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What is a neoplasm?
Any tumor that arises from new, abnormal cell growth.
What are the two ways that cancer spreads?
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.
What is tumor staging?
the extent of disease locally, regionally , and systemically and guides the therapy for most solid tumors.
What causes most childhood cancers?
Why is it difficult to diagnose cancer in children?
Symptoms resemble those of common childhood illness.
Overt cardnial signs of cancer in kids?
- A mass
- Weight loss
- Whitish reflex in the eye
- vomiting in early morning
- Recurrent or persistent fever
S/S that may convert in kid cancer?
- Bone pain
- Persistant lymphadenopathy
- Change in balance gait or personality
- fatiuge, malaise
What do the signs of cancer depend on?
- Location of the tumor
- extent of the disease
- and the childs age.
What is the second leading cause of death in children?
What are the most common cancers in kids
- brain tumors
How many kids will survive 5 years or longer after treatment?
8 out of 10
Even with successful treatment of cancer what may happen?
The disease may recur.
What is a second cancer likley a result from?
How do you treat cancer in kids?
- Stem Cell Transplant (HSCT)
What is chemotherapy?
the use of drugs (antineoplastic agents) to kill cancer cells.
Why are a varity of chemo drugs used?
Tumors possess teh ability to develop resistance to chemo agents.
How may chemo be given?
- intrathecally (through the spinal column)
What can happen if bone marrow is surpressed?
- The nadir occurs 7-14 days after chemo
What is the greatest concern with bone marrow suppresion?
What does neutropenia place the child with cancer at risk for?
Affects of chemo on the GI tract?
What is Alopecia?
What does radiation therapy do?
Slows the growth of tumors and kills rapidly dividing cell nonselectivly.
What can happen if radiation therapy is delivered to areas of growth potential such as facial, spinal or growth plates?
Bone growth is altered.
What does hematopoietic stem cell transplantation do?
Allows extremly high doses of chemo without radiation and without regard for bone marrow recovery because of hematopieseis will be restored through transplantation.
Where are bone marrow harvested from?
- Peripheral blood
- umbilical cord blood
- Bone marrow
What is the major problem associated with allogeneic transplants?
Graft-versus-host disease (GVHD)
What is leukemia?
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.
Pathophysiology of Leukemia?
- altered that prevents maturation
- as to type of WBC affected
- (abnormality of the lymphocyte)
- leukemia (ANLL) includes AML
Why do identical twins have high risks of getting leukemia one after the other?
The genetic basis of this disease.
S/S of Leukemia?
- Brusing bone
- joint pain
- abnormal WBC counts
- and mild to profound anemia and thrombcytopenis
What is the confirmatory test for leukemia?
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.
What is the goal of the first phase of chemo for leukemia?
Induction (to induce remission)
As WBC's break down from chemo what happens?
They release Uric acid and can compramise the kidney function leading to (tumor lysis syndrome)
What does a more than 5% of blast in the marrow on the 28th day of treatment indicate?
A poorer prognosis.
What phase follows induction in therapy for luekemia and what is its goal?
Consolidation the goal is to maintain remission and prevent disease in extramedullary sites such as the testes and CNS.
After the first two phases of treatment for leukemia what come next?
The maintenance phase, lower doses of chemo are given orally and Iv on a regular bases for 2-3 years.
Brain tumors are?
- most common solid tumor of childhood
- 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
The manifestations of brain tumors present how?
They vary with location and childs age and developement.
S/s of brain tumors in posterior fossa?
- poor coordination of upper extremities
- visual changes(nystagumus diplopia, strabismus)
- head tilt
- increased ICP
They are more intense on arising in the morning
s/s of supratentorial tumors?
- focal neuologic deficts
How do you diagnose a brain tumor?
- MRI- the most common.
What is the initial intervention for a child with brain tumor?
What is the goal of brain tumor surgery?
to remove as much of the tumor as possible while minimally disturbing the surrounding brain tissue so that the neruologic function is preserved.
Why is surgery not performed in cases of brainstem tumors or optic pathway glioma?
the risk of post operative neruolgic dysfunction outweighs the benefits of resection.
Why is a ventriculoperitoneal VP shunt inserted?
To relieve hydrocephalus an excessice accumulation of CSF int the ventricle of the brain.
What are kids with tumors located above the roof of the cerebellum at risk for?
What will more than half of kid survivors treated for Brain tumors develope?
Neurologic problems as a result of the tumor and its treatment of surgery, radiation, chemo.
What is the hallmark symptoms of children with brain tumors?
