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PEDS > Oncology > Flashcards

Oncology Flashcards

1
Q

Most common pediatric cancer?

A 
Leukemia
Most common pediatric cancer
Malignant disease of blood
Originates in bone marrow
Characterized by immature white blood cells (leukocytes) that inhibit normal blood cells
Invades organs causing enlargement or dysfunction
Most common pediatric leukemias:
ALL
AML
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2
Q

Acute Lymphocytic Leukemia

A

> 75% of pediatric leukemias
Most common 2-3 yo
Survival >90%

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3
Q

Acute Myeloid Leukemia

A

More common in teenagers
41% survival for 5 years
Can become chronic (CML) <2% of leukemias

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4
Q

Signs & Symptoms (Leukemias)

A 
Fatigue
Fever
Bone/jt pain
Bleeding
Abnormal CBC
Detected via bone marrow biopsy
Thrombocytopenia
Neutropenia
Bruising
Infection
Enlarged lymph nodes
Enlarged spleen
Night sweats
Weight loss
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5
Q

Medical Management

A

Chemotherapy

stem cell transplant

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6
Q

Stages of treatment for leukemia

A

Induction phase: attempt to eradicate all malignant cells of body
Remission: patient asymptomatic
Consolidation/maintenance therapy: continue rx even in remission as prophylaxis
Relapse: signs and symptoms reappear and leukemic cells found in bone marrow

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7
Q

PT and Leukemia . what can we do?

A

Depending on age of child:
Developmental delay
Weakness
Decreased endurance

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8
Q

CNS TUMOR

A

Most common solid tumor in pediatrics

2nd most common type of pediatric cancer
1-10 yo

Astrocytoma-almost half of all CNS tumors (cerebellar and supratentorial)-neural support cells: 70-90% cure rate

Medulloblastoma- usually cerebellar: highly invasive tumors-50% cure rate

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9
Q

Types of CNS Tumors

A

Brainstem glioma -poor cure rate
Ependymoma- cells lining ventricular system- 50% cure rate
Craniopharyngioma-benign- derived from pituitary gland embryonic tissue

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10
Q

Signs and symptoms

A 
Headaches
Nausea
Vomiting
Irritability
Balance disturbances
Dysphagia (swallowing)
Dysphasia (speech)
Paresthesia 
Behavioral changes
Ataxia
Hemiparesis
Visual disturbances
Seizures 
Lethargy
Weakness
Poor coordination
Head tilt
anorexia
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11
Q

Medical Management

A 
Surgical resection or tumor debulking
Chemo
Radiation
XRT or proton beam
Side effects: decreased IQ, learning problems, growth retardation
Shunt for hydrocephalus
65% 5 year survival rate
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12
Q

Post op posterior fossa syndrome

A 
Delays 1-5 days post surgery most common in medulloblastoma 
Decreased cervical ROM
Hemiparesis
Ataxia
Dysmetria
Weakness
Speech disorder
Visual disorder
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13
Q

General PT intervention post op

A 
Positioning
Progress HOB slowly
PROM
Stretching
Progress to gym as soon as able
Increase mobility – may need w/c, wagon, trike to allow for change in environment and increased independence
Transfers, walking with fall prevention
Patient/family education
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14
Q

General PT Intervention Post-opBrain Tumor Resection

A 
Developmental activities
Ball
Bikes
Run
Jump
Mini-tramp
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15
Q

Embryonal Tumors-arise from embryonal tissues

A

Neuroblastoma-sympathetic NS:
75% cure rate <1yo
50% cure rate >1yo
Arises in sympathetic nervous system and especially in adrenal glands or paraspinal ganglion

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16
Q

Neuroblastic Tumors

A 
S &amp; S
Painful abdominal, chest, neck, pelvis mass
Lumps of tissue under skin (lymph nodes)
Bulging eyes with dark circles
Bone pain
Medical management
Surgical resection
XRT
Chemo
17
Q

Retinoblastoma

A 
Tumor of eye
May be hereditary (infants)
Nonhereditary forms too
0-2 yo
S &amp; S: enlarged pupil that appears red or white, crossed eye, vision changes
Medical management
XRT
Removal of eye 
Chemo
Laser photocoagulation
18
Q

Wilm’s Tumor

A 
AKA nephroblastoma
Genetic component
<2 yo
S &amp; S
Abdominal mass
Fever
Anemia
Hypertension
92% survival rate for 5 years
Medical management
Surgical resection
Chemo
XRT
19
Q

Lymphomas

A

Malignant disease of lymphatic system-cancers involving blood cells like leukemias
Hodgkin’s (adolescents)
Non-Hodgkin’s (younger children)

20
Q

Hodgkin’s

A 
More common in adolescence
Boys > girls
91% survival
S &amp; S
Painless swelling of neck, groin, axilla
Non-productive cough
Fatigue
Anorexia 
Weight loss
21
Q

