Cancer peds

Cellular regulations

functions carried out within a cell

No way of preventing it.

Cancer prevention in pediatrics:

CancerM

Leading cause of death from disease in children 1 to 19 years old

Leukemia, followed by

• tumours involving the CNS

• Lymphomas

Most prevalent type of cancer in kids

Reserved for once the child is 5 years off of treatment

When can we say cancer is “cured”?

1. go back to pregnancy

2. up to date on immunizations?

3. growing appropriately with height and weight?

4. what brought you in

5. do physical

History to take for cancer in peds: [5]

WBC with differential

important blood work to get at first when assessing for cancer:

1. complete history

2. review of symptoms

3. physical examination

4. labratory tests

5. imaging studies

6. biopsy

Diagnostic evaluation for cancer in peds: [6]

1. clinical trials

2. state of the art therapy

3. Chemo and radiation, sometimes surgeriesCa

As part of the Children’s Oncology Group, patients and families get access to:

Leukemia

Cancer of the blood-forming cells that are abnormal and immature

If the patient is

• younger (1-9 YO)

• WBC count less than 50

When is prognosis for leukemia better? [2]

• primarily by specific blood cell lineage (lymphoid or myeloid)

• stage of maturity where there is a disruption in the cell development

How is leukemia classified? [2]

1. ALL (Acute lymphoblastic leukemia)

2. AML (acute myelogenous leukemia)

Two forms of leukemia that are generally identified:

Acute lymphoblastic leukemia (ALL), has a prognosis of 90% (as opposed to AML with 70%)

Leukemia with better prognosis

1. morphology (structure: L1, L2, L3)

2. Immunophenotyping (T or B lymphoid origin)

3. Cytogenetic analysis (Chromosomal number and structure identified, translocations, deletions, arrangements)

Subdivisions of ALL type of leukemia: [3]

Children with trisomy 21 have a 20 greater risk of developing ALL

Who has a greater risk of developing ALL?

Overproduction of WBCs in the blood-forming tissues of the body

Main patho of leukmemia:

takes place by infiltration and subsequent competition for metabolic elements

How does cellular destruction take place in leukemia?

1. fever

2. low blood counts

3. lymph node enlargeent

4. enlarged liver and spleen

S+S of leukemia come from what? [4]

1. neutropenia

2. more viruses and illnesses and infections (sick all the time)

If pt with leukemia has low WBC, going to see… :

1. anemia

2. fatigue

3. pale

if RBC count is low, going to see: [3]

1. bone pain

2. more fractures because bones are going to be weakened

S+S of leukemia associated with bone marrow:

1. increased intracranial pressure

2. headache

3. vomiting

4. off balance

5. seizures

6. very lethargic

If leukemia cells go to CNS, going to see:

1. biopsy

2. bone marrow aspiration

tests for definitive diagnosis of leukemia: [2]

Lumbar puncture (deaden the area, consciously sedate the child)

Test to check CNS involvement with leukemia:

1. bleeding

2. bruising

3. complaining of both

S+S of thrombocytopenia in kids [3]

1. anemia from decreased RBCs

2. infection from neutropenia

3. Bleeding tendencies from decreased platelet production

Consequences of leukemia [3]

Targets different cell cycles and want to get rid of the cancer all together

WHy are patients on more than one chemotherapy drug?

tarets rapidly dividing cells

Why do patients receiving chemo lose hair and get sores in the mouth?

Risk of cutting, risk of infection

Why won’t nurses shave child’s head?

They can fall out and get stuck in eye, make sure to rinse

important consideration of eyelashes for chemo

ulcers in mouth and through GI tract. If they don’t want to eat, they don’t have to. Relay all food pressures.

why might kids end up with feeding tube?

1. initial WBC count

2. age at time of diagnosis

3. Type of cell involved

4. sex of the child

5. karyotype analysis

Identified factors for determining prognosis of leukemia: [5]

1. oral

2. Central lines (NOT IV) because its harder on veins

How are chemo drugs administered?

Morphine infusion, not worried about them becoming addicted.

