Peds with Cancer Flashcards
Risk Factors for Cancer
▪Radiation exposure
▪Carcinogenic drugs
▪Immunosuppressive therapy
▪Infections
▪Race
▪Genetic conditions
Diagnostic for cancer
▪History and physical
▪CBC, LFTs, coagulation studies, urinalysis
▪Lumbar puncture, bone marrow aspiration
▪CT, MRI, PET, MIBG
▪Surgery
▪Biopsy
Multimodal therapy
▪Combination surgery, chemotherapy, and radiotherapy
surgery for cancer
▪Remove traces of tumor, restore normal function
what is the primary form of treatment for childhood cancer
chemotherapy
Radiotherapy
▪In conjunction with chemotherapy
Side effects related to lethal damage to tissue
Signs and Symptoms of Cancer in Children
▪Fever and pain, common in childhood, leading to easily missed problem
▪Unexplained loss of energy
▪Sudden vision changes
▪Excessive, rapid weight loss
side effects of cancer treatment
▪Damage occurs to normal tissues as well as malignant tissues
▪Infection—Monitor for septic shock
▪Hemorrhage
▪Anemia
▪Nausea and vomiting
▪Altered nutrition
▪Mucosal ulceration
▪Neurological problems
▪Alopecia
▪Steroid effects
management for infection
Monitor for septic shock
▪Fever with absolute neutrophil count (ANC) lower than 500/mm3
▪Prevention of infection is a priority
management for hemorrhage
▪Prevented or controlled with platelet infusions
▪Teach to avoid activities that may cause injury: riding a bike or skate boards; contact sports
management for anemia
▪Common during induction therapy
▪Limits tolerance of physical activity
management for altered nutrition
▪Monitor intake and nutritional status
▪Monitor height and weight routinely
management for nausea and vomiting
▪Antiemetics used to manage side effect
▪Synthetic cannabinoids are being used in children
▪Administer antiemetic 30 minutes BEFORE chemotherapy begins and routinely for 24 hours after chemotherapy
management for mucosal ulceration
▪Red, eroded, painful in mouth; may extend to rectal area (sitz baths)
▪Increase anorexia due to pain
▪Use bland, moist, soft food, and soft sponge toothbrush
management for neurological problems
▪Severe constipation- stool softners
▪Foot drop, weakness and numbness lead to difficulty walking
▪Severe jaw pain
management for alopecia
anticipatory guidance
-Warn the child and the family of possible side effect early in the treatment to allow them time for preparation
-Explain that hair falls out in clumps, leads to patchy baldness
-Explain that hair regrows in 3 to 6 months but may be a different texture (now curly when it was straight before treatment) or a different color
management for steroid effects
▪Cushingoid appearance (Can be distressful for older children due to weight gain; moon face appearance)
▪Avoid salt intake to reduce fluid retention
what is the most common form of childhood cancer
Acute lymphoid leukemia (ALL)
Types of acute leukemia
▪Acute lymphoid leukemia (ALL)
▪Acute myelogenous leukemia (AML)
Acute Leukemia
A broad group of malignant diseases of bone marrow and lymphatic system
▪Leukemia is an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body
Although leukemia is an overproduction of WBCs, often acute form causes..
