cancer

mortality

life of a cell

-review

cell cycle-formation and ending with 2 daughter cells

different tissues have different lengths of cell life

varies from 16 to 400 hours

some cells never enter the cell cycle and therefore, do not reproduce

abnormal growth and reproduction

can occur in any group of cells

neoplams

cause

unknown

may include: genetics, radiation, exposure to powerlines, cigarette smoking, viruses and chemicals and drugs

neoplasms

who is at risk?

small for gestational age and premature infants

due to lack of nonspecific immune response

benign neoplasms

typically do not metastasize

do not destroy tissue except secondary

can be serious, or fatal, if they interfere with vital functions

tend to reocur after removal

destroy tissue by invasion

growth is rapid

malignant neoplasms

treatment

surgery, radiation and chemotherapy

alone or in combination

cure- when all evidence of the tumor is gone

palliation- treatment is intended to reduce symptoms to promote client comfort

solid tumor outside the cranium

4th most common childhood malignancy

neuroblastoma

patho

originates in neurocrest cells

gives rise to the adrenal medulla, paraglanglia and sympathetic nervous system(cervical and thoracic chain)

neuroblastoma

most common?

neuroblastoma

disease progression

silent tumor

late diagnosis

onset 22 months age group

neuroblastoma

assessment findings

representitive of location and stage of disease

weight loss, abdominal fullness, irritability, fatigue and fever

mediastinal tumors- dyspnea; neck and facial edema

bone- limp, fever, malaise

neuroblastoma

diagnosis

CT of the skull, neck, chest, abdomen and bone

bone marrow aspiration- determines and locates mets

urine testing- detects breakdown of adrenal catecholamines (epinephrine and norepinephrine) since some tumors secrete them

neuroblastoma

patho:

unrestricted proliferation of WBC's

bone marrow infiltration crowds out stem cells that normally produce RBC's

neuroblastoma

effects

anemia- reduction in RBC

thrombocytopenia- reduction in platelets

WBCs are immature; cant fight infection

neuroblastoma

course of action

surgery for tumor removal (biopsy)

radiation therapy

cheomotherapy

combination allows for better cell kill; decreases resistance of cancer cells

neuroblastoma

nursing care

surgical- monitor surgical site for hemmorrhage and infection (temp)

skin integrity at radiation site

mucous membrane integrity!!!

minimize exposure to infection(reverse isolation rooms)

monitor bleeding

-vital signs, test stools

avoid rectal temps, IM injections, vigorous activity, and vigorous tooth brushing)

leukemia

definition

cancer of blood forming tissues

leukemia

age

peak age- 4 years;

boys more than girls

leukemia

classifications

leukemia

ALL

acute lymphocytic leukemia

better prognosis

leukemia

ANLL

acute non lymphocytic leukemia

or AML

acute myelogenous

leukemia

more common in?

leukemia

patho

unrestricted proliferation of WBC

bone marrow infiltration crowds out stem cells that normallt produce RBCs

anemia- reduction in RBCs

thrombocytopenia- reduction in platelets

WBCs immatue(blasts)- cant fight infection

leukemia

clinical manifestations

directly related to area of involvement

spleen, liver and lymph nodes enlarged

CNS at risk for infiltration

leukemia

prognosis:

leukemia

prognosis

the lower the WBC count at diagnosis?

the better the prognosis

-prognosis have improved, especially for ALL

leukemia

assessment

peripheral blood count- anemia, thrombocytopenia and neutropenia (small number of neutrophils in blood)

