is when someone else’s bone marrow is used. this is done when bone marrow is where cancer is
- auto is where bone marrow is taken, treatment done, then it is given back. sometimes called a rescue because bone marrow is rescued from destruction by the treatment
what are some types of biotherapies to treat cancer?
- treatments using substances from living organisms: immunotherapy like vaccines, antibodies, or cytokines, genetherapy, or targeted therapies
Chemotherapy
- a name for a group of medications that work by slowing or stopping growth of cancer cells, which grow and divide rapidly
- often referred to as cytotoxic
- can be used curatively or palliatively
- lots of routes of administration
- most not disease-targeted, meaning they have systemic side effects
- each chemotherapy has a different mechanism of action - some target certain cell stages, why often given in combination and/or at different times
what are side effects of chemotherapy?
- because chemotherapy targets rapidly growing and dividing cells, this often includes normal/healthy cells as well (like GI, hair, skin, etc)
- bone marrow suppression
- mouth sores
- nausea and/or voiting
- anorexia
- hair loss
- pain
- lethargy
- constipation
- diarrhea
when do health care professionals need to take precautions when patients are receiving cytotoxic medications?
- during drug preparation
- during drug administration
- management/contact with body fluids
- spills (5mL is considered a large chemo spill)
what are chemotherapy handling precautions?
- wear double gloves, gown, eye protection, possibly N95 mask
- use special storage and disposal precautions of body fluids for at least 48 hours following last dosage
what is leukemia
a general term that refers to cancer of blood cells, which form and develop in the bone marrow
what is AML?
leukemia that occurs in the myeloid stem cells
what is ALL?
leukemia that occurs in lymphoid stem cells
what type of leukemia is the most common?
b lymphocytic (a form of ALL)
what type of leukemia is less responsive to chemotherapies?
t cell or t lymphocyte leukemia (a form of ALL)
what are signs and symptoms of leukemia?
- mostly directly correlate to effects of leukemic cells crowding out healthy blood cells in bone marrow
- recurrent or prolonged fever
- lethargy/general malaise
- anemia, pallor
- therombocytopenia, ecchymosis and petechiae
- hepatosplenomegaly
- enlarged lymph nodes
- recurrent infections
- bone and joint pain
what age group has the highest incidence of leukemia?
-1-4 year olds
what type of leukemia is more common in older children and teenagers?
-AML
what type of therapy is standard, up-front therapy for all types of leukemia?
- chemo
- for ALL usually 4-5 cycles, followed by 2-2.5 years of maintenance therapy
- for AML 3-4 cycles of intensive, in-patient chemo
when is a bone marrow transplant recommended for children with leukemia?
-when they have a high-risk disease at diagnosis or are not responding to standard treatment or if they experience relapse
which type of leukemia has a better survival rate?
ALL - it has a 5 year survival rate of 90%
while AML has a 5 year survival rate of 65%
what type of CNS tumour has a poor prognosis?
DIPG - a type of tumour in the PONS, this is because it occurs as part of normal tissue and can’t be removed
-though radiation can be used, it can only be given about 3 times
what is an ependymoma?
a CNS tumour
-space occupying lesion in the brain
what is lymphoma?
- a general term for cancer of the immune system and lymphoid tissue
- a blood cancer where dysregulation of immature white cells leads to crowding out of normal cells
- is the third most common type of cancer in children
- most cases occur in children over 5
what are symptoms of lymphoma in children?
-painless, firm, mobile lymphadenopathy (often in cervical/supraclavicular region)
“b symptoms”
- fever
- night sweats
- unexplained weight loss
- fatigue
- mediastinal mass (mass over the heart - a symptoms r/t non-hodgkin’s type)
what types of cells can non-Hodgkin’s lymphoma affect?
– diffuse large B-cells, ALCL, white blood cells but differently than leukemia
what can increase the risk of lymphoma?
- mono infection (EBV)
- transplant recipients because of immunosuppressants
where are neuroblastomas commonly found?
-solid tumour often found in spine, paraspinal nerve tissue, adrenal glands, kidney
what are symptoms of neuroblastomas?
- palpable abdominal mass
- raccoon eyes
- hypertension
- other symptoms depend on location of space-occupying lesion
what are soft-tissue sarcomas?
rare cancers arising in fat, muscle, or connective tissue
what are the most common types of soft-tissue sarcomas?
rhabdomyosarcoma - develop from immature muscle cells
Wilm’s tumour - originate in kidney cells
what are the two most common types of bone tumors?
