Oncological Disorders: PT1 Flashcards
Leukemia, Lymphoma, Brain Tumors, Wilms Tumor, DX tests/labs
Brielfy describe normal cellluar life.
- Cells divide to make new cells in order to replace damaged or old cells
- DNA is coded to direct the cell when to divide or when to die
Brifely describe a how a cell becomes cancerous.
- DNA becomes damaged
- Gives wrong instructions to the cell
- Mutation allows for cells to replicate uncontrollably and stay alive longer
- Cancer cells can crowd out normal cells
- A lump of cancer cells is called a tumor
What are five common diagnostic tests for cancer?
- Bone marrow biopsy
- Bone Scintigraphy
- Gallium Scan
- PET Scan
- SPECT Scan
How does a bone marrow biopsy help us diagnose cancer?
- liquid marrow samples & a bone core segment
- Uses:
- Diagnosis
- Evaluates DNA/Chromosomes
- Prognosis/Risk
- Treatment and response to therapy
How does bone scintigraphy help us diagnose cancer?
We use it to ID areas of increased cellular turnover (rapid growth)
How does Gallium Scan help us diagnose cancer?
- a nuclear medicine scan;
- uses gallium to look for cancer in the body
How does a PET scan help us diagnose cancer?
- IDs differences in metabolism in tissues
- (tumor cells have faster metabolism)
How does a SPECT scan help us diagnose cancer?
- a nuclear medicine scan
- examines the function of organs
- looks at organs from different angles
Where is a bone marrow biopsy taken from?
- < 2, tibia
- > 2, iliac crest
What position is a patient in for a bone marrow biopsy?
- Prone or on side,
- usually on side
What is the nursing care after a bone marrow biopsy?
- put on dressing (possibly pressure to stop in bleeding if present)
- Monitor for bleeding, bruising, infection
- Pain management
Leukemia and Lymphoma are cancers of…
the blood and lymph
What kind of tumor is a Wilms tumor?
organ tumor (kidney)
Neuroblastoma and brain tumors are tumors that effect…
the nervous system
Osteosarcoma and Ewing Sarcoma are…
bone tumors
Rhabdomyosarcoma is a…
muscle tissue sarcoma
What is a sarcoma?
tumor of connective or other nonepithelial tissue.
Retinoblastoma is a cancer of…
the eye
Why is education and emotional support so important in cases of child cancers?
Child cancers are fast growing, which is stressful for family
What is leukemia and where does it originate
- Cancer of the blood-forming cells that are produced in the Bone Marrow
What is the most common childhood cancer?
Leukemia
What age is the peak onset of leukemia?
2-5yrs
(though it is rare, it can happen outside of that age range)
What are the two types of leukemia and which is more common?
- Acute Lymphocytic Leukemia (ALL)
- most common
- Acute Myelogenous Leukemia (AML)
What is occuring with ALL?
- Lymphoblast mutates and proliferates crowding out the healthy cells and using up nutrients
- Will crowd out RBCs, WBCs and platelets -
- s/s will relate accordingly
When screening for Leukemia, what will x-rays and a CBC show?
- X-Rays/Imaging
- Show enlarged liver and spleen
- abnormal cells are building up in liver/spleen
- Show enlarged liver and spleen
- CBC
- HIGH WBC (With greater % of blasts/immature cells)
- Low WBC of healthy type
- Low H&H
- Low Platelet count (<50,000 admitted to hospital)
- HIGH WBC (With greater % of blasts/immature cells)
What are the first steps taken for a pt w/ a new dx of Leukemia?
Briefly explain each
- Symptom management
- Get the stable
- Bone marrow biopsy
- confirm dx/type of Leukemia
- Lumbar Puncture
- to assess CSF involvement
- Central line placement
- prep for chemo
- Chemo
- prophylactic treatment in case CSF involvement
- focused chemo later in tx
Why is chemo given so quickly after dx of Leukemia?
Not going to take a chance of missing CNS involvement, so chemo will be done to make sure if there are any cancer cells starting, they’re eliminated asap
Explain why education and support are so crucial with a new leukemia dx pt.
- Process happens SUPER fast
- As soon as DX is confirmed the process starts.
- w/in 24hrs of dx, they’ll already be in for central line placement and chemo
- Very scary for family and pt and can be overwhelming
- Support and education key!
A lumbar puncture is done to evaluate for leukemic presense in the CNS. Explain the process.
- Patient will be side-lying with head flexed and knees drawn up
- Patient may be sedated
- Provider will take 3-4 vials of CSF
- Pressure will be held and an elastic bandage placed to puncture site
- Monitor site for Bleeding, Hematoma, & Infection
- Child should remain in bed for 4-8 hours flat to prevent leakage, which can lead to spinal headache
Explain the three phases of chemo therapy for Leukemia.
