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SnSs of childlhood leukemia?
- Pallor
- Fatigue
- Bruising/Bleeding
- Recurrent
- Infections
- Adenopathy
- Organomegaly
- Bone Pain
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Tx for leukemia?
- Chemotherapy
- Radiation Therapy
- Allogeneic (stem cell) BMT
- A.L.L.(>60-70% cured)
- A.M.L.(30-40% cured)
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What are the most important factors in determining outcomes for CNS tumors?
- 1) success of resection
- 2) ability to tx across blood/brain barrier.
- (Radiation, although improved, is still devestating especially to children.)
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SnSs for non-Hodgkin's Lymphoma
- Adenopathy
- Organomegaly
- Hyperuricemia
- Tumor Lysis Syndrome
- Superior Vena-Cava Syndrome
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Tx for non-Hodgkin's Lymphoma?
- Prevention & Treatment of Hyperuricemia #1 Priority
- Response often very rapid to induction chemotherapy
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What is Hodgkin's Disease?
- Tumor Lysis issues rare
- Prognosis depends on stage/histology
- Systemic chemotherapy replacing XRT
- Follow-Up for Late Effects vital!
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T/F: Amputation is the gold standard Tx for Osteosarcoma and Ewing's Sarcoma.
- False: Used to be true, but new procedures have made amputation the exception, not the rule, and limbs are salvaged whenever possible.
- Both still require agressive chemo.
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What is a neuroblastoma?
- Tumor of sympathetic nervous tissue
- Common sites include adrenal gland, mediastinum, liver
- Bone involvement = poor outcome
- Infants < 12 months often have spontaneous regression of tumor
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SnSs for Neuroblastoma?
- Pallor
- Bone Pain
- Secretory Diarrhea
- Weight Loss
- Abdominal Mass
- Flushing/Skin Lesions
- Orbital Ecchymoses
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Tx for Neuroblastoma?
- Chemotherapy
- Radiation Therapy
- HD Chemo with PBSC’s (Periferal Blood Stem Cells)
- Infants < 12 mos with Stage IV-S receive no therapy
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What is Wilm's Tumor?
- Primary tumor of the kidney
- Patients often appear well except for palpable mass
- Outcome generally good, even in metastatic cases unless unfavorable histology
- Chemotherapy often curative without radiation
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What is a rabdomyosarcoma?
- Tumor involving muscle cell precursors
- Multiplesites possible
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Where do pts usually express Germ Cell Tumors?
- – Testicular
- – Ovarian
- – Mediastinum
- – CNS
- (usually accompanied by
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What is included in a workup for a pt with cancer who is showing neutorpenia and fever?
- CBC w/manual diff
- Blood Cultures
- Physical Exam
- CXR
- Broad-Spectrum Antibiotics X 48 hours minimum
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What is the greatest risk of toxicity for oncology pts?
- • Greatest risk is for bacteria to get out of where they “belong” and enter the blood stream:
- – Staph (skin)
- – Alpha Strep (Throat)
- – Gram neg’s (GI)
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When do you start thinking blood transfusion in an oncology pt?
- Generally, Transfuse When Hgb < 8.0 (< 10 if Patient is Receiving Radiation Therapy)
- Infuse slowly over 3-4 hrs.
-
When does thrombocytopenia get scary?
- When platelet count <50k.
- Infuse between 30-60 minutes as fast as pt can tolerate.
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What is stomatitis?
- Stomach's response to chemo/radiation toxicity, ie:
- Nausea/Vomiting
- Constipation
- Diarrhea
- Decreased Appetite
- Taste Distortion
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Where does stomatitis occur?
- Breakdown of mucosal lining of:
- Oropharynx
- Esophagus
- Stomach/Lower GI
- Vagina
- Rectum
- Tx with multiple Rx depending on symptoms/locations
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What is most commonly used to treat n/v related to chemo/radation?
- zofran
- kytril
- (neither cases distonia, hallucinations, or sedation)
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What is most important to remember with a patient with constipation issues related to chemo/radiation?
NOTHING PER RECTUM!
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What are some SnSs of renal toxicity in a pt undergoing chemo/radiation?
- Hematuria
- Cystitis
- Frequency/Dysuria
- Colored Urine When Drug Excreted
- Electrolyte wasting
- • Decreased GFR
- • Decreased drug excretion
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What do you do to Tx pancreatic toxicity in the patient undergoing chem/radation?
- Chemical Pancreatitis
- Treatment is Symptomatic & Supportive (“Pseudo-Diabetes”)
- Monitor status by assessment of amylase/lipase
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