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
Fluoride and dental examinations, monitor for effects of irradiation
May have delay in development of permanent teeth
Dental care
Live, attenuated viruses contraindicated
Inactivated vaccines can be used
Family can receive some live vaccines
Varicella dangerous to child, need Varicella immune globulin
Immunizations
Which of the following is a cardinal symptom of childhood cancer? Select all that apply:
1. unusual mass or swelling
2. unexplained paleness and loss of energy
3. Sudden tendency to bruise
4. Persistent localized pain or limping
5. Prolonged unexplained fever/illness
6. Frequent headaches, often with vomiting
7. Sudden eye or vision changes
8. Excessive rapid weight loss
Answer: 1, 2, 3, 4, 5, 6, 7, 8
Want follow-up
Osteosarcoma
Brain tumors
Neuroblastoma
Wilms tumor
Hodgkin’s lymphoma
Type of cancer
Most common bone cancer in children, typically 10-25 years - older kids
Typically found in long bones (femur) - feel bump in leg or arm - feel like growing pain
Surgery, chemo, amputation
Symptoms
Symptoms can be confused with growing pains
Localized pain, palpable mass, limping, progressive limited ROM
Osteosarcoma
There are many types of brain tumors
Red flags - waking up with a headache - gets headache in afternoon - waking up more concerned - sx ICP; surgery - issue as well
Most start in lower parts of the brain
Surgery, radiation, chemo
Post-surgical care
Symptoms
Headaches (worse in AM), dizziness, balance problems, vision/hearing/speech problems, frequent vomiting, seizures (increased ICP)
Brain tumors
Typ Adrenal glands
Outcome not great
Sx: trouble walking, vision issues, HTN common
Arises from immature nerve cells in infant and young children (under 5)
Often begins in adrenal glands)
More common in males
Poor prognosis due to invasiveness
Symptoms
Impaired ability to walk, changes in eyes, pain in various location locations of the body, diarrhea, high BP
Neuroblastoma
Nephroblastoma
Usually in one kidney or both
Typically found in children 3-4 years old
Do NOT palpate abdomen (risk for rupture and spread)
Symptoms
Swelling or lump in the belly, urinary retention/hematuria, fever, pain, nausea, poor appetite (more common in children with anomalies)
Wilms tumor
Starts in lymphocyte cells in immune sys
Affects lymph nodes, lymph tissue and then metastasized
Good prognosis with radiation and chemo
Two main types
Hodgkin lymphoma
Rare in children younger than 5
Non-hodgkins lymphoma
No Reed-Sternberg cells
Symptoms
Swollen lymph nodes in the neck, armpit or groin, weight loss, fever, sweats, non-productive cough, weakness
Hodgkin’s lymphoma
Most common
Leukemia is an unrestricted proliferation of immature WBCs (leukocytes) in the blood-forming tissues of the body
The increasing number of immature proliferation of WBCs depresses bone marrow
All BM focused on immature WBCs and not making anything good that need - start having sx - CBC and diff - see shift
Gold standard: BM biopsy/aspiration - what kind have - present diff and treated diff
Classifications are increasingly complex
Liver and spleen are the most severely affected organs
Acute Lymphoblastic Leukemia (ALL) is the most common childhood cancer
Typically occurs between ages 2-4, more common in males
Begins in bone marrow, spreads to blood, then to organs.
Prognosis depends on various things including age of diagnosis, initial WBC count, type of cell involved, gender of child, and occurrence.
Leukemias
Proliferating cells decrease bone marrow production due to the competition for essential nutrients
Three primary consequences
Bones weaken and are prone to fractures
Bone pain from increased pressure
Signs and symptoms
Bone marrow dysfunction
Anemia - decreased production RBC
Infection - less WBC - immature and not work; decreased mature WBC; have some but not effective
Bleeding - decreased platelets
Three primary consequences
Anemia - decreased production RBC
Infection - less WBC - immature and not work; decreased mature WBC; have some but not effective
Bleeding - decreased platelets
Three primary consequences
Anemia - decreased production RBC
Infection - less WBC - immature and not work; decreased mature WBC; have some but not effective
Bleeding - decreased platelets
Three primary consequences
Fever, pallor, fatigue, anorexia, hemorrhage, bone and joint pain
Signs and symptoms
Based on history, physical manifestations
Peripheral blood smear
Lumbar puncture to evaluate central nervous system (CNS) involvement
Gold standard: Bone marrow aspiration
Diagnostic evaluation of leukemia
Minor infection does not disappear
Pale, listless, irritable, febrile, and anorexia
Based on history, physical manifestations
Immature leukocytes
Frequently low blood cell counts
Peripheral blood smear
Three phases of Chemotherapy
Each relapse means poorer prognosis - comes back issue
Monitor for infection!!! (major cause of death in immunosuppressed child)
Bone marrow transplantation
Therapeutic management of leukemia/treatment
Diagnosed - start treatment righ away - in hospital
Induction
4 to 5 weeks, begins almost immediately
Intensification (consolidation) therapy: To eradicate residual leukemic cells
Chemotherapy given periodically over 6 months
Maintenance therapy: To preserve remission
Weekly or monthly CBCs
Treatment usually stops after 2 to 3 years
Monitor for relapse
Three phases of Chemotherapy
Used in both ALL and AML
Try save as last lines of defense
Bone marrow transplantation
