Oncological conditions Flashcards
What is cancer?
Cancer refers to a group of diseases in which there is
out-of-control growth and spread of abnormal cell
What are the types of cancer?
- Solid Tumors
* Hematological
What is the name of a cancer depend on its cell origin?
• Sarcoma – connective tissue, muscle, bone
• Carcinoma – epithelial tissue (glands, hollow
organs, outer layer of skin that lines the blood
vessels)
What are the most common childhood malignancy?
- Leukaemia ( most common )
- Solid tumours
- Lymphomas
Leukaemia
- Acute Lymphochytic Leukemia
* Acute Myelogenous Leukemia
Solid tumours
• Brain Tumours
Lymphomas
- Hodgkin’s Disease
* Non-Hodgkin’s Lymphoma
What are the common symptoms of leukemia?
Systemic
- weight loss
- fever
- frequent infections
Lungs
- easy shortness of breath
Muscular
- weakness
Bones or joints
- Pain or tenderness
Psychological
- Fatigue
- Loss of appetite
Lymph nodes
- Swelling
Spleen and/or liver
- Enlargement
Skin
- Night sweats
- Easy bleeding and bruising
- Purplish patches or spots
What are the other childhood malignancy?
Neuroblastoma • Nerual crest cells: brain, adrenal medulla, pelvis, mediastinum and sympathetic ganglia Sarcoma • Soft tissue sarcoma – Mesenchymal cells in skeletal muscle, smooth muscle, fat fibrous tissue, bone and cartilage • Rhabdomyosarcoma Wilm’s Tumor • Nephroblastoma (Kidney) Bone Tumor • Osteosarcoma
What are the treatment modalities?
- Surgery
- Chemotherapy
- Radiation therapy
- Hematopoietic stem cell transplantation
- Biological response modifiers
- A combination of these modalities is a frequently use
What are the surgery for cancer?
- Remove all visible and microscopic malignant cell
- Obtain biopsy for microscopical diagnosis
- Tumor staging
- Reconstructive surgery – correct defects
- Insertion of venous access devices
- Palliative: Relieve pain and obstruction
Chemotherapy for cancer
• Most frequently used treatment
• Effective for systemic cancers that cannot be managed by surgery or radiation
therapy
Chemotherapy drugs categories
- Alkylating agents
- Antimetabolites
- Anti-tumor antibiotics
- Plant alkaloids
- Enzymes
- Miscellaneous agents
What are the side effects of chemotherapy?
- Hematopoietic: Myelosuppression, anemia, thrombocytopenia, neutropenia
- Gastrointestinal: Mucositis
- Hepatic: Liver toxicity
- Renal: Renal Toxicity
- Integumentary: Alopecia
- Reproductive: Oligomenorrhea
What is radiation therapy?
• Deliver a dose of ionizing radiation to a tumor with minimal effects to the healthy
surrounding tissue
• External Beam
• Brachytherapy
What is acute lymphocytic ( lymphoblastic ) leukemia (all)
• ALL is responsible for 70-75% of childhood leukemias and involves lymphoblasts (immature
lymphocytes)
• Highest incidence of ALL in children is 2-6 years of age
What is the most common type of cancer in children?
-Leukemia
What is the clinical manifestation for leukemia?
- Fatigue
- Pallor
- Low-grade fever
- Bone and joint pain
- Petechiae & bruising
- Purpura
- Lymph nodes may be enlarged
What is the investigation for acute lymphocytic leukemia?
• Bone marrow aspirate (abnormal lymphoblasts) • Biological markers (origin of leukemia, B-cell precursor, mature B-cell precursor, T-cell) • WBC (<5000/mm3) • Lumbar puncture (CSF for cytospin for blast) - CNS involvement • CXR (mediastinal mass) • Laboratory Tests
What is the treatment for acute lymphocytic leukemia?
• Induction Phase (4 weeks to remission)
• IV Vincristine, L-asparaginase, Prednisolone
• Consolidation
• High-dose chemo, IT/radiation therapy if CNS is involved
• Maintenance
• Chemo agents by oral, IV or IM route
Event free survival rate > 80% (Vrooman & Silverman, 2009)
What is the management for acute lymphocytic leukemia?
- Prevent infection
- Prevent bleeding and injury
- Reducing pain
- Promoting energy conservation
- Relieving anxiety
- Promoting normal growth and development
What is sepsis?
• Sepsis is a generalized bacterial infection that usually occur in the first month of life
• Neonates are highly susceptible because of their immature immune response
• Risk factors includes: prematurity, invasive procedure, steroid use for chronic
condition and nosocomial exposure to pathogens
What is the clinical manifestation for Sepsis?
• For infants: Poor sucking and feeding lethargy, weak cry, irritability
What is the subsequent sign and symptoms for Sepsis?
• Tachycardia, increased or irregular respiration, mottling, GI disturbances,
temperature instability, dehydration, hypotension
What is meningitis?
- Infection of the meninges – usually caused by bacterial invasion
- Prognosis depends on the age, organism and child’s response to therapy
- Most cases occur between 1month – 5 years
- Infants < 12months most susceptible to bacterial meningitis
What is organisms?
• E.coli and Group B Strep are the common organism causing meningitis in neonates
• Infant and children: Neisseria meningitidis, Strep. Pneumoniae and Group B Strep.
HiB vaccine has dramatically decreased the incident of Haemophis Influenzas
meningitis
• Viral meningitis due to coxsackievirus, mumps is self-limiting lasting 7-10days
What is the pathophysiology?
• Bacteria enters the meninges through bloodstream and spread via CSF
• Infection can directly be spread through trauma or neurosurgery
• Pathogen acts as a toxin, creating meningeal inflammation response and results in
release of purulent exudates
Assessment of clinical manifestation
Children < 2 years
- Poor feeding, irritability and lethargy
- High pitch cry, bulging fontanel
- Fever or low temperature
- Hyperextension of neck and spine
Assessment of clinical manifestation
Older children
• Respiratory or GI problem (early stages)
• Stiff neck
• Headache
• Tripod posturing
• Kernig signs - pain and resistance to knee extension when on
supine position
• Brudzinski’s sign – flexion of knees and hips when neck is flexed
when on supine position
Assessment of clinical manifestation
• Monitor vital signs - note clinical characteristic of condition change
• Monitor I/O, fluid and electrolyte balance:
- Maintain IV therapy, fluid restriction may be needed to prevent
cerebral oedema
- Overhydration is avoided to prevent the occurrence of
syndrome of inappropriate antidiuretic hormone (SIADH)
• Assess signs of raise ICP
• Administer prescribed medications - antibiotic, anticonvulsant or steroid to
relieve cerebral oedema
• Provide supportive intervention – quiet room to decrease environmental
stimuli
