Pediatric Brain Tumors & Breast Cancer Flashcards
(39 cards)
1
Q
What types of cancers are derived from neural tissue ?
A
brain tumors & neuroblastoma
- CNS tumors are difficult to treat and survival rates are poor
2
Q
What are some characteristics of brain tumors ?
A
- brain tumors are the most common solid tumors in children
- infratentorial tumors involved the cerebellum and brainstem
- supratentorial tumors occur mainly in the cerebrum
3
Q
What are some differences in pediatric neurological exams ?
A
- Occipitofrontal Circumference (OFC): occipitofrontal diameter where they measure with tape around the head just about at the eyebrows
- Fontanelles: assess for softness/tense and flat/sunken/bulging
- normal= soft and flat
- posterior fontanel: closes by 2 months of age
- anterior fontanel: closes between 12-18 months
4
Q
What are some S&S of increased intracranial pressure in infants ?
A
- tense, bulging fontanel
- separated cranial sutures
- Macewen (cracked-pot) sign: tapping of a certain spot on the skull makes a sound
- irritability and restlessness
- drowsiness
- increased sleeping
- high-pitched cry
- increased fronto-occipital circumference
- distended scalp veins
- poor feeding
- crying when disturbed
- setting-sun sign (eyes focused in the downward position)
5
Q
What are S&S of increased intracranial pressure in children ?
A
- HA
- nausea
- forceful vomiting
- diplopia (double vision), blurred vision
- seizures
- indifference, drowsiness
- decline in school performance
- diminished physical activity, and motor performance
- increased sleeping
- inability to follow simple commands
- lethargy
6
Q
What are some late signs of increased intracranial pressure ?
A
- Cushing’s triad: bradycardia, irregular respirations, HTN
- posturing: abnormal (flexed/rigid body) postures that indicate severe brain damage
- Decerebrate: arms extended away from the head
- Decorticate: arms flexed towards the chest
- decreased glascow coma scale (GCS)
7
Q
What is some post-op pain management for brain tumors ?
A
- HA may be severe (result of edema)
- quiet, dim lit environment
- restrict visitors
- ice pack to face/head
- prevent sudden jarring
- prevent increase in ICP: position changes, and prevention of straining (coughing, vomiting, and defecating)
- facial edema is normal for pt’s post-op from a brain resection
- bowel regimen
8
Q
What is a neuroblastoma ?
A
a tumor that develops from immature nerve cells
- majority of tumors develop in adrenal gland or retroperitoneal sympathetic chain
- other sites: head, neck, chest and pelvis
- metastasis may have already occurred before diagnosis is made
9
Q
What is the diagnostics for a neuroblastoma ?
A
- objective: locate primary site and sites of metastasis
- S&S: depend on location and stage of disease
- skeletal survey, radiologic studies, bone marrow eval
- intravenous pyelography to eval renal involvement
10
Q
What is some therapeutic management for neuroblastomas ?
A
- clinical staging to establish treatment plan
- surgery to remove tumor and obtain biopsy samples
- radiation, chemotherapy
- bone marrow transplantation
- stem cell rescue
11
Q
What is the prognosis for neuroblastomas ?
A
- in general, the younger the patient is at diagnosis, the better the prognosis
- tumor may regress spontaneously as embryonic cells mature and with development of active immune system
12
Q
What are some signs of neurological emergencies ?
A
- sluggish, dilated or unequal pupils
- bradycardia
- HTN
- irregular respiration
13
Q
What patient position is contraindicated for brain tumors?
A
Trendelenburg
- it increases the risk for increased intracranial pressure and risk for hemorrhage
14
Q
What are some risk factors for breast cancer ?
A
- female sex
- age: >55 yrs highest risk
- pregnancy: first full-term pregnancy after 30, no breastfeeding
- family hx: doubles risk
- hormone use: use of estrogen and progesterone especially in postmenopausal women
- environmental exposure: chemicals in cosmetics & foods
- lifestyle: obesity, smoking, inactivity
- genetics: mutations BRCA-1 & 2, everyone has both genes and they usually suppress tumors, when a mutation occurs that’s when the risk occurs
15
Q
Where does the breast cancer arise in ?
A
- epithelium of the lobules: lobular carcinoma
- epithelial lining of the ducts: ductal carcinoma
16
Q
What are the main components of the breast ?
A
- lobules: milk-producing glands
- ducts: milk passages connecting lobules to the nipple
17
Q
What are the 2 different places breast cancer can be ?
A
- in situ: within the duct/lobule (non-invasive)
- invasive: invading through the duct/lobule wall
18
Q
What are the different non-invasive (in situ) breast cancers ?
A
- DCIS: ductal carcinoma in situ
- LCIS: lobular carcinoma in situ
19
Q
What are the different invasive breast cancers ?
A
- IDC: (invasive ductal carcinoma) (most common)
- starts in milk ducts, breaks through walls of the duct, invades surrounding tissue
- from there, may metastasize to body
- subtypes: medullary, tubular, colloid, papillary, metaplastic
- ILC: (invasive lobular carcinoma)
- starts in lobules, breaks out, metastasizes
20
Q
What are some clinical manifestations of breast cancer ?
