Ch. 23 Pediatric Cancer
the three main consequences of leukemia: s/s
anemia - bone pain (limping), lethargy, pallor, anorexia infection - fever, lymphadenopathy, abnormal WBC count, unresponsive to antibiotics bleeding - bruising purpura, nosebleeds
non-hodgkin's lymphoma
cause - incidence increases with age only 2% in children - uknown risk factors - immune system dysfunction s/s - may develop in any lymph system organ (spleen, tonsils, intestines, thymus gland) - pain or swelling - enlarged lymph odes - cervical, axillary, or inguinal area - respiratory probs - weight loss, fever, night sweats diagnosis - x-rays, labs, lymph node biopsy prognosis - rapid disease progression, lower long term survival rates than hodgkins treatment - chemo, radiation, stem cell transplant, targeted drugs, immunotherapy
hodgkin's disease/lymphoma
cause - more common in teens and young adults (15-39) - unknown, may be r/t viral infection - more common in those with HIV, epstein-barr, exposure to ionizing radiation, fam hx - possibly due to pesticides/herbicides s/s - painless, non-tender, enlarged lymph nodes - cervical, supraclavicular, inguinal, or axillary mediastinal mass - fever, weight loss, night sweats, cough, abdominal discomfort, nausea, slow insidious progression diagnosis - clinical manifestations and lymph node biopsy - presence of reed-sternburg cells, large multi-nucleated cells treatment - chemo with/without radiation prognosis - long term survival rate excellent considerations - address fatigue, pain, monitor for infection/fever
considerations/treatment/interventions for BOTH bone tumors
diagnosis - radiology test and biopsies treatment - surgery (removal or tumor or amputate), radiation, chemo, targeted therapy, cyrosurgery considerations - cure rates around 75-85% depending on severity for both, watch long term side effects such as infertility, organ damage, and mental health issues - may metastisize interventions - phantom limb pain - chemo affects - monitor PT progress - prosthesis care - stress importance to follow up
brain tumors
patho - a tumor that arises from any cell within the cranium - life threatening even if non-cancerous s/s - increased head size and ICP - HA first thing in AM - vomiting (^ICP) - sluggish pupils, dilated, or unequal - weak hand grasp diagnostics - MRI, CT, LP, PET scan, brain tissue removal during surgery to diagnose type of tumor treatment - surgery - chemo - radiation - steroids (dexamethasone) - anticonvulsants (fosphenytoin and phenytoin) interventions - monitor for seizures - assess pupils, neuro checks, neuro status can change rapidly - elevate HOB 30 degrees - meds to prevent vomiting and ^ICP
wilm's tumor
patho - malignant renal tumor - peak age at diagnosis 2-5years - in small children large lump in abdomen may first be noticed by parents when dressing or bathing s/s - usually painless - hematuria, HTN, pain infrequent unless tumor ruptures - aniridia (absence of iris) - hemihypertrophy (increased size of half the body) - urinary defects treatment - radiation, chemo, surgery considerations - do not palpate the abdomen!! to prevent rupture of encapsulated tumor, spreads cancer cells
retinoblastoma
patho - malignant tumor of retina, noticed in infancy or early childhood - can be slow or fast growing s/s - leukocoria (cats eye reflex) whitish glow in the pupil noticed in flash photos - strabismus - red painful eyes - blindness treatment - removal of eye, fitted for prosthesis
rhabdomyosarcoma
patho - most common pediatric soft tissue sarcoma - starts in skeletal or smooth muscle cells - causes tumors all over but commonly in head/neck, GI, extremities, and trunk - important to assess all lesions - 5 year survival rate of 65% - most common in children<10 cause - unknown, genetic and environmental links diagnosis - biopsy treatment - surgery (complete removal) and chemo
treatment/considerations of leukemia
treatment - chemotherapy is most common, often followed by radiation - stem cell or bone marrow transplants (autologous or allogenic) considerations - assessment: vague complaints such as fatigue, limb pain, night sweats lack of appetite, HA, bleeding issues, and malaise - total treatment time around 2 years
bone tumor: ewing sarcoma
