Cancer, Hematology, and Immune

What is Wilms tumor?

it is nephroblastoma

• malignant cancer cells form in the tissues of the kidney

Does Wilms tumor have a favorable prognosis?

it does have a favorable prognosis

What are the signs and symptoms of Wilms tumor?

• firm, non-tender unilateral abdominal pain

• hematuria

• hypertension

What is important for the nurse NOT to do with Wilm's tumor?

do not palpate the mass

• it could cause the cancer cells to spread

What is the treatment for Wilm's tumor?

• surgery pretty quickly within 24 to 48 hrs

• 6 weeks of chemo after surgery 

What is a cancer cell?

it is a cell that avoids apoptosis (cell death) and continuous to copy and take up nutrients your body needs

What is chemotherapy treatment?

it is a systemic and cytotoxic to all rapidly diving cells so this kills both healthy can cancer cells

Which cells does chemotherapy affect>

it affects the fast growing cells like hair follicles, skin, nails etc

How is chemotherapy administered?

• IT

• IM

• IV

• Sub q

• PO

What is radiation treatment?

it has the ability to target solid tumors

How does radiation treatment differ from chemotherapy? 

radiation is more targeted  avoids healthy cells and only damages cell genes that multiply and replicate

What is a concern for radiation treatment?

you have to go through the skin, so skin integrity/breakdown becomes a concern

How is surgery used for cancer treatment?

• it is really used to remove the tumor burden or take it out; however, it needs to be a tumor that is accessible

• can also be used to stage the caner and diagnose

What are the common side effects and the respective treatments for chemotherapy?

• n/v

  - antiemetics (zofran, scopolamine, monitor electrolytes

• anorexia

  - let them eat anything they want (least invasive to most invasive)

• malnutrition

• rectal ulcers

  - no cancer kid will get a rectal temp

• mucositis ((inflamed mucus membrane)                                           -prevent with mouthwash

• neuropathy

  - neuropathy is a bad side effect of Vincristine, so we will give these kids gabapentin

• alopecia

  - body image, make this as less traumatic as possible (let them dye their hair pink)

• sterility

  - have a conversation with parents about egg preservation and sperm banking b/c it will be harder to have babies

What are the side effects of steroids?

• weight gain

• puffiness

• mood changes

• difficulty sleeping

• hyperglycemia

What is the biggest issue with radiation?

radiation burns leading to compromised skin integrity

What is common with biotherapy that we should be on the lookout for?

we should lookout for transfusion reactions, so the first thing we want to do is STOP it

Why are frequent lumbar punctures performed on cancer kids?

they are preformed to help determine severity and progression of the disease

What is phantom pain?

it is pain in a missing limb and the nerve ending is still there

Do phantom pains go away? 

this can be very traumatic for the child and will go away eventually, but just remember age-appropriate techniques (dolls, central lines, etc)

What are bone marrow transplants (BMT's) used for?

• cancer relapses

• neuroblastoma

• sickle cell

• CNS or brain tumors

• severe combined immunodeficiency syndrome (SCIDS)

What is severe combined immunodeficiency syndrome (SCIDS)?

they basically have no immune system and extreme risk for infection (these are bubble children)

What might children with severe combined immunodeficiency syndrome (SCIDS) be on?

• prophylactic abx

• clean environment

• treat with bone marrow transplant 

What is the number one risk for kids who receive a bone marrow transplant? 

they are at a risk for infection 

What are education points for cancer patients?

• nothing up the rectum

• no NSAIDS

• be compliant with home medications

• be aware of chemo side effects

What is hyperleukocytosis?

• WBC >100,000

• associated with leukemia, the wbc's get out of control, clump together, and turn blood into the sludge

What are the signs and symptoms of hyperleukocytosis?

• agitated

• restless

• SOB

• blurry vision

• mental status changes

What is the priority treatment for hyperleukocytosis?

• hyper hydration, flood the system with fluid

• strict I&O

• daily weight

• neuro checks

• chemotherapy 

What is acute tumor lysis syndrome (ATLS)?

it is when malignant cancer cells explode, releasing all the bad stuff into the body from the cell

What can acute tumor lysis syndrome (ATLS) eventually lead to? 

it can eventually lead to acute kidney injury

What lab values increase due to acute tumor lysis syndrome (ATLS)?

• uric acid increases

• K+ increases

• phosphorus increases

How can acute tumor lysis syndrome (ATLS) be prevented?

• hyper hydrate prior to chemo

• allopurinol 24hrs before chemo starts

When are children most at risk for acute tumor lysis syndrome (ATLS)?

children are most at risk right before chemo and up to 14 days after chemo has started

What is neutropenia?

it is decrease in neutrophils

What are children with neutropenia at high risk for? 

since neutrophils are the first line of defense, children are high risk for infection and sepsis are 

What might be the only sign of sepsis in a kid with neutropenia?

a fever of 100.4 or above is a sign of sepsis 

What is the point of a fever card?

• children with neutropenia are brought the ER if they present with a fever (100.4)

• the fever cards allow them to bypass the waiting room and go straight into a room

What is treatment for fever with neutropenia?

• cefapine within 1 hr of getting to the ER

• watch for signs of sepsis

• culture from central line

• tylenol to bring fever down once it is documented (no giving tylenol and see what happens, educate parents if they get a fever, bring to ER)

What two things are prohibited in children with neutropenia?

• no NSAIDS

• no IV sticks b/c they won't be able to heal from them and become an infection risk

What is superior vena cava syndrome?

it occurs when tumors compress or invade the vena cava causing decreased blood return to the heart

What are the 3 D's of superior vena cava syndrome?

• dyspnea

• distention

• dilated chest well veins

What should we do with patients that have superior vena cava syndrome?

• treat the cause

• elevate the head of bed to help with breathing effort 

• NEVER sedate them

What is syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

it involves excessive release of antidiuretic hormone

• SOAKED INSIDE

What are the signs and symptoms of syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

• fluid retention

• edema

• increased urine osmolarity (concentration)

• hyponatremia

What are the treatments for syndrome of inappropriate antidiuretic hormone secretion (SIADH)?

• fluid restriction

• strict I&O

• hypertonic IV fluids

• steroids

• increase Na intake

• increase protein intake