leukemic blasts- immature white blood cells

bone marrow aspiration

spinal tap

leukemia

goals

obtain remission
manage symptoms

prevent bleeding

prevent infection

brain tumors

prevelance

brain tumors

location

brain tumors

symptoms

depend on location

visual symptoms, ataxia, seizures, vomiting, motor symptoms; ICP and headache

brain tumors

cancer prevelancy

brain tumors

treatment

biopsy

tumor removal

"debulk" and unremovable tumor

laser surgery- more sensitive areas

radiation therapy at surgical site

chemotherapy- commonly intrathecally

brain tumor

nursing interventions

monitor I and O; urine specific gravity

head circumference- hydrocephalus

nutritional/fluid support

LOC

function; sensory- perceptual status

eye care for swollen eyes

pain management

intrarenal tumor- nephroblastoma

common abdominal tumor for children

wil,'s tumor

age

2-5 years of age

wilm's tumor

familial tendency

wilm's tumor

location

uni or bilateral

may metastasize to liver and lungs

wilm's tumor

prognosis

stage of disease

75% have 5 year survival rate

wilm's tumor

assessment

usually asymptomatic

parents find abdominal mass

hypertension- 25% of cases

wilm's tumor

diagnosis

ultrasound of abdomen and IVP(intravenous pyelogram)

CT and MRI to detect mets to lungs

wilm's tumor

avoid?

wilm's tumor

post op care

based on symptoms!!!

I and O, daily weight

urine specific gravity

fluid levels

IV infusions

BP

bowel sounds

BM

infection and pain

most common bone cancer

osteogenic sarcoma

found in?

osteogenic sarcoma

found during?

osteogenic sarcoma

location

most commonly found in the distal portion of the femer

humerus, tibia, pelvis, jaw, and phalanges

osteogenic sarcoma

initial symptoms

osteogenic sarcoma

tests

often- radical resection or amputation

limb salvaging possible- prosthetics

thoracotomy for mets to the lungs

chemotherapy- both pre and post op

life threatening- emotional support

bone tumor

amputations

a straight forward approach when amputation is necessary.

bone tumor

amputation care

elevate stump 24 hours!

maintain body alignment, sterile stump dressing care

ewings sarcoma

definition

Ewings sarcoma

age

Ewing's sarcoma

mal. or benign?

highly malignant

often mets to the lungs

Ewing's sarcoma

assessment

pain, soft tissue mass

anorexia, malaise, fever, fatigue and weight loss

Ewings sarcoma

tests

Ewing's sacroma

amputations

usually not recommended!!!

Ewings sarcoma

treatments

extensive radiation and chemotherapy

encourage mobility of extremity as tolerated

nadir

the lowest point in the childs blood count or myelosuppression.

occurs 10-14 days after most chemotherapy is given

chemotherapy

rectal temps and suppositories

must be treated as EMERGENT

*goal: to have antibiotics given within 30 mins

chemotherapy children

asprin, asprin containing products, and NSAIDS

not to be given to children on chemotherapy because they interfere with normal platelet function.

while on chemo risks for deveoloping thrombocytopinea are increased so the function of circulationg platelets should not be further compromised

chemo

mucositis

or stomatitis

signs of infection

- not able to mount an immune response

they may not show signs of inflammation such as reddness or the production of pus because they lack the neutrophils to do so.

some will complain of pain and swelling in the area

these symptoms are considered indicative of a infection and should be treated PROMPTLY

*fever may be the only sign of infection

chemo GI side effects

may experience anticipatory vomiting

chemo

renal toxicity

chemo

factors that compound renal toxicity

include the use of:

-certain antibiotics, antifungal agents, and radiation to the kidney area

chemo

to avoid renal side effects

maintain adequate hydration!

and encouraged to void every 2 hours while, and after the drug is given

chemo

kidney fucntion

first sign of renal toxicity

may be a discrepancy in intake and output

monitor all I and O carefully and report discrepancies to doc

when administering a chemotheraputic agent

always:

ensure venous patency proir to the administration to prevent extravasation

*venous blood return is checked during the infusion, and if there is a loss of blood return, the infusion is stopped immediately, and any residual medication is aspirated to reduce the extend of extravasation

over joints

bony prominences

in the anticubital fossa

above tendons

*as extravasation damage in these areas can affect limb function

chemotherapy

fertility in young males

more severe than on female fertility

sterility may be the result from the use of alkylating agents which have a dramatic effect on spermatogenesis

chemotherapy

long term sterility effects

males

decrease in spermatogenesis may be reversible in months or years after completion of chemo.