low leukocyte count
▪Greatly elevated immature cells or blasts
▪Immature cells do not attack and destroy normal blood cells
three primary consequences of leukemia
▪Anemia
▪Infection and neutropenia
▪Bleeding
S/S of Leukemia
▪Fever, pallor, fatigue, anorexia, hemorrhage, bone, joint pain
▪Bones weaken and are prone to fractures
▪Bone pain from increased pressure
Diagnostic Evaluation of Leukemia: Based on history and physical manifestations
▪Minor infection does not disappear
▪Pale, listless, irritable, febrile, anorexia
Diagnostic Evaluation of Leukemia: peripheral blood smear
▪Immature leukocytes
▪Frequently low blood cell counts
Lumbar puncture to evaluate
▪central nervous system (CNS) involvement of leukemia
diagnosis for leukemia
▪Bone marrow aspiration or biopsy
Therapeutic Management of Leukemia
IV and chemotherapy, Bone marrow transplantation
Three phases of therapy for leukemia
▪Induction
▪Intensification (consolidation) therapy
▪Maintenance therapy: To preserve remission
induction phase for leukemia treatment
▪4 to 5 weeks, begins almost immediately
Intensification (consolidation) therapy:
To eradicate residual leukemic cells
▪Chemotherapy given periodically over 6 months
Maintenance therapy:
To preserve remission
▪Weekly or monthly CBCs
▪Treatment usually stops after 2 to 3 years
▪Monitor for relapse
after relapse of leukemia
-Reinduction after relapse
-Each relapse means poorer prognosis
-Testes are resistant to chemotherapy and may lead to relapse
-Relapse in testes leads to intensive chemotherapy and irradiation
Hodgkin disease (lymphoma) age
More prevalent among children 15 to 19 years of age
Non-Hodgkin Lymphoma age
More prevalent among children <14 years of age
Hodgkin Lymphoma
▪Neoplastic disease originating in lymph system
▪Primarily involves lymph nodes
Hodgkin Lymphoma often metastasizes to
▪spleen, liver, bone marrow, lungs, or other tissues
Clinical manifestations of Hodgkin disease
▪painless enlarged cervical or supraclavicular lymphadenopathy
▪Cough, abdominal discomfort, anorexia
▪Fever, weight loss, night sweats
Diagnostic evaluation for hodgkin disease
▪History and physical, CBC, uric acid, liver function, CRP or ESR, alkaline phosphatase, urinalysis, radiological tests
▪Lymph node biopsy, presence of Sternberg-Reed cells
Lymph node biopsy for hodgkin disease
presence of Sternberg-Reed cells
what is measured in your blood and increases when there’s inflammation in your body
CRP = C-Reactive Protein
An ESR blood test is usually done to check
understand the degree of inflammation in the body such as cancers, various kinds of infections as well as autoimmune disorders and diseases.
clinical appearance of Non-Hodgkin Lymphoma
▪Disease usually diffuse rather than nodular
▪Classification is based on the cell type
▪Mediastinal involvement and invasion of meninges
clinical manifestations of Non-Hodgkin Lymphoma
▪Depends on anatomic site involved
▪Metastasis to bone marrow or CNS may appear like leukemia
Diagnostic evaluation for Non-Hodgkin Lymphoma
▪Surgical biopsy for confirmation of disease
▪Bone marrow aspiration
▪Radiologic studies, CT scans of the lungs and GI
s/s of brain tumors
▪Hydrocephalus
▪Headache
▪Vomiting
▪Nystagmus
▪Ataxia
▪Dysarthria
▪Diabetes insipidus
▪Growth failure
Therapeutic Management of Brain Tumors
▪Surgery, radiotherapy, chemotherapy
▪Treatment of choice is removal of tumor without neurological damage
▪Radiation to shrink tumor before removal
▪Chemotherapy alone or in combination
Neuroblastoma
malignant tumor composed mainly of cells resembling neuroblasts that occurs most commonly in infants and children
-“silent tumor”
primary site of neuroblastoma
primary site is within the abdomen; other sites include the head and neck region, chest and pelvis
clinical manifestations of neuroblastoma
▪Depend on location and stage
▪Firm, non-tender, irregular mass in the abdomen
▪Neurological impairment
▪Respiratory obstruction
▪Paralysis
▪Periorbital edema
▪Exophthalmos
