The child with cancer

Any tumor that arises from new, abnormal cell growth.

1. Invasion- in which cells grow in unrestriced disorderly fashion at the site of origin.

2. Metastasis- in which the cells grow in sites other thatn the site of primary cancer.

the extent of disease locally, regionally , and systemically and guides the therapy for most solid tumors.

Unknown.

Symptoms resemble those of common childhood illness.

• A mass
• Purpura
• Pallor
• Weight loss
• Whitish reflex in the eye
• vomiting in early morning
• Recurrent or persistent fever

• Bone pain
• Headache
• Persistant lymphadenopathy
• Change in balance gait or personality
• fatiuge, malaise

• Location of the tumor
• extent of the disease
• and the childs age.

Cancer

• Leuekemias
• brain tumors
• lymphomas

8 out of 10

The disease may recur.

inital treatment.

• Chemotherapy
• surgery
• Radiation
• Stem Cell Transplant (HSCT)

the use of drugs (antineoplastic agents) to kill cancer cells.

Tumors possess teh ability to develop resistance to chemo agents.

• Orally
• IV
• IM
• SubQ
• intrathecally (through the spinal column)

• Neutropenia
• anemia
• thrombcytopenia
• The nadir occurs 7-14 days after chemo

Infection.

opportunistic infections

• Nausa
• Vomiting
• anorexia
• stomatitis 
• constipation.

Hair loss

Slows the growth of tumors and kills rapidly dividing cell nonselectivly.

Bone growth is altered.

Allows extremly high doses of chemo without radiation and without regard for bone marrow recovery because of hematopieseis will be restored through transplantation.

• Peripheral blood 
• umbilical cord blood
• Bone marrow

Graft-versus-host disease (GVHD)

THe most common type of cancer in kids under 15 years. The cause of disease is an abnormal proliferation of immature WBC's which compete with normal cell for space and nutrients. Bone marrow is suppressed so very low numbers of RBC's and platlets may be seen in diagnosis.

• –WBC
• altered that prevents maturation

• –Anemia
• &
• thrombocytopenia

• –Classified
• as to type of WBC affected

• •ALL
• (abnormality of the lymphocyte)

• •Acute
• nonlymphocyctic
• leukemia (ANLL) includes AML

The genetic basis of this disease.

• Fever
• pallor
• excessive
• Brusing bone
• joint pain
• lymphadenopathy
• malaise 
• heptosplenomegaly
• abnormal WBC counts
• and mild to profound anemia and thrombcytopenis

Microscopic examination of bone marrow obtained by bone marrow aspiration or biopsy

A lumbar puncture can also be preformed to look for leukemic blast cell in the spinal fluid which are indicative of CNS involvement.

Induction (to induce remission)

They release Uric acid and can compramise the kidney function leading to (tumor lysis syndrome)

A poorer prognosis.

Consolidation the goal is to maintain remission and prevent disease in extramedullary sites such as the testes and CNS.

The maintenance phase, lower doses of chemo are given orally and Iv on a regular bases for 2-3 years.

• •The
• most common solid tumor of childhood

• •Most
• brain tumors in children are primary and rarely spread beyond the brain and
• spinal cord

• Are seen most often in children 5
• to 10 years

They vary with location and childs age and developement.

• Ataxia
• poor coordination of upper extremities
• visual changes(nystagumus diplopia, strabismus)
• head tilt
• increased ICP
• headaches
• vomitting
• lethargy 

They are more intense on arising in the morning

• Headaches
• seizuers
• focal neuologic deficts

• MRI- the most common.
• CT
• PET

Surgery.

to remove as much of the tumor as possible while minimally disturbing the surrounding brain tissue so that the neruologic function is preserved.

the risk of post operative neruolgic dysfunction outweighs the benefits of resection.

To relieve hydrocephalus an excessice accumulation of CSF int the ventricle of the brain.

Seizures

Neurologic problems as a result of the tumor and its treatment of surgery, radiation, chemo.

Headaches and morning vomit related to teh child getting out of bed. From the shift of ICP

• Notifies the physican and prepares the kid for evaluation MRI/CT scan 
• and the kid should not be placed in the Trendelenburg position.

Neoplasms of lymphoid cells a com

Non-hodgkin 

Hodgkin

in its clinical behavior pathologoy and mode of metastasis and responsiveness to therapy.  

it has a rapid onset with widespread involvment at diagnosis.

• Abd disease
• abd cramping
• constipation
• pain 
• anorexia
• weight loss
• ascites 
• obstruction
• vomiting as a late sign
• enlarged lymph nodes in the cervical and axillary

• Cough
• resp distress
• bronchitis
• tracheal deviation

to measure output.

• Unkown but possibly an infections agent 
• hepes
• epstein barr

Painless, firm, movable adenopathy in the cervical and supraclavicular regions is the most common presentation

• airway obstruction
• fever
• drenching night sweats
• weight loss 
• hepatosplenomegaly 
• fatigue

giant multinucleated cells called Reed-Sternberg cell athat are thought to represent activated B and T lymphocytes.

from lymph nodes to nonnodal sites such as teh spleen liver bone, bone marrow lungs and mediastinum

Negatively

• the most commonly diagnosed malignancy in infants and is only found in infants and children
• it is an embryonal cancer of the sympathertic nervous system.
• May have very aggressive tumors or tumors that regress by themselves

• from neural crest cells, which normally develop into the sympathetic nervous system and the adrenal medulla.
• Cells proliferate and begin to form a solid mass or tumor.  the tumor may infringe and infiltrate into adjacent nomal tissue and organs.