*but sterility frequently is permanent!!!

chemo

hair loss

hair will start to fall out in 10 days to 2 weeks following treatment

the hair loss is slow over several days and can be messy

clients often will cut their hair short to prevent this

**when the chemo treatment is complete the hair will grow back**

chemo

single agent precautions

must be taken for 48 hours after single angentnurses

**can be exposed to these agent through inhalation, absorption, or ingestion, while mixing, administering, or handling the agents or the body excreta of the client**

chemo

multi agent precautions

must be taken for 5 days following chemo.

**can be exposed to these agent through inhalation, absorption, or ingestion, while mixing, administering, or handling the agents or the body excreta of the client**

chemo

guidelines for protection

use of airflow hood while mixing, and the use of protective gowns, gloves, masks, and eyeshields when handling the agents or excreta

chemotherapy

wastes

must be disposed of in labeled, sealed containers

also teach caregivers safe handling procedures

lymphomas

solid tumors

and brain tumors

* can also be given as pain control as a part of palliative care in terminally ill patients (used to enhance the quality of life remaining)

remain immobile on a hard flat surface for 10-15 mins it takes for preparation, positioning, and delivery of treatment

*depending on the developmental level of the child sedation or anesthesia may be necessary to complete the treatment

anemia, thrombocytopenia, and neutropenia

ionizing radiation suppresses the bone marrow and causes a drop in all blood cell lines

side effects of radiation therapy

xerostomia

pain

teeth sensitivity

difficulty speaking may accompany xerostomia

decreased salivary secretions

esophagitis

nurning pain behind the sternum(common complaint)

regurgitation and indigestion

nausea

vomiting

diarrhea

weight loss

skin may become dry, erythematus or pruritus

or more seriously skin breakdown or desquamation

photophobic

alopecia

radiation pneumonitis( acute reaction)

somnolence syndrome

headache nausea and vomiting (common signs)

r/t inflammation, edema, and increased intracrainial pressure

somnolence syndrome

side effect exhibiting subacute toxicity

seen 5-7 weeks after initial radiation and resolves within 1 to 3 weeks

children will experience drowsiness and may sleep up to 20 hours a day. nausea and malaise frequently accompany drowsiness, and fever, dysphasia, ataxia, and transient papilledema, and inflammation of the optic disk may also occur

graft vs host reaction

s/s

can be minimal to life threatening

skin rash begining on the hands and feet, spreading to other parts of the body

diarrhea

jaundice

infection

naturally occuring and synthetic agents, are used to stimulate the bodys immune system and destroy cancerous cells

examples: colony stimulating factors (CSF)

interleukins

monoclonal antibodies

interferon

*the use of these drugs is also referred to as immunotherapy or biotherapy

biologic response modifiers

used:

to accelerate hematopoietic recovery after chemo, which leads to the reduction of hospital admission days secondary to fever and neutropenia, and permits the use of aggressive dosenintensive chemo

used to counteract the myelosuppressive effects of radiation and chemo

leukemia

most common s/s of ALL

fever

bone pain

pallor

bruising

*most children diagnoses have been symptomatic for only 1-2 weeks

the clinical manifestations arise from the affected organ

leukemia

ALL

diagnosis

bone marrow aspiration is required

CBC

lumbar puncture is done to assess the presence of CNS disease

chest x-ray- detect mediastinal mass

*optimal treatment depends on identifying the subtype fo leukemia**

induction

consolidation

maintenance

leukemia

ALL

treatment

3 stages of systemic chemo

symptomatic support

possible radiation

have a very poor prognosis

hematopoietic stem cell transplant is a treatment option if compatible bone marrow donor is possible

leukemia

AML

s/s

less than three years old

due to the damage caused to the developing brain such as intellect and growth impairment