Non-Hodgkin’s

A 
More common in young children
Boys > girls
4 categories of types of lymphoma
72% survival
S &amp; S
Swelling of face, neck, UEs
Difficulty swallowing
Changes in bowel habits
Nausea
Vomiting 
Painful swallowing (dysphagia)
Medical management
XRT
Chemo
22
Q

Sarcomas-solid tumor arising in connective tissue

A 
Bone Tumors
Ewing’s sarcoma
Osteogenic sarcoma or osteosarcoma
Soft Tissue Tumors
Rhabdomyosarcoma
23
Q

Osteosarcoma

A

AKA osteogenic sarcoma
Males>females
10-25 yo
Most common type of bone tumor in teenagers especially during rapid growth spurts
Occurs in long bones such as distal femur, proximal tibia, proximal humerus

24
Q

OsteosarcomaS & S

A 
Mass
Decreased ROM
Pain
Pathologic fractures – child has injury that wouldn’t normally appear serious but with significant pain that doesn’t improve or resolve
CA found on radiograph
25
Q

OsteogesarcomaMedical Management

A 
Amputation
Limb salvage procedure with bone graft and/or hardware 
Rotationplasty – primarily for femur
Chemo
75% survival without mets
30% survival with mets
26
Q

Ewing’s Sarcoma

A 
Originates in neural crest cells
Tumor in vertebral column, rib, sternum, clavicle, pelvis, sacrum, coccyx
2nd most common malignant bone tumor in kids
Birth-14 yo
58% survival rate
S &amp; S
Pain or tenderness at site of tumor
Swelling
Metastasizes to lungs or other bones
Significantly decreases survival rate
Medical management
Surgical resection
XRT
Chemo
27
Q

Rhabdomyosarcoma

A

Tumor of soft tissue of muscle cells of head, neck, pelvis, or extremities
0-14 yo
urinary tract and reproductive tract also common

45-79% survival rate – the younger the child, the better
Signs &amp; symptoms: mass
Medical management
Surgical resection
XRT
Chemo
28
Q

PT and Oncology

A

Blood counts – check regularly and modify intensity of ex accordingly
Bone marrow aspiration/aspiration – painful
Lumbar puncture – often on bed rest for 6-24 hours post procedure

29
Q

Critical Lab Values

A 
PLATELETS
>50,000 resistive ex OK
20,000-50,000 light aerobic ex only
<20,000 no aer. ex
WBC
>5000 resistive ex OK
<5000 no  aerobic ex

HEMOGLOBIN
>10 resistive ex OK
8-10 light aer. ex only
<8 no aer. ex

remember, MMT is considered resistance

30
Q

Bone Marrow Transplant (BMT) and/or Peripheral Stem Cell Transplantation (PSCT)

A

Requires 6-8 week hospitalization in laminar flow room with strict compromised host precautions
Must bleach any object brought into room
Types
Autologous: uses patient’s own bone marrow
Allogenic: uses bone marrow from compatible donor; much higher risk of rejection
Syngenic: uses identical twin’s marrow

31
Q

Stages:Pre-transplant

A

One week
Total body irradiation and chemo to eradicate disease and immunosuppression to prevent rejection of transplant.
This is called the “conditioning phase” and is not done in younger children due to SEs on rapidly growing body

Donor marrow harvested surgically via ASIS and PSIS
Marrow is filtered, treated, replaced

32
Q

Stages:Post-transplant

A

Time period until engraftment occurs and cell counts rise (WBC, platelets)
10-17 days
Complications: graft-versus-host-disease (GVHD) mild to life threatening
Rash, itchy skin and/or discoloration, dry mouth and mouth ulcers, GI irritation, wt loss, joint contractures and liver involvement

33
Q

PT and BMT

A

Routinely ordered on admission for prevention and aerobic care
May include bedside program for strengthening, stretching, endurance (bike in room), and balance
Educate parent and patient re: role of PT and exercise guidelines when platelets low

34
Q

Chemotherapy

A

May be used before or after surgery
Must be aware of side effects of chemo drugs
Often delivered via surgically placed catheter such as Broviac or Hickman (inserted into artery or vein for blood draws and chemo)
**see Table 16.3 p 388 for drugs/dzs/SEs

35
Q

Radiation Therapy

A

May be used before or after surgery
Total body irradiation before BMT
See Table 16.2 p. 386 for effects of radiation therapy
Patient often marked with permanent marker to indicate location of radiation
Never put lotion etc. on this area – very prone to burn from XRT

36
Q

Interventions for kids with cancer

A 
Body Function/Structure
Range of motion exercises
Strengthening exercises
Balance/coordination exercises
Pain control
Activities and Participation
Motor learning
Aerobic activity (walking, biking, swimming)
Participation in sports and age appropriate recreational groups (dance classes, taekwondo)
Physical education classes

PEDS (10 decks)

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