neoplastic disorders oncology

Complications of Neoplasms

Bone Marrow Suppression

Nausea, Vomiting, & Not Wanting to Eat (Anorexia)

Bowel Problems

Alopecia (Hair Loss)

Mucositis (Mouth Sores / Dry Mouth)

Bone Marrow Suppression

• Bone marrow makes white blood cells, red blood cells, and platelets.

• Chemo can make it slow down 😴

• This causes:

  • Neutropenia = low infection fighters 🦠

  • Anemia = tired + pale 💤

  • Thrombocytopenia = easy bleeding/bruising 💜

Why it matters:

• If the child gets a fever above 37.8°C (100°F) → 🚨 EMERGENCY!

• Because they don’t have enough “soldiers” to fight germs.

What nurses do:

• Extra careful with germs 🧼🧴

• Limit visitors 🙅‍♂

• Avoid things that break the skin (shots, rectal temps) 💉

• Press on needle sites for 5 minutes so they don’t bleed ⏱

• Watch for headaches, fever, bone pain 👀

• Give meds to boost blood cells (filgrastim, epoetin) 💊

• Encourage rest 🛌

• Avoid aspirin/NSAIDs ❌

• Teach family good handwashing 🙌

 

Nausea, Vomiting, & Not Wanting to Eat (Anorexia)

What helps:

• Avoid strong smells 🔥🧅

• Small meals often 🍎🍞

• Give anti-nausea meds 💊

• Help the child choose foods they can handle 🍲

• Avoid making them eat foods they once liked → they might start to hate them 😣

• Some foods like high-fiber or lactose might upset their belly 🥛➡😩

🚽 3. Bowel Problems

Diarrhea 💨💩

• Radiation to the belly can make poop loose.

Constipation 🧱

• Some chemo slows the gut.

What helps:

• Healthy diet 🥦🍎

• Good skin care for bum 🧴

• Track intake & output 🧪

• Daily weights ⚖

Alopecia (Hair Loss)

Chemo can make hair fall out because hair cells grow fast and get hit by the treatment.

What helps:

• Happens with radiation to head/neck too

• Be gentle: mild shampoo 🧴

• Don’t use hot blow dryers or curling irons 🔥🚫

• Collect hair with a cap if needed 🎩

• Allow hats, wigs, scarves 🎀🧢

• Hair grows back in 3–6 months 🌱✨

Mucositis (Mouth Sores / Dry Mouth)

Chemo can make the mouth sore, dry, and irritated.

Signs:

• Painful mouth 😣

• Trouble eating/drinking 🥤

• Red sore spots 👄

What helps:

• Chlorhexidine mouthwash or saltwater rinses 🧂

• Soft toothbrush & swabs 🪥

• Keep lips moisturized 💋

• Give pain medicine as needed 💊

• Eat soft, bland foods 🍌🍜

• Avoid hydrogen peroxide & lemon glycerin swabs 🚫🍋

🧬 What Is Leukemia?

• It’s a cancer of the blood 💉

• "Leuk" = white.

• Leukemia = cancer of the white blood cells ⚪🦠

• It’s the most common cancer in kids 🧒⭐

When it usually shows up:

• Around 2–5 years old 🎈

 

🧫 What Happens in the Body?

Leukemia affects the bone marrow, which is the “blood factory” inside your bones 🏭🦴

The problem:

• The bone marrow makes too many baby WBCs (leukoblasts) 👶⚪

• These don’t work right and crowd out the good cells.

So the child has:

• Low red blood cells → anemia → tired 🥱

• Low platelets → bleeding/bruising easily 💜

• Low mature WBCs → infections 🦠😷

🔍 How Do Doctors Check for Leukemia?

🧪 Labs

• CBC to look at:

  • Anemia (low RBCs) 😴

  • Thrombocytopenia (low platelets) 💥

  • Neutropenia (low infection fighters)

  • Blood smear for blasts 🔬

  • Liver & kidney function

  • Baseline labs before chemo

🔬 THE Big Test:

• Bone Marrow Biopsy → the BEST way to diagnose leukemia 🥇🦴

🧠 If worried about CNS involvement:

• Lumbar puncture → checks if cancer cells reached spinal fluid

Leukemia Manifesations

Early Signs:

• Headache 🤕

• Fatigue 🥱

• Not wanting to eat 🍽

• Pale skin 🤍

• Low-grade fever 🤒

• Not playful/listless 😔

• Constipation 🚫💩

• Big liver, joints, or lymph nodes 🤰

• Vomiting 🤢

• Wobbly/unsteady walking 🚶‍♂😵

Later Signs:

• Pain 😣

• Mouth sores 👄

• Increased bruising/petechiae 💜

• Enlarged kidneys & testicles 🙈

• Signs of increased ICP (head pressure) 😵

• Blood in urine 🚨

Leukemia treatment

1⃣ Chemotherapy

• Given through a central line

• Watch for nausea/vomiting 🤢

• Prevent further myelosuppression

• Has 3 phases (induction, consolidation, maintenance)

2⃣ Radiation

3⃣ Stem Cell Transplant (HSCT)

• For some cases when chemo isn’t enough

4⃣ Support Services

• Social work 🧑‍⚕

• Dietitian 🍎

• Mental health support 💚

🧬 Stem Cell Transplant (More Details)

• Donor cells come from another person 🧑➡🧒

• Used for:

  • AML in first remission

  • ALL in second remission

What happens:

• Give high-dose chemo + radiation

• Then give donor cells through IV 💉

Strict Safety Rules After Transplant

Because the immune system is VERY weak:

• Protective isolation 🚧

• Private room 🛏

• Positive-pressure airflow ➡

• 12 air exchanges per hour 🍃

• HEPA-filtered incoming air 🌬

• NO real flowers, plants, fresh fruit 🌷🚫

• Wear N95, gowns, gloves 😷🧤

 

⚠ Complications

• Kidney problems 🩺

• Testicular involvement

• Infection 🦠

• Anemia 😴

• CNS effects: hydrocephalus, seizures ⚡

• Blindness 👁

• Hemorrhage 💔

🩺 What Is Neuroblastoma?

