peds exam 3 (cancer)

retinoblastoma

• Most common sign is leukokoria (white spot)

• Second most common sign is acquired strabismus

• has to be taken care of right away bc its an intraocular tumor

strabismus

eyes do not line up together and point in different directions

tx of retinoblastoma

• Enucleation

• Irradiation and chemotherapy (vincristine, carboplatin,

etoposide)

• Intrathecal chemotherapy if CNS involvement

tx of retinoblastoma: enucleation

removes your entire eyeball while leaving your eye muscles and eyelids in place

leukemia

Group of malignant diseases of the bone marrow

and lymphatic system

types of leukemia

• Acute lymphoid leukemia (ALL) (most common)

• acute Myelogenous leukemia(AML)

organs most severly affected by leukemia

spleen and liver

CBC w leukemia

• low WBC (leukemia)

• elevated immature cells (blasts)

• anemia

• thrombocytopenia

3 main consequences of leukemia

• Anemia

• Infection (bc of low WBC)

• Bleeding (bc of thrombocytopenia)

• weak bones and possible fractures may also happen

tx for leukemia

chemo

• We intend to depress immune system to stop growth of cancer 

SE of chemo

• Alopecia 

• N/V 

• Stomatitis (ulcers in mouth) 

• Secondary cancer 

• Cardiomegaly (bigger heart) 

• Neurodevelopmental complications 

TM for stomatitis from chemo

• May not want to eat so we can give mouth wash to numb mouth (magic mouthwash)

• give soft food, no spicy or acidic food

• NG feeds at night

• zofran or aldesterone

• steroids (bc it increases appetite) 

therapeutic management when taking chemo

• steroids to increase appetite

• antiemetic (zofran)

*all bc of chemo*

Absolute neutrophil count

shows how well kid can treat infections

normal #: >1500

Absolute neutrophil count equation

ANC in cancer pts

>500= can go to school

<500= no school

ways that immunocomp pts can still go out

AMC will have a showing by themselves for immunocompromised kids 

radiation

usually in rays

education for radiation

• skin care (steroid cream) 

• Skin may be sensitive to sun (not a lot of time in sun), heat, and cold 

• Wear soft loose clothes 

Wilms tumor

nephroblastoma (kidney tumor)

s/s of Wilms tumor

painless abdominal swelling or mass that is firm, nontender, and confined to one side

tx of wilms tumor

• Surgery within 24-48 hours after confirmation of mass to remove involved structures

• Radiation or chemotherapy before surgery if both kidneys involved

• Radiation and chemotherapy for 6-15 months after surgery

nursing care of wilms tumor

• Do not palpate abdomen unless necessary

• Careful bathing and handling

s/s of bone tumors

• child limps

• decreased physical activity,

• unable to hold heavy objects

osteosarcoma

lesions most commonly located in the metaphyseal region of bones, often the long bones

tx of osteosarcoma

• Limb salvage or amputation

• Chemotherapy

Ewing sarcoma

involves the diaphysis with detachment of the periosteum from the bone (Codman triangle)

dx of ewing sarcoma

bone marrow aspiration

bone marrow aspiration

• Needle thru bone to hallow part and aspirate some marrow 

• Usually done in iliac crest 

• Looks for blast cells (normal <5% blast cells) (>5%= cancer) 

• Office procedure, not admitted 

tx for ewing sarcoma

• involved field radiotherapy

• Chemotherapy

s/s of brain tumors

• Head may get bigger faster than anticipated if sutures haven't fused 

• Increased ICP if sutures have closed 

• Risk for dysphagia 

therapeutic management of brain tumors

• Surgery

• Radiation

• Chemotherapy

things to look as after brain tumor therapy

neuro checks

neuroblastoma

• Evolves from neuro crest in abdomen (chest tumor) 

• Silent tumor (usually see metastasis first) 

Therapeutic management of neuroblastoma

• Surgery (remove as much of tumor as can and

biopsy)

• Irradiation (except with intraspinal tumors)

• Chemotherapy

• Bone marrow transplantation

• Stem cell rescue

what will we see in neuroblastoma urine

ketones bc cathecholamines is detected

how can we see metastasis

PET scan

• looks for glucose uptake

hodgkin lymphoma ages

• Adolescence and young adult

• increase between 15-19 years

hodgkin lymphoma

• Originates in the lymphoid system and primarily involves the lymph nodes

• Metastasizes to non-nodal or extra-lymphatic sites, especially the spleen, liver, bone marrow, mediastinum, and lungs

• Long-term survival for all stages is excellent

Ann Arbor Staging system of hodgkin lymphoma

Based on the number of sites of lymph nodes

involved, presence of extranodal disease, and

history of any symptoms

• stages by A or B

symptoms in Hodgkin lymphoma used in Ann Arbor staging

• A= asymptomatic

• B=

  • Temperature 100.4 F or higher for 3 consecutive days

  • Drenching night sweats

  • Unexplained loss of body weight (≥ 10%) over the preceding 6 mos

non-specific symptoms of kodgkins lymphoma

• Most common presentation is asymptomatic enlarged

  cervical or supraclavicular lymphadenopathy

• fatigue

• anorexia

• mild to severe pruritus

• slight weight loss

dx of hodgkin lymphoma

•Chest x-ray (CXR)

•Computed tomography (CT) of neck and chest

•CT and magnetic resonance imaging (MRI) of

abdomen and pelvis

•Positron emission tomography (PET) to identify

metastasis

•Lymph node biopsy for histologic diagnosis and

staging

dx of hodgkin lymphoma: Lymph node biopsy for histologic diagnosis and staging

Reed-Sternberg cells

Therapeutic management of hodgkin lymphoma

• Radiation

• chemo

• Prophylactic antibiotics (if splenic irradiation)

• Immunization against pneumococci and meningococci

nonhodgkin lymphoma ages

Children < 14 years

non-hodgkin lymphoma

•Occurs more frequently in children than HL

•Usually diffuse rather than nodular

•Undifferentiated or poorly differentiated cells

•Mediastinal involvement and invasion of meninges are

common

non-hodgkin lymphoma is staged using

• Surgical biopsy of an enlarged node

• Histopathologic confirmation with immunophenotyping and cytogenetic evaluation

• Bone marrow examination

• Radiographic studies (especially CT scans of lungs and GI organs)

• Lumbar puncture

therapuetic management of non-hodgkin lymphoma

•Aggressive chemotherapy and irradiation

•Chemotherapy is the main component of

treatment

•Protocols include induction, consolidation,

maintenance, and sometimes intrathecal

chemotherapy

Rhabdomyosarcoma 

• Striated muscle anywhere in body

• Arises from embryonic mesenchyme in muscles, tendons, bursae, and fascia or in fibrous, connective, lymphatic, or vascular tissue

s/s of Rhabdomyosarcoma 

vague and frequently suggest a common childhood illness

dx of rhabdomyosarcoma

• PET/CT or MRI

• bone scan

• bilateral bone marrow aspiration and biopsy

• LP if parameningeal involvement

staging of rhabdomyosarcoma

• Group I: localized disease, tumor resected, no node

involvement

• Group II: localized disease with residual tumor and

node involvement

• Group III: incomplete resection with gross residual

disease

• Group IV: Metastatic disease present at diagnosis

therapeutic management of rhabdomyosarcoma

• Chemotherapy (about 1 year)

• irradiation