Week 8: Oncology- Nervous System and Solid Tumors

What is the typical cause for adult cancers?

Most are preventable and arise from epithelial cells (organs)

What is the typical cause for pediatric cancers? What is not a cause of pedicatric cancer?

Most often arise from primitive embryonal and neuroectodermal tissues; lifestyle factors are not a cause of childhood cancers

Is pediatric or adult cancer more responsive to treatment?

Pediatric cancer is much more responsive to treatment

What are some of the causes of cancer in children?

Genetics, chromosome abnormalities, immunodeficiency

What are the cardinal symptoms for cancer in children?

Unusual mass or swelling, lymph nodes swollen for an unusually long period of time, unexplained paleness or energy loss, sudden tendency for easy bruising, refusing to walk, persistent and localized pain, prolonged and unexplained fever/illness, frequent headaches and vomiting, sudden eye changes, rapid weight loss

What are some tools and tests used to diagnose cancer?

Complete Hx, review of s/s, physical exam, labs, imaging, biopsy

What is the most definitive way to dx cancer?

Biopsy

What are modes of treatments and therapies for cancer?

Surgery, chemotherapy, radiation, bone marrow transplants

Do we use chemotherapy even if surgery was done to remove the cancerous tissues?

Yes, we use it even if we think we get it all, just to ensure that the cancerous tissues are gone or die

When is it deemed safe to use radiation therapy for cancer treatment in children?

>2yrs; it can interfere with brain development

Does chemotherapy pass through the blood brain barrier?

No

How do we give chemotherapy in children with brain cancer?

Give the chemo through a port that feeds into the brain or through a lumbar puncture

What are s/s of brain tumors?

Headache, vomiting, clumsiness, unsteady gait, blurred or double vision, head tilt, seizures, weakness, behavioral or personality changes, failure to thrive, irritability, VS changes

How do we diagnose a brain tumor?

Neuro assessment, imaging (MRI, CT, EEG), biopsy (lumbar puncture)

What does the treatment for brain tumors look like?

Depends on the type of tumor, surgery, radiotherapy (if >2yrs), chemotherapy, protocol

What is radiotherapy used for?

It helps to shrink the tumor and/or slow its growth so it is easier to remove in surgery and prolong life

What is a protocol?

An individualized treatment plan depending on the location, growth speed, type of cancer, and symptoms that the patient is experiencing

What are nursing interventions for a child post-op from surgically removing a brain tumor?

Positioning (midline, don’t let other parts of the brain shift into the hollowed area), reduce ICP, NPO, comfort measures, pain meds (but be careful not to mask LOC changes), eye care (typically can’t blink so provide lubrication)

What is the most common cancer in infancy?

Neuroblastoma

What does treatment look like for neuroblastoma?

Clinical staging to est. treatment plan, surgery to remove tumor and obtain biopsies, radiation, chemotherapy, bone marrow transplant, prognosis depends on location, if it has spread, and if it is removable

What are the two types of lymphoma?

Hodgkin’s and Non-Hodgkin’s

What is Hodgkin’s Lymphoma?

Cancer originating in the lymphoid system that often spreads to many other organs; presence of Reed-Sternberg Cells

What are s/s of Hodgkin’s lymphoma?

Painless, enlarged lymph nodes, fever, night sweats

What does treatment look like for Hodgkin’s lymphoma?

Radiation, chemotherapy (with or without radiation), HSCT (Hematopoietic Stem Cell Transplant), prognosis depends on stage, tumor bulk, and classification

What are some complications of Hodgkin’s Lymphoma?

Liver failure, secondary cancers, delayed puberty

What are nursing interventions for Hodgkin’s Lymphoma?

Significant pain in affected nodules following any alcohol consumption; teach adolescents to avoid alcohol consumption

What are complications of Non-Hodgkin’s lymphoma?

Metastasis, secondary cancers

What are s/s for Non-Hodgkin’s Lymphoma?

pain, lymph node swelling, diarrhea or constipation

What symptoms may signal mediastinal disease (emergency)?

Cough, dyspnea, orthopnea, facial edema, venous engorgement

What are the two types of bone tumors?

Osteosarcoma and Ewing sarcoma

When are children at the highest risk for bone tumors?

During accelerated growth rate of adolescence

What lab result would indicate a bone tumor?

Elevated alkaline phosphatase

Where are bone tumors typically found in the body?

Long bones such as the femur

What are s/s of osteosarcoma bone tumors?

Pain, limping, decreased ROM, refusing to walk

What are complications of bone tumors?

Metastasis (spreading) to other bones or the lungs, recurrence within 3yrs

What does treatment for osteosarcoma bone tumors look like?

Amputation of the affected area, resection of the bone with prosthetic replacement of the affected area, chemotherapy with surgical treatment

What are nursing interventions for bone tumors?

Pre-op preparation, support during adjustment to the concept of amputation or surgical resection, promote body image, pain management (phantom limb pain)

What are s/s of Ewing Sarcoma bone tumors?

Intermittent pain that progressively worsens, swelling and erythema at the site, systemic symptoms such as fever, spinal cord compression, and respiratory distress

What does treatment for Ewing Sarcoma bone tumors look like?

Radiation (1st approach), chemotherapy, surgical resection, avoid active play or weight bearing due to the high risk of fracture

What is rhabdomyosarcoma?

Highly malignant neoplasm that typically goes undiagnosed due to vague, nonspecific symptoms

What does treatment look like for rhabdomyosarcoma?

Complete removal of tumor if possible, radiation therapy, chemotherapy, long-term chemotherapy (1-2yrs), harvesting eggs and sperm in adolescents before treatment because the chemotherapy will make them nonviable

What is Wilms Tumor (Nephroblastoma)?

A malignant tumor that attaches to one or both kidneys

What are common s/s of Wilms tumor?

A healthy child with an abdominal mass (attached to the kidney)

What are the less common s/s of Wilms tumor?

Abdominal pain, malaise, anorexia, fever, blood in the urine, and hypertension

What is treatment for Wilms tumor?

Immediate nephrectomy (removal of the tumor and sometimes the kidney too), chemotherapy

What should be done if a Wilms tumor is suspected on palpation?

If suspected, get imaging immediately to confirm and do not let anyone else palpate the area due to the risk of rupturing the tumor

What are nursing interventions for Wilms tumor?

Handle and bathe carefully, monitor BP, monitor I&Os, be careful not to rupture the tumor

What are s/s of retinoblastoma?

Cat’s eye reflex (white reflex), strabismus, red/painful eye, blindness (late sign)

What is the treatment for retinoblastoma?

Removal of the affected eye and doing everything possible to protect the unaffected eye (sunglasses and safety goggles), chemotherapy

What are complications of retinoblastoma?

Spread to brain and opposite eye, metastasis (spreading) to lymph nodes, bone, bone marrow, and liver, secondary tumors

What are nursing interventions for retinoblastoma?

Post-op large pressure dressing and dressing changes, family support, protecting the vision in the unaffected eye, eye exams for siblings due to genetic link of the cancer

What is treatment for testicular tumors?

Orchiectomy (removal), chemotherapy and/or radiation

What are nursing interventions for testicular tumors?

Body image, teaching self-exams