Childhood Cancer Flashcards
Cancer Definition
Genetic Mutation
- permanent DNA alteration
- begins in a single cell
Mutation Results in:
- lack of differentiation
- unregulated growth
- cellular immortality
Cancer Classifications
Hematological malignancies
solid tumors
Hematological Malignancies
Leukemia (blood/marrow)
Lymphoma (lymph)
solid tumors
Wilms tumor
CNS tumors (brain/spine)
retinoblastoma (eye)
Childhood cancer characteristics
- usually affects deep tissues
- often disseminated at dx
- sometimes related to peak growth periods
- no screening or early detection available
- usually very responsive to therapy
- 75% overall cure rate
Luekemia
most common childhood cancer
classified: lyphoid & myeloid
lymphoid leukemia
ALL: Acute Lymphoid Leukemia
80% survival rate
Myeloid Leukemia
AML: acute myeloid leukemia
MNLL: Acute Nonlymphoid Leukemia
50% survival rate
Leukemia Etiology
combination of genetic and environmental chemical agents chemotheraputic agents radiation viruses immunologic deficiencies
Leukemia Pathophys
- genetic damage to bone marrow
- uncontrolled proliferation of blasts
- decreased production of normal cells
- accumulation of blasts on organs/ tissues
ALL s/s
Insidious: weakness and fatigue bruising, bleeding fever, infection bone/ joint pain abdominal pain/ vomiting pallor/ tachycardia (due to low RBC count) petechiae/ purpura lymphadenopathy (lymph node swelling) hepatospenomegaly (large spleen/liver)
ALL Dx
CBC Bone marrow aspiration & biopsy lumbar puncture CXR tests to ID cell subtype and stage
ALL prognostic factors
Favorable
- age at Dx
- > 1 year
- 50,0000 at dx (normal is 5,000-10,000 >2 yr)
ALL therapy Phases
Induction
consolidation/ intensification (chemo at reg intervals)
maintenance/ continuation (low doses, outpatient to maintain remission)
CNA: directed therapy: intrathecal chemo
length of tx: 2-3 yrs
ALL Remission
Abscence of s/s of disease Blasts < 5% in marrow near normal blood counts - ANC: > 500 - Platelets > 100,000
Neutrophilia
ANC < 500
neutrphil %
bands %
convert % into decima forms (55%=.55)
Multiply the above by the WBC
stated in thousanths
Neutrophil precautions
Avoid:
- raw fruit and veggies
- fresh flowers or plants
- standing water (water pitcher)
- chickenpox exposure
- live-virus or bacterial vaccines
initiate protective isolation procedures
Infection Sxs
Normal inflammatory response is often absent -erythema -edema -swelling fever: frequently the only infection symptom evaluate focus of infection: -may be medical emer -IV abx w/ in 1-2 hrs -blood C&S before abx started
Chemotherapy Side Effects
fever thrombocyotpenia anemia mucositis N/V constipation diarrhea alopecia anaphylaxix
fever
evaluate focus of infection
may be medical emergency
-IV abx w/ in 1-2 hrs
-blood C&S before abx started
Thrombocytopenia
Platelets 150,000-450,000 Avoid NSAIDS/ ASA Assess for bleeding -brusing, petechiae -epistaxis (nosebleeds), heavy menses no rectal temps, no suppositories avoid constipation
Anemia
< RBC & Hbg pallor/ SOB dizziness/ syncope headaches tachycardia Tx: colony stimulating factors
Mucositis
oral care/ rinses QID -antifungal meds -no alcohol mouthwashes pain management hydration nutrition
Nausea & Vomiting
premedicate before chemo prehydrate before chemo Antiserotonins (Zofran) Substance P antagonists (Emend) Steroids/ Anti-anxiolytics
Imbalanced nutrition : less than body requirements
antiemetics mouth analgesixs fluids (cool, clear liquids) food (small freq meals, high protien, high cal) supplements dietician consult involve patient in food choices
Constipation
Laxative/ stool softeners high fiber diet > fluids no rectal manipulation no rectal meds/ temps increase activity
Diarrhea
Stool cultures of potential for infections
antispasmodic therapy
low residue dietskin protection: barrier creams/ sitz baths
assess stools for blood
Alopecia
hair loss w/ in 2-3 weeks post chemo not all drugs cause hair loss patient education -potential change in hair -wigs, hats, scarves
Anaphylaxis
Always closely observe for 20 mins after infusion begins
- signs
- cyanosis
- hypotension
- wheezing
- severe urticaria
Anaphylaxis Treatment
D/C chemo immediatley keep emergency equip available emergency meds: -epinephrine -antihistamine -aminophylline -corticosteroids -vasopressors
Infant/ Toddler perceptions of death
no understanding of death
fear/anxiety over separation
Preschool perceptions of death
not permanent
death is reversible
something that happens to others
magical thinking: think their bad thoughts may come true
curious about death & people, animals and plants that have died
Young school-age perceptions of death
death is final
believe that they may die but only in distant future
may understand it occurs and suspects parents will some day die
fear pain associated with death
Preadolescent and adolescent perceptions of death
death is permanent and universal understand death in logical manner fear disfigurement fear isolation from peers often believe death won't happen to them Invincibility beliefs: linked with high-risk behaviors