Headaches and morning vomit related to teh child getting out of bed. From the shift of ICP
Post surgery if the patient present with symptoms of ICP what does the nurse do?
- Notifies the physican and prepares the kid for evaluation MRI/CT scan
- and the kid should not be placed in the Trendelenburg position.
What are Malignant lymphomas?
Neoplasms of lymphoid cells a com
What are the two types of lymphomas?
How does non hodgikn differ from hodgkin?
in its clinical behavior pathologoy and mode of metastasis and responsiveness to therapy.
it has a rapid onset with widespread involvment at diagnosis.
S/s of non hodgkin?
- Abd disease
- abd cramping
- weight loss
- vomiting as a late sign
- enlarged lymph nodes in the cervical and axillary
If there is medistinal disease in non-hodgkin what symptoms do you see?
- resp distress
- tracheal deviation
Why do kids with Burkitt lymphoma need a catheter?
to measure output.
What is causes hodgkins disease?
- Unkown but possibly an infections agent
- epstein barr
S/s of hodgkins disease?
Painless, firm, movable adenopathy in the cervical and supraclavicular regions is the most common presentation
- airway obstruction
- drenching night sweats
- weight loss
What is hodgkin characterized by?
giant multinucleated cells called Reed-Sternberg cell athat are thought to represent activated B and T lymphocytes.
how does hodgkins spread?
from lymph nodes to nonnodal sites such as teh spleen liver bone, bone marrow lungs and mediastinum
In hodgkins the presence of B symptoms affects the prognosis how?
What is neuroblastoma?
- 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
How does neuroblastoma arise?
- 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.
S/S of neruoblastoma?
- 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
How many stages in the international neuroblastoma staging system?
What is osteosarcoma?
the most common bone malignancy in kids. the early symptoms are almost always attributed to extremity injury or normal growing pains.
When do incidence of osteosarcoma peak?
in the teenage years and is more common in males
Where does osteosarcoma originate?
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)
s/s of osteosarcoma
- pain at tumor site
- palpable mass
- limping (if a weight bearing limb is affected
- limited range of motion
- fractures at the tumor site.
in osteosrcoma where does it first metastis to?
in osteosarcoma how long is chemo given before surgery?
3 months. then resumes after surgery and cont for 9 months.
Is radiation therapy used in osteosarcoma?
only as palliative pain control in advanced stage. osteosarcoma is generally unresponsive to irradiation.
when a bone mass is identified what must the kid do?
Be non-weight bearing on the affected limb
What is Ewing sarcoma?
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)
what are characteristics of Ewing sarcoma?
none, but it invades the bone.
S/s of ewing sarcoma?
- soft tissue
- swelling around the affected bone
What bones can be removed in ewing sarcoma?
Ribs and proximal fibula.
What is Rhabdomyosarcoma?
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.
What is residual disease?
Tumor cells not removed by surgery.
What is wilms tumor?
the most common renal tumor in kids.
Where can Wilms Tumor occur?
in one or both kidneys, bilateral disease is more common in familial cases that in sporadic cases.
What is wilms tumor assocatied with?
- congential anoomalies
- aniridia (absence of the irises)
Where does Wilms tumor come from?
arisis from the renal paenchyma of the kidney
What must be avoided in wilms tumor before surgery?
Palpation or pressure on the tumor to prevent possible ruptrue and spillage of tumor cells into peritoneum.
What is retinoblastoma?
a rare malignant tumor of the embryonic nerual retina. this tumor of the eye is found only in children.
When do parents bring this disease to attention.
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.
Etiology of retionoblastoma?
a result froma sequence of genietic mutations. Mainley germline mutation.
When does the human eye reach maturation?
what can happen if retinoblaststoma diagnosis is delayed?
Tumors can spread down the optic nerve and spread to CNS sites outside the eye.
what the best means of diagnosing retinoblastoma
A funduscopic examinatin with the child under general anesthesia,
What is the goal of treatment in retinoblastoma?
save the childs life and preserve the eye with full vision.
If there is no chance of teh child will have full vision in the affected eye what happens?
Enucleation (removal of the eye) if it is done the child not require any further therapy and is monitored for tumor recurrence.
If the eye is enucleation what will the child have to do?
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.
Rare Tumors in Children
•Gonadal germ cell tumors
Kids with retinoblstoma can develope a second malignacy later in life which one is most common?
osteosarcoma because of genetic origin of the disease.
Slow growing cells forming a tumor with distinct borders?
Evidence of normal, disease-free tissue in the outermost layer of cells of a sugical sample?
Outside the bone marrow?
Weaking of the bodys normal immune response
With in the spinal colum
Abnormal cells that have invasive and unregulated growth?
