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Peds Exam 5 > Neoplastic Disorders > Flashcards

Neoplastic Disorders Flashcards

1
Q

Neoplastic Disorders

A
  • Leading cause of death from disease in children past infancy
  • Almost half of all childhood cancers involve blood or blood-forming organs
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2
Q

Leukemia

A
  • Most common form of childhood cancer
  • Three to four cases per 100,000 Caucasian children younger than 15 years old
  • More frequent in males over 1 year of age
  • Peak onset is between 2 and 10 years of age
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3
Q

Classification of Leukemia

A
  • Leukemia describes a broad group of malignant diseases of the bone marrow and lymphatic system
  • Complex disease with varying heterogeneity
  • Classifications are increasingly complex
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4
Q

Two forms of Leukemia

A

o Acute lymphoid leukemia (ALL)

o Acute nonlymphoid (myelogenous) leukemia (AML)

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5
Q

Leukemia is an unrestricted ______________________ in the blood

A

proliferation of immature WBCs****

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6
Q

Pathophysiology of Leukemia

A
  • Leukemia is an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body
  • No “tumor” is present, but the same neoplastic properties are seen as in solid cancers
  • Liver and spleen are the most severely affected organs
  • Although leukemia is an overproduction of WBCs, the acute form often causes a low leukocyte count
  • Immature cells do not attack and destroy the normal blood; destruction takes place by infiltration and subsequent competition for metabolic elements
  • Depressed bone marrow function
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7
Q

Consequences of Leukemia

A
  • Depressed bone marrow function
    • Anemia from decreased RBCs
    • Infection from neutropenia
    • Bleeding tendencies from decreased platelet production
  • Spleen, liver, and lymph glands show marked infiltration, enlargement, and fibrosis
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8
Q

Diagnostic Evaluation of Leukemia

A
  • Based on the history and physical manifestations - Tired, frequent illness- sore throat, fever, runny nose, bruising,
  • Peripheral blood smear – blasts on smears
    • Immature leukocytes
    • Frequently, low blood counts
  • Lumbar puncture to evaluate central nervous system (CNS) involvemen (To see if crossed the blood brain barrier)
  • Bone marrow aspiration or biopsy
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9
Q

Symptoms of Leukemia

A
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10
Q

Managing Chemotherapeutic Agents

A
  • Vesicants: Sclerosing agents even in minute amounts
  • Interventions for extravasation
  • Risk for anaphylaxis

Premedicate with zofran for nausea, get port or picc line placed
Before give benedril and Tylenol
VS – tachycardia, regular bp

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11
Q

Managing Problems of Drug Toxicity (from chemo)

A
  • Nausea and vomiting - Keep zofran everywhere
  • Anorexia – make sure are eating
  • Mucosal ulceration - Magic mouth wash (lidocaine (numbs), bacterial – ¯ swelling, mylanta – ¯acid)
  • Neuropathy
  • Hemorrhagic cystitis
  • Alopecia
  • Mood changes – from steroids, very sick and are hateful
  • Moon face – from steroids
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12
Q

Stages of leukemia treatment**

A

Induction, Consolidaiton, Maintenance, CNS prophylaxis

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13
Q

Induction Stage**

A
  • rapid, last 3-4 weeks, steroids, chemo IV
  • Very fast! Dx then put on and start chemo the next day
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14
Q

Consolidation**

A
  • high dose methotrexate, length varies
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15
Q

Maintenance**

A

eliminate all residual cells, 2-3 years

ALL tx is 3-4 years

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16
Q

CNS prophylaxis**

A

given during all stages, intrathecal chemo

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17
Q

If child with leukemia has fever…

A

go straight to ER and wear a mask at all times

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18
Q

Lymphomas

A

Neoplastic disease originating in the lymphoid system; metastasizes to non-nodal sites

Hodgkin disease

Nonhodgkin’s lymphoma

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19
Q

Hodgkin diseas More prevalent

A

in patients 15 to 19 years of age

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20
Q

Non-Hodgkin lymphoma (NHL) More prevalent

A

in children younger than 14 years of age

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21
Q

Classification of Hodgkin Disease

A

Classification A: Asymptomatic
Classification B: Temperature of 38°C (100.4°F) or higher for three consecutive days, night sweats, unexplained weight loss of 10% or more over the previous 6 months

22
Q

Hodgkin Disease

A

Neoplastic disease originating in the lymphoid system
Often metastasizes to the spleen, liver, bone marrow, lungs, and other tissues
Classified by histologic type

