Pediatric Nervous System Tumors

Here are the questions and answers based on the previous flashcards:

Question: What are the two main categories of nervous system tumors discussed in the provided material, and what general percentage of childhood cancers do Central Nervous System (CNS) tumors represent?

Answer: The two main categories of nervous system tumors discussed are brain tumors and neuroblastoma. Central Nervous System (CNS) tumors account for approximately 25% of childhood cancers1.

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Question: Brain tumors in children are classified based on their location. What are the two main locations, and which parts of the brain do they primarily involve?

Answer: The two main locations for brain tumors in children are:

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Infratentorial tumors, which involve the cerebellum and brainstem1.

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Supratentorial tumors, which mainly occur in the cerebrum1.

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Question: What are some key components of the diagnostic evaluation for nervous system tumors in children? What is the definitive method for diagnosis?

Answer: Key components of the diagnostic evaluation include assessing signs and symptoms related to the tumor's anatomic location, size, and the child’s age, as well as presenting clinical signs2. Diagnostic procedures include MRI, CT scan, EEG, and lumbar puncture2. The definitive diagnosis is based upon specimens obtained during surgery2.

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Question: Describe the key components of a neurologic examination in children, as outlined in the material.

Answer: A neurologic examination in children includes assessment of:

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Vital signs2

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Skin2

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Eyes2

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Motor function2...

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Posturing (decerebrate and decorticate)2...

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Reflexes2

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Occipitofrontal Circumference (OFC), measured using a tape around the head just above the eyebrows5.

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Assessment of fontanelles (anterior and posterior) for whether they are soft/tense and flat/sunken/bulging5.

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Assessment of developmentally appropriate commands & questions5.

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Question: What are some signs and symptoms of increased intracranial pressure (ICP) specifically seen in infants?

Answer: Signs and symptoms of increased intracranial pressure in infants include:

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Tense, bulging fontanel5

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Separated cranial sutures5

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Macewen (cracked-pot) sign6

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Irritability and restlessness6

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Drowsiness6

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Increased sleeping6

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Question: What are some common signs and symptoms of increased intracranial pressure (ICP) seen in children?

Answer: Common signs and symptoms of increased intracranial pressure in children include:

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Headache6

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Nausea6

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Forceful vomiting6

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Diplopia, blurred vision6

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Seizures6

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Indifference, drowsiness6

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Decline in school performance4

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Diminished physical activity and motor performance4

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Increased sleeping4

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Inability to follow simple commands4

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Question: What are the components of Cushing's Triad, and what do they indicate?

Answer: Cushing's Triad is a late sign of increased intracranial pressure and includes:

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Bradycardia4

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Irregular Respirations4

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Hypertension4

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Question: What are the general therapeutic management options for nervous system tumors in children? What determines the specific approach?

Answer: Therapeutic management options for nervous system tumors depends on the type of tumor4 and may include surgery, radiotherapy, chemotherapy, or a combination of these modalities4.

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Question: What are some key aspects of care management for a child with a nervous system tumor, encompassing preparation, support, and recovery?

Answer: Key aspects of care management include:

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Preparing the child and family for diagnostic and operative procedures3.

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Considering how the disease affects the child’s body image3.

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Preventing postoperative complications3.

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Supporting the child and family3.

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Promoting return to optimum functioning3.

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Question: What are some important elements of post-operative care for a child who has undergone surgery for a nervous system tumor?

Answer: Important elements of post-operative care include:

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Neurochecks, including assessment of strength & motor function3.

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Seizure prophylaxis3.

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Management of External Ventricular Drains3.

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Infection prophylaxis3.

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Appropriate positioning3.

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Ensuring adequate nutrition3.

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Post-operative pain management3.

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Question: How might severe headaches be managed non-pharmacologically in a child post-operatively after nervous system tumor surgery?

Answer: Non-pharmacological management of severe post-operative headaches may include:

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Providing a quiet, dim lit environment7.

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Restricting visitors7.

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Applying an ice pack to the face/head7.

