cancer

Chapter 24: Nursing Care of the Child With an Alteration in Cellular Regulation/Hematologic or Neoplastic Disorder

Childhood Cancers Compared to Adult Cancers

• Factors Compared

  • Tissue Types Affected:

  • Child: Blood, lymph, brain, bone, kidney, muscle

  • Adult: Breast, lung, prostate, bowel, bladder

  • Most Common Sites:

  • Child: Blood, lymph, brain, bone, kidney, muscle

  • Adult: Breast, lung, prostate, bowel, bladder

  • Environmental Factors:

  • Child: Minimal influence

  • Adult: Strongly influences cancer development

  • Detection Methods:

  • Child: Usually accidental or incidental, very early detection possible

  • Adult: Often detected at later stages

  • Response to Treatment:

  • Child: Generally more responsive to treatment

  • Adult: Less responsive to treatment compared to children

Common Types of Childhood Cancers

• Blood Cancers:

  • Leukemias:

  • ALL (Acute Lymphoblastic Leukemia): Most common leukemia in children

  • AML (Acute Myelogenous Leukemia)

  • Lymphomas:

  • Hodgkin Disease

  • Non-Hodgkin Lymphoma

• Brain Cancers:

  • Medulloblastoma: Most common type of brain tumor in children

  • Brainstem Glioma

  • Ependymoma

  • Astrocytoma

• Other Types of Childhood Cancers:

  • Neuroblastoma

  • Osteosarcoma

  • Wilms Tumor

  • Rhabdomyosarcoma (can affect multiple sites)

  • Retinoblastoma

Common Medical Treatments

• Chemotherapy:

  • Mechanism: Chemical destruction disrupting the cell cycle systemically; affects both cancerous and normal cells that are rapidly dividing, including:

  • Bone marrow

  • Gastrointestinal tract

  • Reproductive tract

  • Hair follicles

Normal Hemogram Values

Table 24.1 Normal Hemogram Values

• WBC (White Blood Cell Count):

  • Birth - 2 weeks: 9.0-30.0 x10³/mm³

  • 2 - 8 weeks: 5.0-21.0 x10³/mm³

  • 2 - 6 months: 5.0-19.0 x10³/mm³

  • 6 months - 1 year: 5.0-19.0 x10³/mm³

  • 1 - 6 years: 5.0-19.0 x10³/mm³

  • 6 - 16 years: 4.8-10.8 x10³/mm³

  • 16 - 18 years: 4.8-10.8 x10³/mm³

  • >18 years (males): 5.0-10.0 x10³/mm³

  • >18 years (females): 5.0-10.0 x10³/mm³

• RBC (Red Blood Cell Count):

  • Age 2-6 months: 4.1-6.1 x10⁶/mm³

  • 1-6 years: 3.9-5.3 x10⁶/mm³

  • 6-16 years: 4.0-5.2 x10⁶/mm³

  • >18 years (males): 4.5-5.5 x10⁶/mm³

  • >18 years (females): 4.0-5.0 x10⁶/mm³

• Hgb (Hemoglobin):

  • Age 2-6 months: 9.9-14.5 g/dL

  • 1-6 years: 9.5-14.1 g/dL

  • 6-16 years: 10.3-14.9 g/dL

  • >18 years (males): 14.0-17.4 g/dL

  • >18 years (females): 12.0-16.0 g/dL

• Hct (Hematocrit):

  • Age 2-6 months: 20%

  • 1-6 years: 30%

  • 6-16 years: 32-42%

  • >18 years (males): 42-52%

  • >18 years (females): 36-48%

• MCV (Mean Corpuscular Volume) etc. (and other values follow this structure with specifics per age) (Table continues)

Short-Term and Long-Term Side Effects of Chemotherapy

• Short-Term Side Effects:

  • Nausea/Vomiting (N/V)

  • Oral Mucositis

  • Immunosuppression

  • Constipation

  • Alopecia (hair loss)

  • Neuropathy

  • Pain

• Long-Term Side Effects:

  • Changes in hearing and vision

  • Altered growth

  • Missing teeth

  • Precocious (early) or delayed puberty

  • Increased risk of adult cancers

Managing Side Effects of Chemotherapy

• Preventing Infection:

  • Emphasizing hygiene practices

  • Using a private room

  • Refraining from raw food and fresh flowers

  • Restricting visitors

  • Wearing a mask

  • Using a soft toothbrush

• Preventing Hemorrhage:

