Neoplastic Disorders Flashcards
What is the difference between cancer in a child and an adult?
Pediatric cancers usually originate from primitive embryonal and neuroectodermal tissues. (Why we see more leukemias, lymphomas, sarcomas, or central nervous system tumors.)
**Common sites in children: blood, lymph, brain, bone, kidney, muscle
In comparison, adult cancers usually originate from epithelial cells. (This is why we see a lot of carcinomas.)
** Common sites in adults: breast, lung, prostate, bowl, bladder
Usually impacts tissues as compared to organs in adults
Childhood cancer is rarely influenced by environment - or dietary factors - things like smoking; not carcinomas
Children usually respond well to cancer treatment.
Things to note
Relatively low incidence
Approximately 1300 deaths per year
Incidence of 18 cases per 100,000 children
Genetic alteration leads to unregulated cell proliferation
Not necessarily hereditary
Mutation in tumor suppressor gene - Downs: more like to have cancer and tumors
Chromosome abnormalities contribute to development of cancer
Immune system conditions may contribute to cancer
Cancer: epidemiology
Multimodal therapy
Combination surgery, chemotherapy, and radiation
Surgery - may need it
Chemotherapy
Radiotherapy
Biologic response modifiers
Blood or marrow transplantation
Cancer: treatment modalities
Impact cancer cells: stops cycle: interferes cycle when replicating - fast growing ones - based on cells growing quicker: cells quick cell cycle: blood cells - impact BM - issues with bleeding and platelets, anemia - less erythrocytes - issues with infection - WBC less; skin and hair; reproductive organs; digestion
Primary form of treatment
Combination drug regimens
IV infusion through venous access devices
Precautions
Experienced and trained nurses
Chemotherapy
In conjunction with chemotherapy
Side effects related to lethal damage to tissue
Radiotherapy
Alter the host’s immunologic mechanisms
Direct antitumor effect
Biologic response modifiers
Try avoid in kids - last treatment options
Used if high doses of chemotherapy or replace dysfunctional marrow
Cells previously stored are given IV after conditioning regimen
Blood or marrow transplantation
Anorexia, N/V - give meds for nausea, mucosal ulceration - sores in mouth - bland in diet - no spicy food - not hot in temp - avoid sour things - fruit can be too much, diarrhea and common for constipation - try focus on that and be supportive
Not hungry esp certain phases of treatment and around treatment
Gastrointestinal - Radiation and chemotherapy - Managing side effects of treatment
Big psychologic factor
2 weeks after started treatment - after 6 months stopped treatment
Lose hair - big deal - therapy offered to kids and fam
Alopecia, dry or moist desquamation
Skin - Radiation and chemotherapy - Managing side effects of treatment
Cystitis - double gloving, gown; excrete them - in bladder - sitting in bladder - inflammation and irritation - give in morning - hydrate well and take to bathroom and lot
Mensa - protects bladder
Urinary bladder - Radiation and chemotherapy - Managing side effects of treatment
Suppression
Infection, anemia, hemorrhage
Bone Marrow - Radiation and chemotherapy - Managing side effects of treatment
taken out immune sys
Protective isolation (private room)
Hand hygiene
Strict aseptic technique
Monitor for infections closely
Urine, lungs, mucosa, wounds
No live vaccines - gotten vaccines and treat them week after need immunizations again - not protected
Avoid unnecessary procedures
Deep breathing
Limit number of caregivers
Reduce exposure to environmental organisms
Protecting the child from infection
Steroid effects
Negative impacts on kids
Decrease tumor size in conjunction - decrease N&V - decreases swelling; almost always on some kind of steroid
Prevents allergic rxn to chemo
Often presents as anaphylactic
Prevents more severe rxns
Causes to swell - weight gain - often in face - round in face; hungry; skip periods; increase BP and glucose levels; can impact the bones - osteoporosis
Can be distressful for older children
Cushingoid appearance
Avoid salt intake to reduce fluid retention
Loose-fitting clothes helpful
Managing side effects of treatment
Prep child and parents as involved as possible
Typically sedated
Explanations according to age and development provided
Emotional support
Topical anesthetics before venipunctures and accessing implanted port
Deeper infiltration of lidocaine used for bone marrow biopsy
Preparation for procedures
Cancer treatment can take forever - still child - need health maintence - often miss dental care - go to regular PCP, check BP, need check eyes and hearing - impacted by chemo - watch closely
Want keep in school if can - WBC too low not reasonable - get tutor so not too behind
Edu imp - care if get sick or temp - call oncologist
Children with cancer still need basic health care, can be overlooked with focus on cancer care
Cognitive, physical, and neurologic status carefully monitored
Dental care
Immunizations
Education
Health promotion