23
Q

CM of hodgkins disease

A

Asymptomatic enlarged cervical or supraclavicular lymphadenopathy is most common

· Knot over clavicle or in neck

Cough, abdominal pain, anorexia

· Phrenic nerve is compressed – what causes cough and abdominal pain

24
Q

Diagnosis of Hodgkin Disease

A
  • CBC; T-cell and radiographic tests
  • Lymph node biopsy for diagnosis and staging
  • Bone marrow aspiration if the stage is advanced
25
Q

Lymph node biopsy will find presence of what type of cells for Hodgkins**

A

Presence of Reed-Sternberg cells**

26
Q

Stage I (Hodgkins)

A

one gropu of lymph nodes is affected

27
Q

stage II (Hodgkins)

A

two or more groups on the same side of the diaphragm are affected

28
Q

stage III (Hodgkins)

A

groups of lymph nodes above and below the diaphragm are affeted

29
Q

stage IV (Hodgkins)

A

Metastasis to organs such as liver, bones, or lungs

30
Q

stage A (Hodgkins)

A

absence of systemic symptoms at diagnosis

31
Q

stage B (Hodgkins)

A

systemic symptoms present at diagnosis (fever, night sweats, weight loss)

32
Q

Approximately 60% of pediatric lymphomas are

A

Non-Hodgkin Lymphoma (NHL)

33
Q

Clinical appearance of Non-Hodgkin Lymphoma (NHL)

A

Disease is usually diffuse rather than nodular
Cell type is undifferentiated or poorly differentiated
Dissemination occurs early, often, and rapidly
Mediastinal involvement and invasion of meninges – goes to brain an spinal fluid

34
Q

Immunologic Deficiency Disorders

A

Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS)
Horizontal transmission- sexual contact, blood or body fluids
Perinatal or vertical transmission-

Clinical Manifestations (don’t worry about)

Lymphandenopathy
Hepatosplenomegaly
Oral candidasis
Chronic or recurrent diarrhea
FTT
Developmental delay
Parotitis – salivary glands

35
Q

Medulloblastoma-

A

cerebellum, fast growing, invasive, mets everywhere, poor prog

36
Q

Brain stem glioma-

A

aggressive, hard to resect, chemo resistant, affects cranial nerve function

37
Q

Ependymoma-

A

4th ventricle, causes hydrochephalus

38
Q

Astrocytoma-

A

slow, responds to chemo, low grade is good, high grade is bad

39
Q

Preopp Care

A

Watch for increased ICP
Look at pupils for any deviations
Administer dexamethasone - to decrease intracranial inflammation
Stool softeners to prevent straining

40
Q

dexamethasone -

A

admin preopp to decrease intracranial inflammation

41
Q

Post opp care

A

Watch fluid administration – excess may cause/worsen cerebral edema
Mannitol – decrease cerebral edema
Pupils
VS
Watch for increased ICP

42
Q

Mannitol

A

admin postopp to decrease cerebral edema

43
Q

post opp position

A

Position on unaffected side, maintain head in alignment with remainder of body when changing positions

· If brain tumor on R side then put pt on L side

· Someone hold head while changing positions

44
Q

neuroblastoma

A

Most common extracranial tumor.
Found in abdomen usually on adrenal gland
Usually mets by time of diagnosis
Staging determines treatment and prognosis

45
Q

Osteosarcoma

A
  • Peaks in adolescents at peak of growth spurt (So pt old enough to know what is going on and know what want)
  • More common in males
  • Shrink tumor before surgery
  • Limb sparing or amputation - remove only affected portion of bone and replacing with endoprosthesis or cadaver bone
  • Include pt in planning
46
Q

Ewing Sarcoma

A

Highly malignant, rarer than osteo
pelvis, chest wall, vertebra, midshaft long bones
Prognosis determined by level of mets – mets very quickly

47
Q

Rhabdomyosarcoma

A

Soft tissue tumor
Between 2-5 years old
If in neck –may have compromised airway – devated trachea

48
Q

Most Common Sites of Rhabdomyosarcoma

A
49
Q

reproductive cancer

A
  • Cervical- sexually active at young age, multiple partners - Typically from HPV
  • Testicular- rare in teens but dx 15-34 yoa
  • Teach about protection
  • Teach self exams
50
Q

Education

A

Much education for families and patients
Must take into account developmental stage
Must offer support emotionally
Financial burdens
Fear

Peds Exam 5 (5 decks)

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