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Preventing sudden jarring7.

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Preventing increases in ICP through measures like position changes7 and prevention of straining (coughing, vomiting, defecating)7.

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Question: What is neuroblastoma, and where do the majority of these tumors develop?

Answer: Neuroblastoma is the most common malignant extracranial solid tumor of childhood8. The majority of tumors develop in the adrenal gland or retroperitoneal sympathetic chain8.

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Question: What is the primary objective of the diagnostic evaluation for neuroblastoma? What does the presence of metastasis imply?

Answer: The primary objective of the diagnostic evaluation for neuroblastoma is to locate the primary site and sites of metastasis8. Metastasis may have already occurred before diagnosis is made8.

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Question: What are some methods used in the diagnostic evaluation of neuroblastoma to locate the primary site and metastasis?

Answer: Methods used in the diagnostic evaluation of neuroblastoma include:

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Skeletal survey9

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Radiologic studies9

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Bone marrow evaluation9

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Intravenous pyelography to evaluate renal involvement9

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Question: What are the main components of the therapeutic management of neuroblastoma?

Answer: The main components of the therapeutic management of neuroblastoma include:

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Clinical staging to establish a treatment plan9

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Surgery to remove the tumor and obtain biopsy samples9

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Radiation9

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Chemotherapy9

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Bone marrow transplantation9

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Stem cell rescue9

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Question: What are the general survival rates for children with low-risk and high-risk neuroblastoma at 5 years? What is a general trend regarding prognosis and the age of the patient at diagnosis?

Answer: The general survival rates are:

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95% survival at 5 years for low-risk disease9.

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30% survival at 5 years for high-risk disease9. In general, the younger the patient is at diagnosis, the better the prognosis9. In some cases, the tumor may regress spontaneously as embryonic cells mature and with the development of an active immune system10.

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Question: Briefly describe the pathophysiology of nervous system tumors and how this relates to the signs and symptoms.

Answer: The pathophysiology of nervous system tumors involves abnormal and uncontrolled growth of cells within the neural tissue1. This growth can lead to increased intracranial pressure in CNS tumors due to the confined space of the skull, causing symptoms like headache, vomiting, and altered mental status5.... The location and size of the tumor directly influence the specific signs and symptoms by compressing or invading nearby neural structures, leading to neurological deficits such as motor weakness, sensory changes, vision problems, or seizures2. In neuroblastoma, the signs and symptoms depend on the primary site and any metastatic spread8, potentially affecting various organ systems.

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Question: Outline the diagnostic evaluation process for nervous system tumors and summarize the factors influencing prognosis.

Answer: The diagnostic evaluation typically begins with assessing the child's clinical signs and symptoms2 and includes neurological examination, potentially involving head circumference measurement and fontanelle assessment in infants5. Imaging studies like MRI and CT scans are crucial for visualizing the tumor2. A lumbar puncture and EEG may also be performed2. The definitive diagnosis relies on obtaining tissue specimens during surgery2. Prognosis for CNS tumors is generally difficult with poor survival rates1, and it depends on the type and location of the tumor, the extent of resection, and the response to therapy4. For neuroblastoma, prognosis is variable, with higher survival rates for low-risk disease and younger patients9. Tumor stage and the presence of metastasis are also significant prognostic factors8....

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Question: Describe the key nursing interventions and priorities when caring for a child with a nervous system tumor, both pre-operatively and post-operatively.

Answer: Key nursing interventions and priorities include:

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Pre-operatively: Preparing the child and family for diagnostic tests and surgery3, assessing the impact on body image3, and providing psychological support3.

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Post-operatively: Frequent neurochecks to monitor neurological status3, implementing seizure and infection prophylaxis3, managing external ventricular drains as needed3, ensuring proper positioning3, addressing nutritional needs3, and providing effective pain management, including both pharmacological and non-pharmacological strategies to alleviate headaches and prevent increased ICP3.... Emotional support for the child and family remains a continuous priority throughout the entire course of care3. Promoting a return to optimum functioning is also a key goal3.

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