T3-Blueprint: Cancers Flashcards
What are the s/s of brain tumors in children?
- Vomiting
- Seizures
- Weakness of face, trunk, arms, or legs
- Slurred speech
- Difficult to stand or walk
- Poor coordination
- Headache
*In babies, a rapidly enlarging head
Nephroblasoma-What cancer?
Wilm’s tumor
S/s of the most common kidney tumor of childhood (Wilms aka nephroblasoma)
- Hematuria
- Abdominal swelling or mass (firm, nontender)
- HTN
- Anorexia (fatigue, malaise, weight loss)
- Fever
What is treatment for Wilms Tumor?
Surgical removal or tumor or kidney
Chemo
Post op radiation
What are the chemo drugs for Wilms?
Dactinomycin or vincristine
Cancer that arises from the retina and is the most common intraocular malignancy in childhood
Retinoblastoma
S/S of retinoblastoma?
Leukocoria
Strabismus
Blindness (late sign)
Retinoblastoma: What is leukocoria?
Whitish glow in pupil (cats eye reflex)
Retinoblatoma: Why would enucleation be used?
To treat advanced disease with optic nerve invasion in which there is NO HOPE for saving vision
Retinoblastoma: Why would we use chemo?
To reduce tumor size to allow for other therapies
Retinoblastoma: Sometimes chemo is used to reduce the tumor size to allow for treatment of other therapies. What are those 3 therapies?
- Plaque brachytherapy
- Photocoagulation
- Cryotherapy
Retinoblastoma: What is plaque brachytherapy?
Surgical implantation of iodine-125 applicator on sclera until max radiation dose has been delivered
Retinoblastoma: What is photocoagulation?
Use of laser beam to destroy retinal blood vessels that supply the tumor
Retinoblastoma: What is cryotherapy?
Freezing tumor to destroy microcirculation that feeds it
Retinoblastoma: Does chemo work in advanced diseases to increase survival rate?
NO
Malignancy that occurs in the adrenal gland, sympathetic chain of the retroperatitoneal area, head, neck, pelvis, or chest
Neuroblastoma
What are s/s of neuroblastoma?
Depend on location and stage of disease
T/F: Half of children who have neuroblastoma have lots of symptoms
FALSE–half of children who have neuroblastoma have FEW symptoms
What are s/s of metasis of neuroblastoma?
- Ill appearance
- Periorbital ecchymoses
- Proptosis
- Bone pain
- Irrirability
What is treatment for neuroblastoma?
Surgical removal of tumor
Chemo and/or radiation used for metastasis and residual disease
Originates in skeletal muscle in any part of body (mostly in head and neck, with orbit of eye frequently affected)
Rhabdomyosaracoma
What are s/s of rhabdomyosarcoma?
Local pain due to compression by tumor
Rhabdomyosarcoma
T/F: Some places will not have pain until the tumor presses against the organs
True
S/S of rhabdomyosarcoma for CNS?
Headaches
Diplopia
Vomiting
S/S of rhabdomyosarcoma for orbit?
Unilateral proptosis
Ecchymosis of conductive
Strabismus
S/S of rhabdomyosarcoma of nasopharynx?
Stuff nose, pain, nasal obstruction, epistaxis, palpable neck nodes
*visible mass= late sign
What is treatment for rhabdomyosarcoma?
Surgical biopsy, local radiation therapy, and chemo rather than surgical procedures
Most common type of bone tumor in peds. More in boys or girls?
Osteosaracoma; boys
Common sites of osteosarcoma?
Ends of long bones
- distal femur
- proximal tibia
- proximal humerus
S/s of osteosarcoma?
- Pain and swelling at the site of disease
- Palpable lymph nodes near site of timor
- Limpness, inability to hold a heavy object
- Weakness, decreased movement of extremitiy
S/s of osteosarcoma. One of the signs is pain and swelling at the site of disease What can be done to provide temporary relief?
Flex extremity
Treatment for osteosarcoma?