- Chemotherapy: three phasesInduction therapy
- 4 to 5 weeks
- Goal: “remission”
- Intensification/Consolidation
- 6 months of “bursts” of treatment
- Goal: make sure it doesn’t come back
- Maintenance therapy
- 2-3 years
- Goal: To preserve remission
Why would cranial irradiation be used?
If the cancer has crossed the blood/brain barrier
Why is a leukemia pt at risk for infection?
- due to the destruction of health WBCs
Why is a leukemia pt at risk for anemia?
Due to the destruction of RBCs
Why is a leukemia pt at risk for Bleeding?
Due ot the destruction of platelets
Why do we not do rectal temps for a Leukemia pt?
may tear the rectum and they are at risk for bleeding
What are some indicators that the Leukemia has metastasized?
- Bone pain and/or fractures
- Liver/spleen enlargement
True or False
One of the main places a cancer can matastesize is in the lungs.
True
What is lymphoma?
Cancer of the lymphocytes
What is the difference between hodgkins and non-hodgkins lymphoma?
- Hodgkins = If lymphocyte has Reed-Sternberg cell
- Non-Hodgkins = If lymphocyte does NOT have Reed-Sternberg cell
What is worse, Hodgkins or non-Hodgkins lymphoma? Why?
- Non-hodgkins
- Because it can appear in the same places as Hodgkins as well as others and when it is discovered, it is usually at an advanced stage
- Hodgkins has a 90% survival rate for ≥ 5yrs
What is Wilms Tumor?
- Tumor on the kidneys, usually unilateral
- Most often diagnosed at 3-5 yrs of age
- 90% survival rate
- If untreated, the mass will block the vena cava/other organs and death will follow
What are the s/s of Wilms Tumor?
- Firm, non-tender abdominal mass
- Fatigue
- Weight loss
- Fever
- Hematuria
How is Wilms Tumor confirmed?
- Intravenous pyelogram
- dye is injected and observed
What is THE key thing to make sure of once a Wilms Tumor is confirmed?
- That NOBODY palpates the mass
- It is encapsulated and keeps the cancer cells in one spot.
- Palpation can burst the tumor and the cells would then be released into the body
What is the medical treatment for Wilm’s Tumor?
- Tumor AND kidney resection
- Post op chemo and radiation for to eliminate anything missed, and prevent recurrance and metastasis.
What is our Nursing Care for Wilms Tumor?
- Family education/support
- Monitor central line
- Post surgical/chemo care
What is a Neruoblastoma and whom does it affect?
- A cancer that arises from neural crest cells
- Only occurs in babies
What are the dx tests for Neuroblastoma?
- CT scan
- Chest x-ray
- Skeletal scintigraphy
- Biopsy of tumor
What is scintigraphy?
A technique in which a scintillation counter or similar detector is used with a radioactive tracer to obtain an image of a bodily organ or a record of its functioning.
What is the Medical tx for Neuroblastoma?
- Surgery
- Chemo
- Radiation
- BMT (Bone Marrow Transplant)
Where can Neuroblastomas occur?
- Adrenal glands
- Retroperitenal area
- Head/neck/pelvis/chest
- Can happen anywhere along the neural pathways
What are the s/s of Neuroblastomas?
- s/s are based on where it happens
- If in spine, child may have leg weakness, balance issues
- May have bowel and bladder issues not present before
- If in face
- May see bruising/swelling around the eyes
True or False
Very commonly the kids will have metastastes somewhere else (bone marrow, lympnodes, bone or skin, etc) before they’re even dx’d w/ neuroblastoma
True
What is the recovery rate for Neuroblastomas?
- 30-90% recovery rate
- Lower numbers are with metastasis at time of dx
- Higher number is when its caught prior to any metastasis
What are some general points to remember in regards to Brain Tumors?
- Most common solid tumor
- Second most common cancer after leukemia
- Tumors that are confined to brain and spine, mostly brain
- There are benign and malignant
- Benign wouldn’t kill a person, but they still need to be removed because they take up space
What are the s/s of Brain Tumors?
- s/s based on where it is in the brain
- Occiptal tumor = vision issues
- Frontal lobe = irritable, poor decision making, behavior/memory issues
- Parietal = hearing, speech, etc
In addition to s/s due to location of Brain Tumor, what are some other manifestations to keep an eye out for?
- Irritability
- lethargy
- increased head circumferance (infants),
- headache
- loss/delay of milestones (waking, crawling, etc)
Dx tests for Brain Tumors?
- MRI
- CT Scan
- PET (to eval tx)
- LP
- Biopsy
- Labs
What is the Medical tx for Brain tumors?
- Resection of tumor
- Possible chemo and radiation
What is the number one concern regarding brain tumors?
- ICP, stroke, herniation (out the skull hole)
