Pedia 2 Module 5A: Responses to Malignancies in Children

Neoplasm

• “new growth” refer to a new abnormal growth that does not respond to normal-growth mechanisms

Leukemia

• the distorted and uncontrolled proliferation of WBCs

• the most frequently occurring type of cancer in children

Acute Lymphoblastic Leukemia

• malignant proliferation of lymphoblast due to disorder of single lymphoid stem cell & grows quickly

• most common among children

Acute Myelogenous Leukemia

• malignant disorder that affects monocytes, granulocytes, erythrocytes ad platelets

• incurable, but there are many effective treatment

Risk Factors of Leukemia

people are often affected by:

• radiation

• smoking

• chemotherapy

• Exposure to benzene

• Genetic predisposition

• Use of fertility drugs

• chromosomal abnormalities

• human T-cell leukemia virus type I (HTVL - I)

Signs and symptoms of leukemia

people with the following symptoms may have the disease

• swollen lymph nodes

• fever

• night sweats

• nose bleeds

• severe infections

• bleeding easily

• bone pain

• red spots on skin

• weight loss

Side effects of leukemia treatment

1. nausea and vomiting

2. stomatitis

3. alopecia

4. diarrhea

5. infections

Nursing management of leukemia

• small frequent, high calorie, high potassium, high protein diet

• foods should be easy to swallow

• frequent mouth care

• pleasant environment

• NGT, IV, Hyperalimentation

• soft tooth brushes

• frequent mouth care; oral salt mouth gargle

• avoid hot drinks or food; bland foods is best

• advise short hair before treatment

• gentle combing

• use wig or scarf when necessary

• low residue diet - high fiber diet

• increase fluids

• avoid hot or cold drinks and foods

• avoid uncontrolled crowds and sources of infection

• balanced diet

• skin care

3 phases in therapeutic management

1. induction phase

2. sanctuary or consolidation phase

3. maintenance phase

Induction phase

• to achieve complete remission or absence of leukemia cells

• 3-6 weeks or 1 month

sanctuary or consolidation phase

• to prevent leukemia cells from invading the CNS

• extended for 2-3 weeks

Maintenance phase

• administered for several years after diagnosis to sustain remission

Nephroblastoma (Wilm’s Tumor)

• rare type of kidney cancer

• most common intra abdominal and kidney tumor of childhood early life

Risk Factor of Nephroblastoma

people who have these traits are more common in:

• people of African descent

• children between 3 - 3.5 years old

• a genetic predisposition to Wilms’ Tumor in individuals with aniridia (lack of color in the iris)

Symptoms of Nephroblastoma

common signs of this disease are the following:

• Abdominal Pain

• Blood in the Urine

• Fever

• Loss of Appetite

• Lump in the abdomen and chest

• bone pain

• bruising around the eyes

Stage 1 Wilms Tumor

stage in Wilms Tumor wherein tumor is confined to the kidney and completely removed surgically

Stage 2 Wilms Tumor

stage in Wilms Tumor wherein tumor extending beyond the kidney but completely removed surgically

Stage 3 Wilms Tumor

stage in Wilms Tumor wherein there is a regional spread of disease beyond the kidney with residual abdominal disease postoperatively

Stage 4 Wilms Tumor

stage in Wilms Tumor wherein it metastases to the lung, liver, bone, distant lymph nodes, or other distant sites

Main Treatment for Wilms Tumor

this disease can be treated with the following procedures:

• Surgery

• Radiation Therapy

• Biologic Therapies

• Chemotherapy

Osteosarcoma

• 20% of all primary bone tumours typically occurs in young patients (10 Y/O - 20 Y/O) with 75% occuring before the age of 20

• usually develops around the hip, shoulder, or knee (lower end of the thighbone, and the upper end of the lower leg bone) where the bones are most actively growing (growth plates)

Primary Tumors

• originate in bone or from bone-derived cells and tissues

• most common locations: the distal femur and proximal tibia

Secondary Tumors

• originate in other sites and spread to the skeleton

Symes

amputation of the foot through the articulation of the ankle with removal of the malleoli

Hemipelvectomy

whole leg is removed with one half of the pelvis