NUR 232 Cancer Week 10 Student view

Week 10: Cellular Regulation

  • Focus on childhood cancers:

    • Ewing's Sarcoma

    • Osteosarcoma

    • Hodgkin's Lymphoma

    • Leukemia

    • Wilm's Tumor

    • Cure for Childhood Cancer initiatives

Cellular Regulation

  • Scope:

    • Proliferation: Production of new cells through growth and division.

    • Differentiation: Process where less specialized cells become more specialized.

Physiologic Consequences

  • Normal Cellular Growth and Reproduction:

    • Replication and Differentiation.

  • Abnormal Growth and Reproduction:

    • Benign Neoplasm: Non-cancerous growth.

    • Malignant Neoplasm: Cancerous growth that invades surrounding tissues.

Cellular Regulation Risk Factors

  • Age: Risk increases with older age.

  • Smoking: Tobacco exposure raises cancer risk.

  • Infectious agents: Exposure can lead to certain cancers.

  • Radiation: UV and ionizing radiation can cause mutations.

  • Nutrition and Activity: Poor diet and lack of exercise affect health.

  • Carcinogens: Chemicals that promote the formation of cancer.

  • Racial/Socioeconomic Disparities: Access to healthcare and resources vary.

  • Genetics: Family history increases risk.

Assessment

  • Methods:

    • History: Personal and family medical history.

    • Physical Exam: Check for signs and symptoms.

    • Diagnostic Tests: Essential for cancer identification.

    • Radiographic Tests: Imaging to visualize abnormalities.

    • Direct Visualization and Lab Tests: For cellular analysis.

    • Pathology: Examining tissue for cancer cells.

    • Classification: Grading and staging per Giddens (pg. 107-108).

Clinical Management

  • Prevention:

    • Primary: Avoiding disease onset.

    • Secondary: Early detection and intervention.

  • Collaborative Interventions:

    • Surgery: Removal of tumors.

    • Radiation: Targeting cancer cells with radiation.

    • Chemotherapy: Drug treatment to kill cancer cells.

    • Hormonal therapy: Blocks hormone production.

    • Targeted therapy: Attacks specific cancer cells.

    • Biologic therapy: Uses the immune system to fight cancer.

    • Bone Marrow and Stem Cell Transplantation: Replacement of damaged bone marrow.

Interrelated Concepts

  • Key Areas:

    • Infection

    • Elimination

    • Immunity

    • Fluid & Electrolytes

    • Nutrition

    • Pain

    • Anxiety

    • Fatigue

    • Coping

    • Sexuality

Bone Marrow and Leukemia

  • Pathophysiology:

    • Competition for nutrients and infiltration leads to ( RBC ) and ( WBC ) abnormalities.

    • Types of Leukemia:

      • Acute: Rapidly progressing population of immature white blood cells.

      • Generalized CNS hyper-metabolism can occur with leukemia.

    • Manifestations:

      • Anemia, increased infection risk, bleeding, pain.

Classification of Leukemia

  • Types:

    • Classified by affected ( WBC ).

    • Common Types in Children:

      • ALL (Acute Lymphoblastic Leukemia)

      • AML (Acute Myelogenous Leukemia).

      • Generally, boys are more affected than girls; Caucasians > African Americans.

Clinical Manifestations of Leukemia

  • Symptoms Include:

    • Pale, febrile, irritable, anorexia, easy bruising, joint pain, organ involvement, hepatosplenomegaly, lymphadenopathy.

Diagnosis of Leukemia

  • Tests:

    • History and Physical Exam: Initial assessments.

    • Peripheral Blood Smear: Identify immature leukocytes.

    • Bone Marrow Aspiration/Biopsy: Definitive diagnosis through cell examination.

Treatment of Leukemia

  • Management:

    • Includes history, physical exam, and various tests (CBC, bone marrow biopsy).

    • Treatment plans often involve chemotherapy and potential bone marrow transplants.

Hodgkin Lymphoma

  • Malignancy of the Lymph System:

    • Primarily affects lymph nodes; can metastasize to other organs (spleen, liver).

    • Associated with the Epstein-Barr virus (EBV).

Diagnosis of Hodgkin Lymphoma

  • Biopsy:

    • Identifies Reed-Sternberg cells unique to Hodgkin Lymphoma.

    • Commonly diagnosed in adolescents, especially males.

Clinical Manifestations of Hodgkin Lymphoma

  • Symptoms:

    • Enlarged lymph nodes (supraclavicular, cervical), low-grade fever, weight loss, night sweats, rash, itching.

Treatment of Hodgkin Lymphoma

  • Approach:

    • Combined radiation and chemotherapy typically yield excellent long-term prognosis.

Non-Hodgkin Lymphoma

  • Incidence Rates:

    • 10 children per 1 million under 20 years old.

  • Risk Factors:

    • Infection (EBV), immunodeficiency, DNA repair syndromes, previous cancer treatments.

Characteristics of Non-Hodgkin Lymphoma

  • Heterogeneous: Multiple causes and variations in morphology.

  • Clinical Manifestations: Vary based on site and extent; usually widespread at diagnosis.

  • Survival Rates: Approximately 85% to 95% of children with limited disease involvement can be cured.

Bone Tumors

  • Common Types:

    • Osteosarcoma: Most frequent bone tumor in adolescents.

    • Manifestations: Localized pain and palpable mass; confirmed via imaging and biopsy.

    • Therapeutic Management: Involves surgery and chemotherapy.

Ewing's Sarcoma

  • Characteristics:

    • Second most common bone cancer in children, affecting pelvis, long bones, and chest wall.

    • Treatment includes radiation and chemotherapy.

Wilm's Tumor

  • Nephroblastoma:

    • Most common malignant renal tumor in childhood, presents as abdominal mass/swelling.

    • Generally has a high survival rate.