Decrease in number of WBC's that results in reduced ability to fight infection?
Plan of research-based care outlining drug therapy and follow up interventions?
Reduction in platlet count?
Any tumor that arises from new, abnormal growth is called a _____?
The two ways that cancer cells are spread are____and____?
Invasion and metastisis
Why is staging done for tumors?
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>
T/F- the cause of most childhood cancers is unkown?
T/F- Screening tests for cancer in childhood are the same as adult cancer screening?
T/F-Cancer in children is a common occurrence?
T/F- symptoms of cancer in children resemble those of common childhood illnesses?
How is a child positioned for a bone marrow aspiration?
Prone with a small pillow under the hips to facilitate access to the posterior illiac crest
Identify the three primary treatment modalites for children with cancer?
Chemotherapy is the use of ______to kill cancer cells?
Identify the three body sytems whose cells are most often affected by chemotherapy?
- Hematopoietic system
- gastrointestinal tract
- Integumentary system
_____places the child with cancer at risk for the development of opportunistic infections?
How would a central venous catheter facilitate chemotherapy administration?
To provide easy IV access so that hte child does not have to undergo frequent venipunctures for IV access
Leukemia is caused by the proliferation of?
List five clinical manifestaions of leukemia?
- Excessive brusing
- bone or joint pain
- enlarged liver and spleen
- abnormal WBC count
Diagnostic tests that confirm a diagnosis of leukemia is?
Bone marrow aspiration and biopsy
The preferred treatment of leukemia is?
WHen is a child with acute lymphocytic leukemia considered to be in remission?
When immature blast cells in the bone marrow are reduced to less than 5%
List two sanctuary sites?
- Central nervous system
Why are rectal temps contraindicated for teh child with neutropenia?
A rectal thermometer can damafe delicate rectal tissue and cause abcesses
A child is at severe risk of infection when his or her absolute neutrophill level Is____?
WHat should the nurse teach the child with leukemia and his or her family about oral hygiene?
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
What action is indicated if an immunosuppressed child is exposed to someone with chickenpox?
Give the child varicella-zoster immune globulin within 96 hours.
What precautions should be taken for a child who is thrombocytopenic?
- 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?
Manifesstaions of brain tumors vary with _____and _____?
Tumor location and childs age and stage of develpment
What are the two hallmark symptoms of brain tumors in children?
- Vomiting in the morning after getting out of bed
Currently the imaging modality used to evaluate brain tumors is?
Which treatment modalities are used to treat brain tumors in children younger than 3 yrs?
T/F- The abdominal mass on a child with Wilms tumor should be palpated every shift for changes?
T/F- Treatment for tumor lysis syndrome includues allopurionl and hydration with IV fluids containing potassium.
T/F- The primary treatment modality for non-Hodgkin lymphoma is surgery?
T/F- Neuroblastoma is a solid tumor that is found in infants and children?
T/F-In most cases neuroblastoma manifests as a primary abdominal mass?
T/F-Ewing sarcoma is the most common primary bone malignancy in children?
T/F-tumors in Ewing sarcoma are sensative to radiation
T/F- Treatment of osteogenic sarcoma involves surgery and chemotherapy?
T/F- Leukocoria and strabismus are common findings in most cases of retinoblastoma?
Bone marrow transplantation is considered standard therapy for which childhood cancer?
acute myelocytic leukemia?
The most common side effect of radiation therapy is
Erythema at the radiation site
Which position is contraindicated for a child following surgery to remove a brain tumor?
When a child's own bone marrow is used in a bone marrow transplant it is called?
A child with neutropenia following a round of chemotherapy is receving a CSF. THe purpose of the CSF is to stimulate the production of?
A child has a history of fever of unknown origin excessive brusing and fatugue. This combination of symptoms is suggestive of which childhood cancer?
A diagnosis of leukemia is confirmed by which study?
Bone marrow biopsy
Which instruction would the nurse give to a 15- year old with a platelet count of 18000?
Use soft bristle toothbrush
What is teh best fluid choice for the child who is nauseated from chemotherapy?
Sips of cold soda
What should teh nurse tell an adolescent receiveing chemotherapy about alopecia?
YOur hair will grow back but it might be a diffrent color or texture
What should not be included in a plan of care for a child with Wilms tumor?
Palpate the abdominal mass for any changes
The prevention of tumor lysis syndrom includes?
Hydration and alkalinizing the urine.
What is the risk for infection if a childs absolute neutrophil count is less than 400 cells/mm
What is considered a hallmark symptom of brain tumor in children?