- 2nd most malignant bone tumor in children - can occur in any bone but most common in pelvis, thigh, upper arm, or ribs - cancer of primitive nerves found within bone, cartilage, or soft tissue) - can occur at any age, but most common in children/adolescents during rapid growth s/s - pain in the affected area that gets progressively worse - swelling and tenderness risk factors - more common in europeans, less common in africans or east asians
side effects of chemo and radiation
- NV (give antiemetics before and after) - anorexia, constipation, diarrhea, mouth ulcers (mouth care) - hair loss, may have different color and texture when grows back - neutropenia
causes of childhood cancer
- chemical carcinogens and drugs - radiation exposure - viruses - most of time unknown - increased risk with downs syndrome
common treatments of cancer in pediatric pts
- chemotherapy - surgery - radiation - stem cell transplantation - newer immunotherapy
medical emergencies to monitor for after chemo or radiation
- hemorrhagic cystitis - tumor lysis syndrome - septic shock
most common types of cancer
- leukemia (33%) - brain tumors (25%) - lymphomas (8%)
lymphomas
- malignant tumors or lymphocytes - represent about 1/4 of childhood cancers 2 types - non-hodgkins lymphoma - hodgkins lymphoma
bone tumor: osteosarcoma
- most common primary bone tumor in children - tumor of osteoblasts - usually found in long bones (common at metaphyses around knee) - mostly commonly seen in teens (15) s/s - bone pain, warm mass or lump that can be felt through skin, limping, limited movement, broken bone, fever
cancers unique to children
- neuroblastoma - wilms tumor - rhabdomyosarcoma - retinoblastoma
lymph nodes
- normally small, mobile, non-tender, not warm to touch - infectious process if quickly enlarging, warm, firm, reddened, tender - possibly cancerous if slowly enlarging, firm, non-tender
leukemia patho/cause/diagnosis
- proliferation of immature WBCs, these cells then compete with other body cells for space and nutrients leading to low RBCs and platelets - apoptosis: increased rate of cell growth and decreased cell death - most common type of cancer: acute lymphocytic leukemia cause - unknown - genetic links (identical twins and down syndrome) - exposure to radiation - treatment with anticancer agents diagnosis - microscopic exam of blood shows proliferation of immature leukocytes - bone marrow aspiration or biopsy (confirmation test) - lumbar puncture for presence of CNS disease and staging
6yr old female undergoing cancer treatment is at your office today to update her vaccinations for school. Due to he condition, which is the only vaccination the nurse can administer. A. Tdap B. LAIV C. MMR D. VAR
A
A 8yr old female undergoing treatment for A.L.L. is having her yearly physical. The nurse notices she has a puffy face and is below 5% on the growth charts. Which medication should the nurse suspect is contributing to the child's conditions? A. Prednisone B. Adriamycin C. Dactinomysin D. Blenoxane
A
A diagnosis of Hodgkin's disease is suspected in a 12-year-old child. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test result will confirm the diagnosis of Hodgkin's disease? a.Elevated vanillylmandelic acid urinary levels b.The presence of blast cells in the bone marrow c.The presence of Epstein-Barr virus in the blood d.The presence of Reed-Sternberg cells in the lymph nodes
A
The mother of a 4-year-old child tells the pediatric nurse that the child's abdomen seems to be swollen. During further assessment, the mother tells the nurse that the child is eating well and that the activity level of the child is unchanged. The nurse, suspecting the possibility of Wilms' tumor, should avoid which during the physical assessment? a. Palpating the abdomen for a mass b. Assessing the urine for the presence of hematuria c. Monitoring the temperature for the presence of fever d. Monitoring the blood pressure for the presence of hypertension
A
The pediatric nurse is aware that the peak age of onset for Acute Lymphocytic Leukemia is A. 3-5 years B. 10-12 years C. 3-5 months D. 12-14 years
A
The nurse provides a teaching session to the nursing staff regarding osteosarcoma. Which statement by a member of the nursing staff indicates a need for information? a."The femur is the most common site of this sarcoma." b."The child does not experience pain at the primary tumor site." c."Limping, if a weight-bearing limb is affected, is a clinical manifestation." d."The symptoms of the disease in the early stage are almost always attributed to normal growing pains."
B
----- must be given through a Port-a-cath, PICC, Hickman lines
Chemotherapy