PEDS PULM AND CA Flashcards
When is Cancer seen mostly in children (of any age)?
Infancy to 4 years old and 15 to 19 years old (times of growth)
What is Cancer etiology?
Genetic alteration results in unregulated proliferation of cells including Apoptosis (programmed cell death); Oncogenes (genes that activate tumor growth) and Tumor suppressor genes (genes that keep tumor growth in “check”)
Can result from mutiple genetic events but doesn’t mean hereditary
What are some Risk factors associated with Cancer (CA)?
What is a major concern with Childhood CA?
Lifestyle related factors have little to no effect on cancer in children: (UNLIKE IN ADULTS)!!!
There are a few, well-established risk factors including:
Exposure to radiation; Carcinogenic drugs; Immunosuppression therapy
;Certain viral infections (EBV, HPV); Race/ethnicity; Genetic conditions
Of major concern is the risk of developing secondary malignant neoplasms because of curative treatment for childhood cancer
What has changed with Surivial Rates?
What group is behind on survival rates?
What is the Criteria for a “Cure”?
Increased dramatically over the last 50 years since chemotherapy was first given to children
Survival improvements among adolescents has lagged compared to other age groups
Cure = completion of all therapy, no clinical and radiological evidence of diseases, and 5 years since diagnosis
What is the Major concern with the long-term effects of Childhood CA?
Factors that affects the patient into adulthood (relationships, coping skills, emotional well-being)
What are the CARDINAL SIGNS of CA in Children? What is the overall takeaway with these signs?
An unsual lump or swelling
Unexplained paleness and loss of energy
Easy bruising or bleeding
Ongoing pain in one area of the body
Limping. unexplained fever or illness that does not resolve
Frequent H/A (often w/ vomiting)
Sudden eye changes or vision changes
Sudden unexplained weight loss
Overall takeaway: Anything that NOT normal and DOESN’T GO AWAY
How should the S/E of treatment be handled?
S/S include (Infection – destruction of WBC; Hemorrhage –loss of platelets; Anemia – loss of RBCs; Nausea and Vomiting; Altered Nutrition; Mucosal Ulceration – mouth, pharynx, esophagus, rectal; Neurologic Problems neurotoxicity; Hemorrhagic cystitis chemotherapy injures bladder lining; Alopecia)
Inf- S&S of infection and sepsis, IV therapy treatment, prophylaxis common, biologics, prevent infection is important!
Hem- Used to be leading cause of death in cancer pts, avoid skin puncture when possible!, avoid additional trauma, platelet transfusions during bleeding episodes
Anemia- RNC transfusions, let child regulate activity
N/V- meds (pheng, Compazine, Tigan),
Altered Nutrition- assess weight, intake, height, etc. High calorie foods, d/t mucosal ulcers
Mucosal Ulceration –bland food, soft toothbrush or tooth sponge, antiseptic mouth washes, warm sitz bath, ointments
Neuro- jaw pain, foot drop, numbness, weakness, constipation
Hemorrhagic- Lots of fluid before, during, after chemo.
Alopecia- set expectations
What is Leukemia(s)?
What is the most common form of Childhood Cancer?
Umbrella term for cancers of the blood, bone marrow, and lymphatic system
In health children, bone marrow makes blood stem cells which mature into lymphoid or myeloid stem cells
Myeloid stem cells–> Red blood cells, Platelets, WBCs and Lymphoid stem cells–> Lymphoblasts (become B and T lymphocytes) and natural killer cells
Acute Lymphoblastic Leukemia (ALL) is the most common form of childhood cancer (80% of leukemias)
Where does the most common solid tumor in children arise from?
Tumors of the CNS are the most common solid tumor in children
What are some Manifestations/Behaviors of Brain Tumors?
Signs and symptoms are directly related to their location and size
Headache and vomiting upon waking (increased ICP)
Behavioral changes, visual disturbances, motor skill disruption, seizures, hemiparesis (half of the body is paralyzed)
Diagnosis based on:
Clinical signs and symptoms
Imaging
Biopsy (usually done during surgery)
Treatment for Brain tumors includes?
Surgery: Survival increases with complete tumor removal
Chemotherapy
Radiation
Shrinks tumor before attempting
surgical removal
Kill remaining tumor cells after
surgery
Treatment depends on the type of tumor involved
What are s/s of bone tumors?
Pain in affected site
Limping, stops physical activity, unable to hold heavy objects
Palpable mass
Cord compression & Respiratory distress (Ewing’s sarcoma)
What are examples of Bone tumors?
Osteosarcoma: Most common bone tumor in adolescents and young adults; Thought to originate during rapid bone growth; Tumor sites often in long bones near growth plate (40% in femur)
Ewing’s sarcoma
Less common – approx. 200 cases per year; Predominantly in Caucasians; More than half are adolescents
What is a neuroblastoma?
What are S/S?
Most common extracranial childhood solid tumor
S/S include:
Depend on location and extent of the disease progress
Most common site: abdomen
Other sites: head and neck, chest, pelvis
Firm, non-tender, irregular mass that crosses the midline (TEST Q)
Excrete catecholamines if tumor on adrenal glands or sympathetic chain. Urinary excretion can be measured to determine
What is a Wilm’s Tumor? (AKA)?
Also called nephroblastoma
Most common kidney tumor of childhood
Approximately 10% of children with Wilms have congenital anomalies
