Childhood Cancer

Question 1

Cancer Definition

Answer 1

Genetic Mutation

• permanent DNA alteration
• begins in a single cell

Mutation Results in:

• lack of differentiation
• unregulated growth
• cellular immortality

Question 2

Cancer Classifications

Answer 2

Hematological malignancies

solid tumors

Question 3

Hematological Malignancies

Answer 3

Leukemia (blood/marrow)

Lymphoma (lymph)

Question 4

solid tumors

Answer 4

Wilms tumor
CNS tumors (brain/spine)
retinoblastoma (eye)

Question 5

Childhood cancer characteristics

Answer 5

• 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

Question 6

Luekemia

Answer 6

most common childhood cancer

classified: lyphoid & myeloid

Question 7

lymphoid leukemia

Answer 7

ALL: Acute Lymphoid Leukemia

80% survival rate

Question 8

Myeloid Leukemia

Answer 8

AML: acute myeloid leukemia
MNLL: Acute Nonlymphoid Leukemia
50% survival rate

Question 9

Leukemia Etiology

Answer 9

combination of genetic and environmental 
chemical agents
chemotheraputic agents
radiation
viruses
immunologic deficiencies

Question 10

Leukemia Pathophys

Answer 10

• genetic damage to bone marrow
• uncontrolled proliferation of blasts
• decreased production of normal cells
• accumulation of blasts on organs/ tissues

Question 11

ALL s/s

Answer 11

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)

Question 12

ALL Dx

Answer 12

CBC
Bone marrow aspiration & biopsy
lumbar puncture
CXR
tests to ID cell subtype and stage

Question 13

ALL prognostic factors

Answer 13

Favorable

• age at Dx
  
  • > 1 year
  • 50,0000 at dx (normal is 5,000-10,000 >2 yr)

Question 14

ALL therapy Phases

Answer 14

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

Question 15

ALL Remission

Answer 15

Abscence of s/s of disease
Blasts < 5% in marrow
near normal blood counts
- ANC: > 500
- Platelets > 100,000

Question 16

Neutrophilia

Answer 16

ANC < 500
neutrphil %
bands %
convert % into decima forms (55%=.55)

Multiply the above by the WBC
stated in thousanths

Question 17

Neutrophil precautions

Answer 17

Avoid:

• raw fruit and veggies
• fresh flowers or plants
• standing water (water pitcher)
• chickenpox exposure
• live-virus or bacterial vaccines

initiate protective isolation procedures

Question 18

Infection Sxs

Answer 18

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

Question 19

Chemotherapy Side Effects

Answer 19

fever
thrombocyotpenia
anemia
mucositis 
N/V
constipation
diarrhea
alopecia
anaphylaxix

Question 20

fever

Answer 20

evaluate focus of infection
may be medical emergency
-IV abx w/ in 1-2 hrs
-blood C&S before abx started

Question 21

Thrombocytopenia

Answer 21

Platelets 150,000-450,000
Avoid NSAIDS/ ASA
Assess for bleeding
	-brusing, petechiae
	-epistaxis (nosebleeds), heavy menses
no rectal temps, no suppositories
avoid constipation

Question 22

Anemia

Answer 22

< RBC & Hbg
pallor/ SOB
dizziness/ syncope
headaches
tachycardia
Tx: colony stimulating factors

Question 23

Mucositis

Answer 23

oral care/ rinses QID
-antifungal meds
-no alcohol mouthwashes
pain management
hydration
nutrition

Question 24

Nausea & Vomiting

Answer 24

premedicate before chemo
prehydrate before chemo
Antiserotonins (Zofran)
Substance P antagonists (Emend)
Steroids/ Anti-anxiolytics

Question 25

Imbalanced nutrition : less than body requirements

Answer 25

antiemetics
mouth analgesixs
fluids (cool, clear liquids)
food (small freq meals, high protien, high cal)
supplements
dietician consult
involve patient in food choices

Question 26

Constipation

Answer 26

Laxative/ stool softeners
high fiber diet
> fluids
no rectal manipulation
no rectal meds/ temps
increase activity

Question 27

Diarrhea

Answer 27

Stool cultures of potential for infections
antispasmodic therapy
low residue dietskin protection: barrier creams/ sitz baths
assess stools for blood

Question 28

Alopecia

Answer 28

hair loss w/ in 2-3 weeks post chemo
not all drugs cause hair loss
patient education
	-potential change in hair
	-wigs, hats, scarves

Question 29

Anaphylaxis

Answer 29

Always closely observe for 20 mins after infusion begins

• signs
  
  • cyanosis
  • hypotension
  • wheezing
  • severe urticaria

Question 30

Anaphylaxis Treatment

Answer 30

D/C chemo immediatley
keep emergency equip available
emergency meds: 
	-epinephrine
	-antihistamine
	-aminophylline
	-corticosteroids
	-vasopressors

Question 31

Infant/ Toddler perceptions of death

Answer 31

no understanding of death

fear/anxiety over separation

Question 32

Preschool perceptions of death

Answer 32

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

Question 33

Young school-age perceptions of death

Answer 33

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

Question 34

Preadolescent and adolescent perceptions of death

Answer 34

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