• depend on the extent of disease and the location of the tumor.
• abd mass
• protuberant firm abd 
• impaird range of montion and mobility
• pain and limping
• chest tumors my have cough
• decreased chest expansion with resp compramise

compresion of the super vena cava results in periorbital edema

Spinal cord compression may cause inabiltiy to walk and impaird bowel and bladder

• dark circles under eyes (raccoon eyes)
• dancing eye movement
• droopy eye lids.
• restless and uncomfortable

4,

the most common bone malignancy in kids. the early symptoms are almost always attributed to extremity injury or normal growing pains.

in the teenage years and is more common in males

bone producing cells that invade the nedullary canal of the bone and form a solid tumor.

• usually in the 
• distal femur 
• proximal tibia
• proximal humerus ( rapid growing bones)

• pain at tumor site
• palpable mass 
• limping (if a weight bearing limb is affected 
• limited range of motion 
• fractures at the tumor site.

The lungs.

3 months. then resumes after surgery and cont for 9 months.

only as palliative pain control in advanced stage.  osteosarcoma is generally unresponsive to irradiation.

Be non-weight bearing on the affected limb

the second most common bone tumor seen in children. The disease mimics infection and may be difficult to differntiate from other malignancies. it may also mainfest as a soft tissue. it can also be referred to as peripheral primitive neroectodermal tumor (PPNET)

none, but it invades the bone.

• pain 
• soft tissue
• swelling around the affected bone
• fever

Ribs and proximal fibula.

Malignacy of muscle or strited tissue that most often occurs periorbitally in the head and neck in younger children or in the trunk and extremities in older children.

Tumor cells not removed by surgery.

the most common renal tumor in kids.

in one or both kidneys, bilateral disease is more common in familial cases that in sporadic cases.

• congential anoomalies 
• aniridia (absence of the irises)
• Hemihypertrophy 
• cryptorchidism 
• hypospadias

arisis from the renal paenchyma of the kidney

Palpation or pressure on the tumor to prevent possible ruptrue and spillage of tumor cells into peritoneum.

a rare malignant tumor of the embryonic nerual retina. this tumor of the eye is found only in children.

when they look at a photograph and see a white reflection(leukocoria) in one of the childs eyes instead of the normal red color from the flash.

a result froma sequence of genietic mutations. Mainley germline mutation.

3 years.

Tumors can spread down the optic nerve and spread to CNS sites outside the eye.

A funduscopic examinatin with the child under general anesthesia,

save the childs life and preserve the eye with full vision.

Enucleation (removal of the eye) if it is done the child not require any further therapy and is monitored for tumor recurrence.

wear a patch over the socket for about a week, to preserve the shape of the orbit for prosthesis which will be fitted 5-6 weeks after surgery. a conformer is placed in the orbit.

•Liver

•Gonadal germ cell tumors

•Melanomas

•Lung cancer

osteosarcoma because of genetic origin of the disease.

Benign cells

Blast cells

Clean margins

Extramedullary.

Immunosuppression

Intrathecal

malignant cells

Neutropenia

Protocol

Thrombocytopenia

Neoplasm

Invasion and metastisis

Staging describe the extent of disease locally regionally and syteically and guides the therapy for most solid tumors.  Each tumor has its own specific system of staging wich assist in determing treatment and prognosis>

True

False

False

True

Prone with a small pillow under the hips to facilitate access to the posterior illiac crest

• Chemotherapy
• radiation
• surgery

Antineoplastic drugs

• Hematopoietic system
• gastrointestinal tract
• Integumentary system

Neutropenia

To provide easy IV access so that hte child does not have to undergo frequent venipunctures for IV access

Immature WBC's

• Fever  
• Pallor
• Excessive brusing
• bone or joint pain
• Malaise
• enlarged liver and spleen
• abnormal WBC count 
• Anemia
• Thrombocytopenia

Bone marrow aspiration and biopsy

Combination chemotherapy

When immature blast cells in the bone marrow are reduced to less than 5%

• Central nervous system 
• testes

A rectal thermometer can damafe delicate rectal tissue and cause abcesses

500 cells/mm

USe soft bristle toothbrush or toothettes. Perform oral hygined four times daily, if the platelet count is low usea a cotton-tipped applicator, finger cot or washcloth wrapped around a finger instead of a toothbrush, do not use mouthwash conatining alcohol notify doctor at first sign of mouth ulcers

Give the child varicella-zoster immune globulin within 96 hours.

• NO contact sports
• use soft bristled toothbrush
• give stool softners
• check urine and stools for blood
• avoid sharp foods
• teach how to control nosebleeds 
• Evaluate menstral flow in adolescent girls?

Tumor location and childs age and stage of develpment

• Headaches
• Vomiting in the morning after getting out of bed

MRI

• Surgery
• chemotherapy

False

False

False

True

True

False

true

True

True

acute myelocytic leukemia?

Erythema at the radiation site

Trendelenburg

Autologous transplant

WBC'S

Leukemia

Bone marrow biopsy

Use soft bristle toothbrush

Sips of cold soda

YOur hair will grow back but it might be a diffrent color or texture

Palpate the abdominal mass for any changes

Hydration and alkalinizing the urine.

Severe

Morning vomiting