- Amputation
- Tiknoff linbergy procedure
- TCA antidepressents to treat phantom limb pain following an amputation
Osteosarcoma: If limb is amputated, how far above the site does the amputation begin?
5-6 cm
Osteosarcoma: What is the tiknoff-linberg procedure?
Procedure to spare the limb if the bone has stopped growing (older adolescents)
Most common cause of childhood cancer? Who is ti more common in? Peak onset?
Leukemia
More common in boys and caucasians
Peak onset: 2-5 years of age
Children with ____ have a greater risk for developing leukemia
Downs syndrome
What is leukemia?
Group of malignancies that affect the bone marrow and lymphatic system
How is leukemia classified?
Type of WBC that becomes neoplastic
Leukemia is classified by the type of WBC that becomes neoplastic. What are the two groups?
- Acute lymphoid leukemia (ALL)
2. Acute myelogenous or non lymphoid leukemia (AML/ANLL)
Leukemia causes an increase in the production of _____, which leads to infiltration of organs and tissues
Immature WBC
Leukemia: What results of deficient RBC?
Anemia
Leukemia: What results of deficient WBC?
Neutropenia–bleeding and bruising
Leukemia: What results of deficient platelets?
Trhombocytopenia–bleeding and bruising
Symptoms of leukemia?
- Pallor
- Easy bruising
- Lethargy
- Malaise
- Enlarged liver, lymph nodes and joints
- Abdominal, leg, and joint pain
- Constipation, headache, vomiting, anorexia, unsteady gait
What are late signs of leukemia?
- Pain
- Hematuria
- Ulcerations in mouth
- Enlarged kidneys and testicles
- Signs of ICP
What is treatment for leukemia?
Chemo
Bone marrow transplant
Malignancy that originates in the lymphoid system and primary involves the lymph nodes
Hodgkins
Hodgkins primarily involves the lymph nodes..where does it metatasize?
Non-lymp sites, especially the spell, liver, bone marrow, lungs, and mediastinum
Hodgkins stage 1?
Lesions in one lymph node area OR only one extralymphatic site
Hodgkins stage 2?
2 or more node regions on same side of diaphragm OR 1 additional extralymphatic site or organ on same side as diaphragm
Hodgkins stage 3?
lymph node regions on both sides of diaphragm OR one extra lymphatic site, spleen, or both are involved
Hodgkins stage 4?
Cancer has metastisized diffusely thoughout body to one or more extralymphatic sites
T/F: With Hodgkins, there is painless enlargement of lymph nodes
TRUE
Hodgkins: Most common findings of lymph nodes?
Firm, nontender, enlarged, movable nodes in supraclavicular or cervical area
What is treatment for Hodgkins?
Chemo and radiation
Third most common cancer in meds–lymphatic cancer that derives from mature B Cells, T cells and cells of uncertain lineage
Non-hodgkins
Non-hodgkin’s stage 1?
Single tumor at single site
Non-hodgkin’s stage 2?
Single tumor with regional involvement on same side as diaphragm
Non-hodgkin’s stage 3?
Tumor on both sides of abdomen; also all primary thoracic, intraabdominal, and paraspinal or epidural tumors
Non-hodgkin’s stage 4?
Stages 1-3 + CNS or bone marrow involvement
What are sites of non-hodgkin?
Abdomen
Mediastinum
Head and neck
What are symptoms if non-hodgkins is in the abdomen?
Pain
Distention
N/V
What are symptoms if non-hodgkins is in the mediastinum?
- Pleural effusion
- Dyspnea
- Dysphagia
- SVS Syndrome (swelling of upper arm, face, and neck)
What are symptoms if non-hodgkin is in the head and neck?
Painless, non-tender mass
What is treatment for non-hodgkin?
Aggressive approach using radiation and chemo
When is bone marrow transplant used?
For children who have malignancies that are unlikely to be cured by any other means
Bone marrow transplant allows for administration of _____ of chemo, often combined with radiotherapy, to rid body of all cancer cells
Lethal dose
Bone marrow transplant: New transfused marrow or stem cells begin to produce ___________–recepient accepts a new blood-forming organ
Functioning, nonmalignant blood cells
What is the primary form of treatment in cancer?
