Pediatric Cancers, death, dying

Incidence of Cancer in Childhood

Approximately 11,000 children under age 15 diagnosed annually
Under age 15, cancer is leading cause of disease-related death

Approximately 1,500 children die annually of cancer

Types of tumors vary by age and affect survival rate

Signs and Symptoms

Vary by type and location
Pain
Cachexia
Anemia
Infections
Bruising and petechiae
Neurologic symptoms
Palpable mass

Diagnostic Tests

• Complete blood count and differential

• Bone marrow aspiration

• Bone marrow biopsy

• Lumbar puncture

• Radiographic examination

• Magnetic resonance imaging (M R I)

• Computerized tomography (CT)

• Ultrasound

• Tumor biopsy

Surgery

Solid tumors (Wilms’ tumor)
remove or reduce solid tumor

Chemotherapy

• Protocols often involve a group of drugs that work in different modes
• Scheduled with breaks to allow normal cells to repair themselves while the cancer cells die

Radiation

• Breaks down DNA, destroying cells
• Usually local or regional
• Total dose is divided (fractionated) over several weeks. Ex: once daily for 4 days a week for 2-7 weeks

Biotherapy

• Biologics such as DNA, antibodies, vaccines
• Cytokines (interferons, GM-CSF...)
• Monoclonal antibodies
• Vaccines (i.e. HPV)
• Gene therapy

H S C T and BMT

• Allogenic or autologous
• Used for blood cancers, including leukemia and lymphoma, as well as solid organ cancers

Complementary therapies

• Can improve the care experience
• Symptom management
• Enhances patient and family’s resiliency and capacity to cope

End-of-life care

• symptomatic care (pain, dyspnea, nausea, fatigue)
• Best practice: palliative care team to coordinate

Nursing Management: infection control

• Altered immune system from cancer and cancer treatment
• Prevention
• Fever must be reported and investigated promptly
• Immunizations can resume after treatment, usually about 6 months

Nursing Management: pain

• Cancer AND treatment cause pain
• Assess
• 24-hour management

Nursing management: nutrition

• Cancer and treatment mean higher need for nutritional support
• N/V, anorexia common
• Antiemetics, tube feeds, TPN, lipids

Nursing management: growth and development

• Young children with cancer need regular developmental assessment
• Neurocognitive performance can be altered

Nursing management: psychosocial

• Body image amputation, scars, swelling in face, stretch marks from steroids, hair loss
• Stress and coping
• Support

Nursing management Side effect management

• Neutropenia
• Thrombocytopenia
• Chemo: n/v etc.
• Radiation: burns etc.

Solid Tumors

Brain and CNS 2nd most common malignancies in children, after leukemia
Neuroblastoma
Wilms tumor (kidney cancer)
(Also: medulloblastoma, cerebral astrocytoma, ependymoma, brainstem glioma)

Neuroblastoma

Most common cancer in infants, usually found in children aged 5y and younger

Starts in immature nerve cells outside the brain (often adrenal glands)
Common s/s:
- Dark circles under eyes, Bone pain, Bulging eyes, Lump in belly, neck, chest, Swollen stomach, Painless, blue lumps, under skin, Weakness

Treatment based on protocol, type and stage

- Surgical Watchful waiting Chemotherapy Radiation Stem cell transplant

Wilms tumor – Kidney Cancer

Any age can but kids under 5 years of age affected most
common symptoms
- palpable mass, pain and swelling in stomach, blood in urine
appetite loss, fever, headache, weight loss
Treatment based on stage
- Requires surgical removal, Radiation, Chemotherapy

Osteosarcomas

Most common tumor affecting the skeleton of children, most common in adolescents- Usually in long bones
Symptoms
- Swelling near a bone, Bone or joint pain, Bone injury or bone break for no clear reason

Treatment
- Surgery required, Chemotherapy, sometimes radiation

Blood-related cancers

Leukemias: cancers of white blood cells
- Acute lymphoblastic leukemia (ALL)
- Acute myeloid leukemia (AML)
- Chronic myeloid leukemia (CML)
Lymphomas: cancers of the lymphatic system
- Hodgkin lymphoma
- Non-Hodgkin lymphoma

Leukemia

• Most commonly diagnosed malignancy in children under 14y

• Cancer of blood-forming organs

• Proliferation of abnormal white blood cells

• Common symptoms

  • Fever Infections Easy bruising or bleeding

  • Pale skin Tiredness/weakness Bone pain Weight loss Swollen lymph nodes

Acute lymphoblastic leukemia (A L L) most common in children
Acute myelogenous leukemia (A M L) second most common in children

Retinoblastoma

• Cancer of the retina

• Heritable and non-heritable forms (most common)

• Symptoms

  • Pupil of the eye appears white instead of red when light shines into it, Pain or redness in the eye, Eyeball is larger than normal
    Iris and pupil look cloudy, Amblyopia, Poor vision

• Treatment

  • Radiation, Chemotherapy sometimes used, but often, ineffective, Focal therapy, Removal of eye if other treatment fails