  • Assessing for signs of bruising

  • Avoiding rectal temperatures

  • Possible platelet transfusions

• Preventing Anemia:

  • Limiting blood draws

  • Administering erythropoietin as needed

• Managing Nausea/Vomiting & Anorexia:

  • Using antiemetics

  • Reducing light and sound disturbances

  • Encouraging relaxation

  • Addressing food aversions

Determining Body Surface Area (BSA)

• Importance: Used for calculating chemotherapy dosages

• Method: Utilizes height and weight to estimate BSA

• Nomograph: Visual tool to determine BSA based on height (cm) and weight (kg) (exact values and graphical representation needed)

Radiation Therapy

• Mechanism: Utilizes ionizing radiation delivered to a specific site of cancer, localized treatment

• Effects:

  • Affects both cancerous and normal cells

  • Can be curative, as an adjunct, or palliative

  • Goal includes shrinking tumor size before surgery

• Short-Term Side Effects:

  • Fatigue

  • N/V

  • Oral mucositis

  • Immunosuppression

  • Changes in skin integrity at treated sites

• Long-Term Side Effects:

  • Changes in hearing and vision

  • Altered growth patterns

  • Learning difficulties

  • Organ dysfunction

  • Changes in puberty onset

  • Risk of developing adult cancers

Hematopoietic Stem Cell Transplantation (HSCT)/Bone Marrow Transplant

• Pre-Transplant Phase:

  • Aims to destroy patient’s own bone marrow

  • Donor's bone marrow harvested and infused via IV into the patient

Short-Term and Long-Term Effects of HSCT/Bone Marrow Transplant

• Short-Term Effects:

  • Requires supportive care

  • Management of complications

• Long-Term Effects:

  • Risk of developing graft-versus-host disease (GVHD) which may present in stages from rash to desquamification (further descriptions could be explored)

Neoplastic Disorders: Goals of Care

• Promoting a Normal Life: Support psychological and social well-being

• Promoting Growth: Addressing growth impacts post-treatment

• Preventing/Treating Complications: Proactively managing side effects and potential complications

• Support: Comprehensive care addressing physical, emotional, and educational needs

Specific Childhood Cancers

• Leukemia:

  • Acute Lymphoblastic Leukemia (ALL):

  • Survival rate over 70%

  • Characterized by the bone marrow's overproduction of non-functional, immature WBCs

  • Results in infiltration of WBCs, leading to deficiency in mature WBCs, RBCs, and platelets

  • Treatment: Chemotherapy followed by bone marrow transplant

  • Assessment:

  • Diagnostics such as CBC

  • Management includes controlling pain, managing side effects, and monitoring for clinical signs (e.g., low-grade fever, bruising, vomiting, etc.)

• Acute Myelogenous Leukemia (AML):

  • Survival Rate: 50%

  • Characterized by malignant myeloblast cells in the bone marrow affecting maturity of hematopoietic cells

  • Treatment: Similar to ALL (Chemotherapy followed by bone marrow transplant)

• Neuroblastoma:

  • Description: Arises from embryonic neuro crest cells located in the chest, abdomen, or adrenal gland

  • Metastasis: Common to brain, bone, lung

  • Most commonly affects toddlers

  • Assessment/Management:

  • Abdominal mass

  • Treatment may include surgery, chemotherapy, and radiation

• Bone & Soft Tissue Tumors:

  • Osteosarcoma:

  • Arises from embryonic mesenchymal tissue typically found in long bones

  • Assessment/Management: Pain management, chemotherapy, potential limb amputation, and rehabilitation therapies (e.g., crutch walking)

  • Ewing’s Sarcoma:

  • Occurs in various bones including pelvis and long bones

  • Assessment/Management: Involves pain management and possible stem cell transplant if metastasis to bone marrow occurs

  • Rhabdomyosarcoma:

  • Arises from embryonic mesenchymal cells, highly malignant

  • Management: Involves chemotherapy and radiation, with surgical intervention based on location

• Wilms Tumor:

  • Description: Tumor of the kidneys, high survival rate

  • Assessment/Management: Such as abdominal mass, weight loss, and hypertension; treatment may require surgery and radiation

Conclusion

• While childhood cancers often present unique challenges, understanding their types, treatment options, and side effects is crucial for effective nursing care and supportive treatment planning. This comprehensive knowledge will support clinical practice and care strategies in pediatric oncology settings.