A
- lump or thickening in the breast
- if palpable: hard, irregularly shaped, non-tender
- abnormal mammogram
- breast asymmetry
- dimpling (pulling in)
- presence of nipple discharge
21
Q
What are some diagnostic studies for breast cancer ?
A
- history
- physical examination
- mammography
- ultrasonography
- biopsy
- MRI, if indicated
- prognostic factors: axillary lymph node status, tumor size, hormone receptor status, cell proliferative indices, genomic assays (HER-2 marker)
22
Q
What are the screening guides for breast cancer ?
A
- at 45: yearly mammograms
- at 55: mammograms every other year or continue with annual mammogram (depending on preference) as long as you are still healthy
23
Q
What is the TNM system ?
A
- tumor size (T)
- nodal involvement (N)
- presence of metastasis (M)
24
Q
What is a Sentinel Lymph Node Biopsy (SLNB) ?
A
- dye is injected near the tumor to identify which lymph nodes are involved/need to be removed
- works by seeing which lymph nodes the injected tumor drains dye into
25
What is axillary node dissection (ALND) ?
removal of section of lymph nodes
- can lead to lymphedema
- Post-op: pain control, assessment of incision, limb alert for no BP or IV in the affected arm
- restoring arm function after surgery is important and may require physical therapist
26
What is some acute lymphedema care ?
- immediately post-op: most important is to protect the arm (no BP/sticks)
- intermittent pneumatic compression sleeve may be prescribed
- elevation of arm (level with heart)
- diuretics
- isometric exercises: encourage use of arm to prevent fluid build-up
- wear a fitted elastic pressure gradient sleeve during waking hours
- prevent trauma
27
What is a mastectomy ?
complete removal of the breast tissue
28
What is the modified radical mastectomy ?
removal of the breast tissue and axillary lymph nodes
29
What is a transverse rectus abdominis musculotaneous (TRAM) flap ?
surgical procedure for breast reconstruction following mastectomy
- they take some fat, muscle or skin from the lower abdomen and use this to form a new breast
30
What is a deep inferior epigastric artery perforator (DIEF) flap ?
breast reconstruction
- fat, skin, and blood vessels from the lower abdomen to rebuild the breast without an muscle
- is more of a natural appearance
- can restore sensation by transferring a sensory nerve
- more of an aesthetic results
31
What is some post-op concerns for surgery for breast cancer ?
- no BP/sticks on the arm
- apply an arm band so all care team members are aware
- this will remain for the rest of their life
- first night post-op, keep the arms still at their chest (like T-rex) then day 1 post-op can start moving
- restoring arm function to prevent muscle shortening post-op and after discharge
- encourage activity of arm including normal ADLs like bathing, brushing hair, etc
- incision care/drain care
- drain log education
- encourage incentive spirometer
- pain control
- supportive care
- body image concerns & fear and coping concerns
32
What are some radiation therapy SE ?
- fatigue
- skin changes
- breast edema
33
What are some characteristics of radiation therapy for breast cancer ?
- often done after surgery based on chance that local, residual cancer cells are present
- may also be done when axillary lymph nodes are involved to decrease risk for axillary lymph nodes recurrence
34
What is the use of palliative radiation therapy for breast cancer patients ?
- decreases size, therefore decreasing pain
- controls recurrence and metastasis
35
What is the use of chemotherapy for breast cancer patients ?
- often neoadjuvant or adjuvant therapy
- often given to patient with node involvement, and to those with a high risk for recurrence and/or metastatic disease
36
What is targeted therapy for chemotherapy ?
used in HER2 (+) breast cancer (monoclonal antibody)
- Trastuzumab (Hereceptin)
- blocks the HER2 receptors and blocks signals that tell cancer cells to proliferate
- SE: cardiotoxic, hypersensitivity reactions, flu-like S&S
- RN Considerations: monitor for S&S of cardiotoxicity
37
What is Cell Cycle Non-Specific chemotherapy ?
targets cancer cells in all phases
- cyclophosphamide (Cytoxan)
- SE: myelosuppresion, N/V, alopecia, hemorrhagic cystitis
- RN Considerations: increase fluid intake, empty bladder frequently, give early in day
- Doxorubicin (Adriamycin):
- SE: cardiotoxicity, HF, dysrhythmias, ECG changes
- RN Considerations: needs lifetime dose limit, monitor closely, first void will be pink (med is red in color), no immunizations w/o HCP approval
38
What is hormone therapy for breast cancer patients ?
(prevents estrogen from promoting cancer cell growth)
Estrogen receptor blockers: Tamoxifen
- used in ER (+) in pre/post menopausal women
- SE: hot flashes, irregular vaginal bleeding/spotting, increased risk for endometrial cancer, decreased visual acquity
- RN Considerations: report changes in vision, monitor for S&S of DVT, pulmonary embolism and stroke
Aromatase inhibitors:Anastrozole/Exemestane/Letrozole
- used in ER (+) in POSTmenopausal women only
- SE: vasodilation, HTN, hot flashes, mood disorders,
- won't cause endometrial cancer
- pt's with triple (-) disease can't use hormonal suppressors
39
Why is knowing if the breast cancer is estrogen (+) or (-) important ?
different meds target different types of breast cancers