Pain management for ped patients getting chemo

prevent infection

1. isolate child

2. hand hygiene

3. private room (or room with someone with the same condition)

4. visitor restrictions

5. Avoiding crowds

6. Clean surfaces and toys

7. no live plants

8. no live vaccines (MMR)

precautions from low leukocytes: [8]

Depends on blood levels. Might have to get reimmunized afterwards.

What happens if patient with low WBC count is due for a live vaccine?

Transfusion (kids can tell you when they need a transfusion)

Treatment for low RBCs

1. NO IM injections

2. mouth care (soft bristle toothbrush)

3. no rough activities

precautions for low platelets: [3]

Excreting chemo drugs in pee and poop, can be irritated

Why no rectal temp for patients getting chemo?

1. weight gain

2. increased risk for infection

Steroid effect of chemotherapy: [2]

1. spleen

2. liver

3. bone marrow

4. lungs

Where can lymphoma metastasize often? [4]

Lymphoma

Cancer primarily of the lymph nodes:

Enlarged neck

Normally a patient with cancer in the cervical lymph nodes presents complaining of:

mediastinal mass

Lymphoma can metastasize and cause:

uSurvival rates vary according to stage of disease 85 – 95% for Stage I & II and 70-90% for stage III & IV

uStage I – 1 lymph node region

Survival rate for lymphoma

Two or more lymph node regions on same side of diaphragm

Lymphoma stage 2:

Multiple regions on both sides of the diaphragm

Lymphoma stage 3:

1. Class A: asymptomatic

2. Class B: lump with fever, night sweats, abdominal discomfort/cough

Two classes of Hodgkin’s disease:

• more frequently in children

• cell type is undifferentiated

• diffuse rather than nodular

• dissemination occurs early, often, and rapidly

• mediastinal involvement is more common

Things that make non-hodgkin’s lyphoma diferrent:

In bone marrow and thymus

Where are lymphocyte precursers for non-hodgkins

Non-Hodgkin’s Lymphoma

Malignancy of the lymphocyte precursors in bone marrow and thymus. Involvement of various areas of the body beyond the lymph nodes

1. abdomen

2. mediastinum

3. bone marrow

4. lungs

5. bones

6. brain

Non-Hodgkin’s Lymphoma can involves other areas such as: [6]

  -  small noncleaved - B cell  (<25% lymphoblasts in the bone marrow)

  -  Lymphoblastic -T cell

  -  Large cell – B cell, T cell, Indeterminant

Three types of non-hodgkin’s lymphoma:

1. lymph node biopsy

2. bone marrow aspiration

3. lumbar puncture

4. blood tests (to see if its in blood)

Definitive diagnosis of lymphoma

1. radiation to shrink tumours down

2. chemotherapy

Therapeutic treatment for lymphomaL

Mediastinal mass

Enlarged lymph node in the chest, big lump. can cause breathing issues.

1. prepare for procedures

2. explain treatment adverse effects

3. child and family support

Nursing care for therapeutic management of lymphoma: [3]

1. adrenal gland

2. retroperitoneal sympathetic chain

Where does neuroblastoma normally develop?

could burst it

Why shouldn’t palpate neuroblastoma

Metastasis may have already occurred before diagnosis is made.

Why can neuroblastoma be a “silent tumor”

•Prognosis for neuroblastoma is 75% for children under the age of 1 and less than 50% for children older

prognosis for neuroblastoma

•Staging for neuroblastoma goes from 1 for localized tumor only; to stage 4 with diffuse involvement of various organs including bone marrow and bone

Staging of neuroblastoma:

MIBG (metaiodobenzylgaunidine)

scan used to determine involvement of bone, bone marrow, and soft tissue (associated with neuroblastoma)

to locate the primary site and sites of metastasis

diagnostic objective for neuroblastoma:

depends on location and stage of disease

S+S of neuroblastoma depends on

Accurate clinical staging

what is required to establish a treatment plan for neuroblastoma?

1. surgery to remove tumour and obtain biopsy

2. radiation

3. chemotherapy

4. stem cell rescue

therapeutic management for neuroblastoma