Bone/Soft Tissue Cancers and Arthritis

When does osteosarcoma typically occur?

during adolescent growth spurts (and more commonly in boys)

Where does osteosarcoma typically start?

long bones, closer to the joints (then metastasizes to lungs)

What is osteosarcoma typically mistaken as?

a sprain/strain that doesn’t heal

How is osteosarcoma treated?

chemo, then surgical limb removal, then more chemo

Nursing care for osteosarcoma

• pain management (incl. phantom limb pain)

• chemo management

• prepare the child for what to expect (e.g. limb removal, prosthetics)

Ewing sarcoma

bone cancer that starts in the bone marrow (typically closer to the center of the bone)

How does ewing sarcoma differentiate from osteosarcoma?

• pain located in middle of the bone (rather than near the joints)

• child feels sicker + needs longer hospital stays

• can relapse

How is ewing sarcoma treated?

chemo, then surgery, then chemo + radiation

Rhabdomyosarcoma

cancer in the muscle tissue, typically occurring around 6yo

What are the main sites to watch with rhabdomyosarcoma?

• head and neck - airway risk

• GU tract - incontinence or difficulty voiding

How is rhabdomyosarcoma treated?

surgery, chemo, and radiation

Education for radiation site care

• don’t wash off marks for radiation

• avoid sun exposure

• no lotions on the site

Nursing care for rhabdomyosarcoma

• pain management

• radiation site care

• watch I/Os (GI/GU issues) + airway

Juvenile idiopathic arthritis (JIA)

autoimmune, inflammatory joint disease

Pauciarticular JIA

4 or less joints affected

Polyarticular JIA

5 or more joints affected

Signs/symptoms of JIA

• worsening pain in the morning

• redness, swelling, and warmth around the joints

• joint stiffness + pain

Which labs are affected by JIA?

low Hgb/Hct and high ESR (inflammation)

Systemic s/s of JIA

• uveitis - eye inflammation

• intermittent fever w/ intermittent rash

TRUE or FALSE: JIA can be cured.

false; but it can sometimes go into remission as the child grows up

How is JIA treated?

supportive care (NSAIDS, steroids, DMARDS, exercise, and heat)

NSAIDS education

• used to decrease inflammation and pain

• risk of bleeding + stomach ulcers

Corticosteroid education

• used for immunosuppression + reducing swelling

• risk for glucose imbalance, weight gain, + infection/illness

DMARDS (e.g. methotrexate) education

• antirheumatic meds (given IV)

• girls are required to use two forms of birth control after starting their periods

Non-pharm methods to help with JIA

• exercise

• movement in the mornings!

• warm baths + compresses