Neuroblastoma is a tumor that grows from nerve cells 🧠⚡

It often starts in the adrenal gland (a little “hat” on top of the kidney) 👒🟡

Who gets it?

• Mostly toddlers 👶

• 95% of cases happen before age 10 🎈

Why it’s tricky:

• Half of kids don’t show big symptoms at first 😐

• Symptoms depend on where the tumor is (head, neck, chest, pelvis, abdomen)

🏥 Treatment

• Surgery to remove the tumor 🔪

• Chemo and/or radiation if cancer has spread ☢💊

 

Neuroblastoma Manifesations

Depends on where tumor grows:

• Ill appearance 🤒

• Swelling/bruising around eyes (periorbital ecchymosis) → “raccoon eyes” 🦝

• Eyes bulging out (proptosis) 👀

• Weight loss 🪶

• Bone pain 😣

• Irritability 😠

• Pelvic/abdominal mass (hard tummy bump)

• Metastasis common → can spread to bone, liver, skin, lymph nodes 🧬

Neuroblastoma testing

📊 Labs:

• CBC

• Coagulation studies

• Urine catecholamines (these are high in neuroblastoma) ⚗

📸 Imaging:

• CT scans

• Skeletal survey (checks bones)

• Inferior venacavogram → checks if tumor is squeezing big blood vessels 🩸

• Bone marrow aspiration → checks if cancer spread to bone marrow

• MIBG scan → special scan that sticks to neuroblastoma cells ✨

• Biopsy → final confirmation 🧪🦴

Neuroblastoma complications

• Metastasis 🧬

• Kidney failure 🚫🩺

• Pancytopenia (low RBCs, WBCs, platelets) 🩸⬇

• Bone marrow depression 🦴😴

• Anorexia, nausea, vomiting 🤢

• Constipation or diarrhea 🚽

• Mucositis & dry mouth 👄🔥

• Alopecia 🧑‍🦲

Neuroblastoma 👩‍⚕ Nursing Care

Handle with care:

• Be VERY gentle when bathing or moving the child → tumor sites can hurt easily 🛁🤲

Emotional & developmental support:

• Support coping for child + family 💛

• Watch for developmental delays ⏳

• Provide play appropriate for age 🎨🧸

Physical monitoring:

• Check weight daily ⚖

• Keep skin clean & dry 🧼

• Oral hygiene 🦷

• Give antibiotics as ordered 💊

Education:

• Teach the family about scans, treatments, and the plan 🧠📘

BIG SAFETY WARNING:

• Monitor for infection

• FEVER = MEDICAL EMERGENCY 🚨🔥🩺

Family support:

• No false promises — listen and support ❤

• Allow time to discuss grief, fears, emotions 🫂💬

🧪 Chemotherapy Basics

• Kids can have a special IV line (like a central line or PICC) so they don’t get poked all the time 💉

• They get different combinations of chemo meds — nurses handle them VERY carefully ⚠

• Give anti-nausea medicine before chemo 🤢➡💊

• Let the child eat their favorite foods 😋 unless they cause nausea

• Watch the mouth for sores 👄

• Give cool drinks to soothe sore mouths 🧊

• Expect side effects:

  • Mouth sores 😣

  • No appetite 🍽

  • Nausea/vomiting 🤮

  • Hair loss 🧑‍🦲

  • Diarrhea or constipation 🚽

  • Easy bruising/bleeding 💜

  • Fatigue 🥱

  • High infection risk 🦠

• They still need vaccines and follow-up appointments 💉📅

• ALWAYS practice good infection control 🧼

FEVER = MEDICAL EMERGENCY!!!

Because their immune system is VERY weak.

100.3F or higher

Neutropenic precautions:

• Wash hands well 🙌

• Avoid fresh fruit, flowers, dirt, and crowds 🌸🚫

• Reverse isolation (protect the child from germs) 😷

• Monitor ANC (absolute neutrophil count) 📉

🔍 Causes of Cancer

• Unknown in most cases ❓

• Sometimes linked to:

  • Peak growth periods 📈

  • Environmental exposures 🌎

  • Electromagnetic fields 🔌

  • Chemicals 🧪

  • Pesticides 🐜

  • Viruses 🦠

 

🧬 Risk Factors for cancer

• Genetic problems 🧬

• Down Syndrome

• Family history of leukemia 👨‍👩‍👧

• Retinoblastoma gene mutation 👁

• Immune problems (immunodeficiency) 🛡

• Past cancer or cancer treatments 🎗

• Congenital conditions

☢ Radiation Therapy

Radiation is like a super strong beam of energy that kills cancer cells 🔦💥

Important facts:

• Radiation is given in special doses over several weeks 📆

• It attacks fast-growing cells (not just cancer — also skin, hair, GI cells) 🌱

• Kids must wear lead aprons to protect other parts of their body 🛡

Skin Care:

• Do NOT wash off the marker lines used for the radiation target ✏🚫

• Wash skin with lukewarm water 🛁

• Pat dry, don’t rub 🙅‍♀

• Avoid:

  • Hot/cold water

  • Soaps, creams, lotions unless prescribed

• Wear loose cotton clothing 👕

• Protect skin from the sun 🌞🧢

• If you see blisters, weeping, redness → call provider 🚨