TLO 103c Neoplastic Flashcards

Question

Chemo side effects

Answer 1

``` Chemo side effects: Bone marrow suppression Alopecia Malaise/fatigue Nausea Vomiting Anorexia Stomatitis (oral, rectal sores) ```

Answer 2

``` Radiation side effects: Skin reactions (burns, redness) Fatigue Bone marrow suppression Nausea Vomiting Anorexia Mucositis (oral sores) ```

Answer 3

Broad term for group of malignant disease of bone marrow and lymphatic system Most common childhood cancer Peak onset 2-6 years old > in males and Caucasians Lymphoid leukemia 80% survival rates Acute nonlymphoid leukemia has 50% survival rate

Answer 4

Leukemia is an abnormal proliferation of immature white blood cells which compete with normal cells for space and nutrients Bone marrow production is suppressed which results in low numbers of WBC, RBC and platelets

Answer 5

``` Liver and spleen are most effected (vascular organs) Acute form: leukocyte count is low S/S: Anemia Neutropenia Thrombocytopenia ```

Answer 6

H&P Peripheral blood smear: contains immature forms of leukocytes, low blood count Bone marrow aspirate/biopsy: flow cyometry of cells in bone marrow Lumbar puncture to determine CNS involvement

Answer 7

Infant may be irritable, lethargic, feed poorly, have increased head, bulging fontanels Young child loss of developmental milestones School age have declining academic performance, fatigue, personality changes, seizures Older children: HA upon waking, vomiting

Answer 8

Decrease RBC= anemia; neutropenia= infection | Decrease platelets= bleeding tendencies

Answer 9

Pallor, fatigue, fever, hemorrhage, fractures, pain

Answer 10

Infiltration, enlargement, eventual fibrosis (scarring) | Manifestations: hepatomegaly, splenomegaly, lymphadenopathy

Answer 11

Increased ICP, meningeal irritation

Answer 12

Cell deprivation of nutrients by invading cells lead to muscle wasting, weight loss, anorexia, fatigue

Answer 13

``` MRI CT EEG Lumbar puncture Biopsy ```

Answer 14

The most common primary bone lesion in children Originates from the bone producing cells that invade the medullary canal of the bone, incidence is higher in the most rapidly growing bones in adolescence Goals of therapy: remove tumor, prevent spread

Answer 15

Induction therapy: achieves complete remission or less than 5% leukemia cells in bone marrow CNS prophylactic therapy: prevents leukemia cells form invading CNS Consolidation/intensification therapy: eradiation prevents emergence of resistant leukemic clones Maintenance therapy: maintain remission phase

Answer 16

Primary tumor sites are in the metaphysis adjacent to the epiphyseal plate of long bones Other sites: tibia, humerus, pelvis, jaw, phalanges Higher in lower extremities

Answer 17

Hematopoietic stem cells transplant: success with ALL and AML. Capable of differentiating into specialized calls. ``` Donors: antigen matched related donors matched unrelated mismatched donors obtained from related or unrelated donors or umbilical cord blood ``` ``` Transplant cons: Significant morbidity and mortality Graft vs host disease Overwhelming infection Severe organ damage ``` ``` Prognosis: long term survival depend on the following initial WBC count Child's age at diagnosis Type of cell involved Gender of child Karyotype analysis ```

Answer 18

Pain, mass, limping, limited ROM, pathological fractures

Answer 19

Surgery: biopsy, limb salvage or amputation Chemo Radiation, used only in the palliative pain control in the advanced patient

Answer 20

``` Depend on type of surgery Post-op; emotional support Prepare for alopecia Permanent prosthesis fitting 6-8 wk posts op Elavil for phantom leg pain Physical therapy Planning for return to school ```

Answer 21

Arises in the marrow spaces of the bone Tumor originates in the shaft of long and trunk bones Most common site: femur, tibia, fibula, humerus, ulna, vertebrae, scapula, ribs, pelvic and skull 2nd most common bone tumor seen in children

Answer 22

Radiation, chemo Amputation if radiation causes deformity, loss of function Vincristine, actinomycin D, cyclophosphamide, ifosfamide, etoposide, doxorubicin Prognosis: new chemotherapy agents have increased 3 years survival to 80%

Answer 23

Psychological adjustment Prepare pt and family for bone marrow aspiration, surgical biopsy, radiation Skin care Encourage loose fitting clothing Protect site from sunlight/temperature changes Physical therapy Prepare for alopecia, N/V, peripheral neuropathy, possible cardiotoxic side effects

Answer 24

``` Wilm's tumor or nephroblastoma (kidney cancer) One or both kidneys involved Diagnostic: H&P Ab swelling/mass Ab US Ab/chest CT Hematologic studies Urinalysis Determine kidney function on opposite side ```

Answer 25

``` Pre-op: Surgery in 24-48 hr of admit BP, hypertension due to excess in renin production Do not palpate ab, post sign above bed Radiation/chemo teaching ``` ``` Post-op: Recover is rapid GI activity BP, urine output, signs of infection Pulmonary hygiene Protect kidney that is left ```

Answer 26

A neoplastic disease that originates in the lymphoid system | Most common: asymptomatic enlarged cervical or supraclavicular lymphadenopathy

Answer 27

``` A= asymptomatic B= 3 symptoms: Fever 100.4 or higher for 3 days Drenching night sweats Unexplained loss of body weight over 6 mo ``` ``` Cough Ab discomfort Anorexia N/V Pruritus Fatigue Non painful lymph node enlargement ```

Answer 28

``` Radiation Chemo Splenectomy in some cases: Prophylactic antibiotics Immunizations against pneumococci and meningococci ```

Answer 29

Can be unilateral or bilateral Caused by mutation in gene Hereditary retinoblastomas are transmitted as an autosomal dominate trait

Answer 30

Ophthalmologist exam under general anesthesia | US, CT

Answer 31

White eye reflex

Answer 32

Strabismus | condition in which the eyes do not properly align with each other when looking at an object

Answer 33

Red, painful eye

Answer 34

Pre and post op teaching Post op care of eye/socket care Preparing parents for post op facial appearance Post op enucleation (removal of the eye that leaves the eye muscles and remaining orbital contents intact): Facial features return to normal w/in 3 wk of prosthesis

Answer 35

``` Survival rate 90% Long term concerns: decreased visual acuity facial disfiguration secondary tumor ```

Answer 36

Two forms of leukemia in children? Classified by the type of WBC affected ``` Acute lymphoid leukemia (ALL) **most common: Stem cell or blast cell Lymphatic Lymphocytic Lymphoblastic Lymphoblastoid ``` ``` Acute nonlymphoid leukemia (ANLL): Granulocytic Myelocytic Monocytic Myelogenous Monoblastic Monomyeloblastic ```