Pediatric Oncology Flashcards
Etiology
- Radiation
- Chemicals
- Genetic disorder
- Embryological origins
- Cancers staged from I (least severe) to IV (worst)
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
Acute Lymphocytic Leukemia (ALL)
- >75% of pediatric leukemias
- Most common 2-3 yo
- Survival >90%
Acute Myeloid Leukemia (AML)
- More common in teenagers
- 41% survival for 5 years
- Can become chronic (CML) <2% of leukemias
Signs/Symptoms (Leukemias)
- 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
Medical mgmt
Chemotherapy
Stem cell transplant
Stages of Treatment for Leukemia
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
PT and Leukemia
- Depending on age of child:
◦Developmental delay
◦Weakness
◦Decreased endurance
CNS Tumors
- 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
- Brainstem glioma -poor cure rate
- Ependymoma- cells lining ventricular system- 50% cure rate
- Craniopharyngioma-benign- derived from pituitary gland embryonic tissue
S/S of CNS Tumors
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
Medical Mgmt of CNS Tumors
- 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
Post-op Posterior Fossa Syndrome
- Delays 1-5 days post surgery most common in medulloblastoma
- Decreased cervical ROM
- Hemiparesis
- Ataxia
- Dysmetria
- Weakness
- Speech disorder
- Visual disorder
General PT Intervention Post-opBrain Tumor Resection
- 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
- Developmental activities
Ball
Bikes
Run
Jump
Mini-tramp
Embryonal Tumors-arise from embryonal tissues
Neuroblastoma-sympathetic NS:
◦75% cure rate <1yo
◦50% cure rate >1yo
–Arises in sympathetic nervous system and especially in adrenal glands or paraspinal ganglion
Neuroblastic Tumors
- S & 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
Retinoblastoma
- Tumor of eye
- May be hereditary (infants)
- Nonhereditary forms too
- 0-2 yo
- S & S: enlarged pupil that appears red or white, crossed eye, vision changes
Wilm’s Tumor
- AKA nephroblastom
- Genetic component
- <2 yo
- S & S
- Abdominal mass
- Fever
- Anemia
- Hypertension
- 92% survival rate for 5 years
- Medical management
- Surgical resection
- Chemo
- XRT
Lymphomas
Malignant disease of lymphatic system-cancers involving blood cells like leukemias
Hodgkin’s (adolescents)
Non-Hodgkin’s (younger children)
Hodgkin’s
- More common in adolescence
- Boys > girls
- 91% survival
- S & S
- Painless swelling of neck, groin, axilla
- Non-productive cough
- Fatigue
- Anorexia
- Weight loss
Non-Hodgkins
- More common in young children
- Boys > girls
- 4 categories of types of lymphoma
- 72% survival
- S & S
- Swelling of face, neck, UEs
- Difficulty swallowing
- Changes in bowel habits
- Nausea
- Vomiting
- Painful swallowing (dysphagia)
- Medical management
- XRT
- Chemo
Sarcomas-solid tumor arising in connective tissue
- Bone Tumors
- Ewing’s sarcoma
- Osteogenic sarcoma or osteosarcoma
- Soft Tissue Tumors
- Rhabdomyosarcoma
Osteosarcoma
S & S
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
Osteogesarcoma
Medical Management
Amputation
Limb salvage procedure with bone graft and/or hardware
Rotationplasty – primarily for femur
Chemo
75% survival without mets
30% survival with mets
Ewing’s Sarcoma
- 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 & S
◦Pain or tenderness at site of tumor
◦Swelling
Rhabdomyosarcoma
- 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 & symptoms: mass
- Medical management
◦Surgical resection
◦XRT
◦Chemo
PT and Oncology: Tips
- 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
Critical Platelet Counts
- 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**
Platelets: helps blood to clot
Hemoglobin: protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues back to the lungs
WBC: fight infection
Bone Marrow Transplant
- Allogenic compatibility based on Human Leukocyte Antigen (HLA)
- Stages
◦Pre-transplant
◦Transplant
◦Post-transplant
Stages:
Pre-transplant
- 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
Stages:
Transplant
Donor marrow harvested surgically via ASIS and PSIS
Marrow is filtered, treated, replaced
Stages:
Post-transplant
- 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