- osteosarcoma - develops from immature bone cells
- ewing sarcoma
what is osteosarcoma
a bone tumor that develops from immature bone cells that would normally form new bone tissue, but instead destroy bone and lead to it weakening
-area affected must be extracted
what are oncologic emergencies?
- serious complications related to cancer patients
- includes metabolic emergencies like tumor lysis syndrome, sepsis, hypercalcemia, and SIADH
- hematologic - like bone marrow suppression, bleeding, coagulopathy, hyperleukocytosis
- space-occupying lesions like mediastinal mass, brain tumors, neuroblastoma, lymphoma, spinal cord compression
what is tumor lysis syndrome?
- when cancer cells break down and release cytoplasmic materials into blood stream
- this occurs in leukemia patients and much less commonly neuroblastitis patients
- causes elevation of serum potasium, phosphorus, uric acid
- causes decrease in serum calcium and urine output
- can cause pain, cardiac changes, neurological changes, kidney failure, death
what are possible symptoms of sepsis in children with cancer?
- fever
- low temperature
- neutropenia
- a positive blood culture for infection
- hypotension
- mottling
- decreased LOC
- reduced urine ouput
- metabolic acidosis
What are late effects of cancer?
- a long-term or chronic effect as a result of their cancer treatment
- approximately 2/3 of cancer survivors experience at least 1
- common late effects: deficiencies of endocrine, sensory, neurocognitive, cardiopulmonary, reproductive, immunologic, and/or GI/GU systems; secondary malignancies, psychosocial impact
What is a blast result in a CBC indicate
- though less than 6% can mean nothing, higher values indicate leukaemia
- normally theses aren’t reported on CBC results unless present - this is important to inform parents and children when being tested while in remission (otherwise they may think cancer isn’t being looked for and worry)
what does AML stand for?
acute myeloid leukemia
what does ALL stand for?
acute lymphoblastic leukemia
what is bone marrow?
the spongy tissue inside bones that is responsible for hematopoiesis
-hematopoiesis also occurs secondarily in the spleen, lymph nodes, and thymus (in children)
what kind of tumor is a neuroblastoma?
a solid tumor found outside the CNS
what are some oncological emergencies?
- metabolic emergencies like tumor lysis syndrom, sepsis, hypercalcemia, or SIADH
- hematologic emergencies like bone marrow suppression, bleeding, coagulopathy, hyperleukocytosis
- space-occupying lesions like mediastinal masses, brain tumors, neuroblastomas, lymphoma, or spinal cord compression
what are symptoms that may indicate tumor lysis syndrome?
- elevated serum potassium, phosphorous, uric acid
- decreased serum calcium and decreased urine output
what are complications that tumor lysis syndrome can cause?
- pain
- cardiac changes/abnormalities
- neurologic changes/abnormalities
- kidney failure
- death
what is the treatment/prevention for tumor lysis syndrome?
- IV fluids
- diuretics
- oral medications to eliminate serum uric acids (things to bind the toxic stuff)
- dialysis
a fever in a child with cancer should not be ignored, what should be done?
- check a full set of vitals and perfusion
- do a full systems assessment
- notify the MRP
- obtain blood cultures
- if an antibiotic is indicated, ensure first dose is administered as soon as possible (this should really be within 60 minutes of first temperature spike - why antibiotics should be considered to be given to parents who live far from hospital)
what are some advantages and disadvantages to a port-a-cath being placed for chemotherapy?
- less pokes
- can draw blood work from it
- it is an inserted needle, which can be dislodged by kids through normal play
- port access can be frightening for kids
what are some side effects of dexamethasone treatment?
- can cause irritability
- can cause hunger
- hunger can come on quickly and child can become “hangery” easily
- sleep can be heavily impacted
what are the three most common types of cancers in children?
leukemia (32%)
CNS tumors (19%)
lymphoma (11%)
what type of cancer is the number 1 cause of cancer deaths in children?
CNS tumors (account for 1/3 of cancer-related deaths)
what are ependymonas?
tumors that arise from ependyma, a tissue of the central nervous system
-they are space occupying lesions
how are CNS tumors treated
surgery radiation chemotherapy https://en.wikipedia.org/w/index.php?title=Ependymoma&oldid=772286118 note: chemo doesn't work for DIPG tumors
what are the effects of space-occupying lesions on the brain or spinal cord?
increased ICP
invasive surgical interventions
immediate effects
long-term effects