Supraorbital ecchymosis
diagnostic fro neuroblastoma
CT scan of abdomen, pelvis or chest to located primary tumor
Bone scan to evaluate for skeletal metastasis
Bone marrow biopsies
staging and prognosis of neuroblastoma
▪Diagnosis often made after metastasis occurs
▪Age and stage of disease impacts prognosis
▪Younger age = more likely survival
therapeutic management for neuroblastoma
▪Surgery to remove as much as possible
▪Irradiation postoperatively
▪Chemotherapy
most common type of bone tumor
Osteosarcoma
clinical manifestations of Osteosarcoma
▪Localized pain at affected site (severe/dull sometimes attributed to growing pains)
▪Limping, decreased physical activity, unable to hold heavy objects
▪Palpable mass
▪Fever
▪Respiratory distress
prognosis of Osteosarcoma
▪Most can be cured
diagnosis of Osteosarcoma
Thorough history and physical
Rule out trauma or infection
Functional status of affected area
Signs of inflammation
Size of mass
Anemia
Weight loss
Infections
X-ray, CT, MRI
Biopsy
Osteosarcoma likely arises from
▪bone-forming mesenchyme
Osteosarcoma found mostly in
lower extremities near growth plate
Osteosarcoma therapeutic management
▪Surgery and chemotherapy
▪Surgery for biopsy and to save or amputate limb
▪Limb salvage includes prosthetic bone placement
▪Chemotherapy to decrease tumor size
Ewing Sarcoma
rare malignant tumor arising in bone; arise in marrow spaces most often occurring in children
Ewing sarcoma originates from:
bone marrow;
▪shaft of long and trunk bones
▪Pelvis, femur, tibia, fibula, humerous, ulna, vertebrae, scapula, ribs, skull
Ewing sarcoma therapeutic management
▪Limb salvage or amputation depending on situation
▪Radiation
▪Chemotherapy
Wilms Tumor
nephroblastoma
▪Most common kidney tumor of childhood
clinical manifestations of wilms tumor
▪Painless swelling or mass in abdomen
▪Firm, nontender, confined to one side, deep within flank area
▪Often discovered during routine bathing/dressing
Wilms Tumor therapeutic management
-In surgery, the tumor, affected kidney and adjacent adrenal gland are removed
-Radiation and chemo usually started right after surgery
If the wilms tumor ruptures it can
send cancer cells throughout the abdomen, lymph channel, and bloodstream
pre-op care for wilms tumor
▪Surgery usually occurs within 24 to 48 hours of diagnosis
▪DO NOT palpate tumor—Careful bathing and handling of child important
▪Tell parents what to expect; keep terms simple
Rhabdomyosarcoma
▪Most common soft-tissue sarcoma in children
▪Most common in children 9 years and under
-Found in striated (rhabdo) muscle throughout the body - the most common for this cancer is head and neck, especially the eye orbit - thus the myo [meaning eye] in the name
-The tumor tends to compress the adjacent organs
clinical manifestations of Rhabdomyosarcoma
▪Signs and symptoms related to site of tumor and compression of organs
▪Earache or runny nose
Rhabdomyosarcoma treatment
-Complete removal of primary tumor whenever possible
-Chemotherapy effective and radiation may also be used
Retinoblastoma
tumor arising from a retina
Retinoblastoma clinical manifestations
▪Whitish “glow” in the pupil
▪Strabismus
▪Blindness (late)
diagnosis Retinoblastoma
▪Detailed family history
▪Ophthalmoscopy
▪Ultrasound
▪CT and MRI
therapeutic management for retinoblastoma
▪Radiation
▪Chemotherapy
▪Surgical implantation of iodine-125 for radiation
▪Photocoagulation
▪Cryotherapy
what is used to treat advanced disease with optic nerve invasion in which there is no hope for salvage of vision
Enucleation
Photocoagulation
use of a laser beam to destroy retinal blood vessels that supply nutrition to the tumor
Cryotherapy
freezing of the tumor
The Childhood Cancer Survivor
▪Late effects are of concern
▪Radiotherapy can decrease growth in bones or reproductive organs
▪Treatments may cause hormonal dysfunction
▪Growth and Tanner stages are important to document
▪Assess all body areas for abnormalities based on treatment used