Chemo, or adjunct to radiotherapy
What is the action of chemo?
Interfere with the function/production of DNA and RNA
Chemo contain vesicants. What does this mean?
Can cause cellular damage if the drug infiltrates (special training is needed to administer these drugs)
One side effect of chemo is mucosal alteration. Why is mouth care so important when a patient has chemo?
- Mouth is one of the easiest places to get an infection due to immune system being diminished
- Must do frequent oral care to inspect for ulceration and hemorrhage
- Use soft-bristled tooth nurse, lube lips to avoid cracking; offer soft, bland foods
What can we apply to reduce the pain in the mouth if a patient has chemo treatment?
Local anesthetics and antiseptic mouthwash
Mouth care if pt. is having chemo:
What do we avoid? (4)
- Viscous lidocain: causes aspiration; depressed gag reflex
- Hydrogen peroxide: delays healing
- Milk of magnesia: dries mucous membranes
- Lemon glycerin swabs: causes tooth decay and erosion of tissue
Skin breakdown is another effect of chemo. What do we do to help with this?
- Inspect skin daily
- Avoid rectal temps
- Provide sitz bath as needed
- Reposition frequently
Neuropathy is an effect of chemo. What do we do to help with this?
- Constipation is likely so encourage a diet high in fiber, administer stool softeners, encourage fluid
- If jaw pain, give a soft diet
Loss of appetite is an effect of chemo. What do we do to help with this?
- Control n/v with antimetic
- Small, frequent, well-balanced meals
- Weigh child daily
- Monitor electrloytes
- Administer chemo early in day
Hemorrhage cystitis is an effect of chemo. What do we do to help with this?
Encourage fluids and frequent voiding
Administer chem early and administer MESNA to protect the bladder
Alopecia is an effect of chemo. What do we do to help with this?
PREPARE THEM FOR THIS!!!!!
Encourage use of cotton hat or scarf or wig if they are self-conscious
How is intrathecal chemo delivered?
Through lumbar puncture (spinal tap) or device placed under the scalp
Why is intrathecal chemo given?
To treat cancers that have reached CNS (including some types of leukemia and lymphoma)
Intrathecal chemo delivers chemo drug directly into ____ surround the brain and spinal cord to target cancer cells that have spread there.
Cerebrospinal fluid
*typically chemo doesnt cross the BBB, so this method has to be used instead
What is low blood counts?
Anemia
What is low platelets?
Thrombocytopenia
What is low neutrophils?
Neutropenia
What is immature RBCs?
Leukemic blasts
A deficiency of granulocytes in the blood, causing increase vulnerability to infection
Agranulocytosis
Low plateltes in blood–causes bleeding into tissues, bruising, and slow blood clotting after injury
Thrombocytopenia
An abnormally increase concentration of hemoglobin in blood, through either reduction of plasma volume or increase in red cell numbers. It may be a primary disease of unknown cause, or a secondary condition liked to respiratory or circulatory disorder or cancer
Polycythemia
A red blood cell that is typical biconcave disc without a nucleus. They contain the pigment hemoglobin, which imparts the red color to blood, and transports oxygen and carbon dioxide to and from the tissues
Erythrocytes
A colorless cell that circulates in the blood and body fluids and is involved in counteracting foreign substances and disease; there are several types, all amoeboid cells with a nucleus, including lymphocytes, granulocytes, monocytes, and amcrophages
Leukocytes
Immature WBCs; fill bone marrow spill into the blood stream; production of normal blood cells is affected, causing anemia, bleeding problems, and infection
Leukemic blasts
Normal platelet count?
150-450 billion
Normal HCT in male? female?
Male: 38.8- 50%
Female: 34.9-44.5%
Normal hgb in male? female?
Male: 13.5-17.5 g/dl
Female: 12-15.5 g/dl
*Above 11 g/dl is key
Normal leukocyte count?
Aka WBC
4500-11000
