MB4 peds cancer Forsythe

leukemias

abnormal WBC proliferation that crowds out normal cells

very elevated WBC count with most of them being immature WBC

brain tumors - solid tumor

non-Hodgkins lymphoma - cancer of lymph system

insidious

may not take them to the MD until s/s get bad

• 1. fever - WBC up
• 2. pallor - low RBC
• 3. malaise - low RBC
• 4. bruising
• 5. bone or joint pain- WBC content growing causes pain esp in long/flat bones
• 6. lympadenopathy
• 7. hepatosplenomegaly

• 1. WBC increased
• 2. RBC decreased
• 3. platelets decreased

chemotherapy for 2 to 3 years

• 1. altered LOC
• 2. HA
• 3. NV upon arising with no nausea preceding

surgery, radiation, chemo

read the label and make sure it is not multidose or benzyl alcohol included

should not give any multi-dose / benzyl to newborns ever

not used if < 5 years old

toxic effects on developing brain

remove as much as possible with minimal disturbance to brain to preserve function

through Ommaya reservior

• 1. give with small gauge needle
• 2. withdraw CSF in = amnt to dose to be admin
• 3. DO NOT inject med if CSF is bloody or cloudy
• 4. Use only preservative free solutions
• 5. no benzyl alcohol

• 1. infection - brain
• 2. bleeding
• 3. destroyed & havbe to do new surgery to replace it

25 g

hydrocephalus and increased ICP

clear

multi-dose vials

it can act as an anticoagulant

rapid onset

widespread involvement at diagnosis

• 1. widespread involvement a Dx
• 2. abd cramping
• 3. constipation
• 4. anorexia & weight loss
• 5. ascites
• 6. lymphadenopathy

enlarge nodes press on GI structures

mediastinal lymph nodes are esp swollen

presses on bronchi ->  cough, chest tightness, & edema of the face

nodes press on veins returning blood from the head

radiation and chemo

6 mo to 2 years

in emergencies only:  when there is CNS involvement or respiratory obstruction

NEUROBLASTOMA

cancer that arises from the nervous tissue that will develop into the SNS & the adrenal medulla

tumor will have tissue similar to that of SNS and affects kidneys (adrenal medulla)

1. abd mass that is protruberant and firm

huge abd

• 1. radiation
• 2. chemo
• 3. stem cell transplant for advanced disease

osteosarcoma or osteogenic sarcoma

bone tumor

adolescents

• 1. distal femur
• 2. prox. tibia
• 3. prox. humerus

s/s in early stage are almost always attributed to extremity injury or normal growing pains

• 1. pain at tumor site
• 2. palpable mass
• 3. limited ROM
• 4. limping
• 5. pathologic fracture at site

• 1. progressive
• 2. insidious
• 3. intermittent

• 1. Ewing sarcoma has fever
• 2. Ewing sarcoma can be treated with radiation (not just for palliative care)

• 1. chemo then surgical resection of tumor then chemo again
• 2. non-weight bearing on affected limb - crutches

will be very tired

is not used to Tx

may be used at end of life for palliative pain control

bone tumor

AKA prmitive neuroectodermal tumor of the bone (PNET)

adol

• 1. fever
• 2. pain
• 3. soft tissue swelling around the affected bone
• 4. pathologic fracture at site

combination fo chemo and surgical resection or radiation

malignancy of sriated or skel muscles, tendons, bursa, and fascia that occurs in head & neck especially the eye orbit

<5years of age

highly malignant with metastasis

• 1. mass:  soft-hard, nontender, relatively immobile
• 2. periorbital
• 3. ptosis - drooping upper or lower lid
• 4. exopthalmos - bulging of the eye

drooping upper or lower eyelid

combo of chemo, radiation, and possible surgery

wilms tumor

nephroblastoma

renal tumor

• 1. very vascular
• 2. double in size overnight
• 3. asymptomatic, movable mass

may thing the child is constipated

NO abd palpation b/c very vascular

put a sign above the bed an tell all visitors

rare tumor of the eye/retina

• 1. leukocoria
• 2. strabismus

combination therapy with goal to save life and preserve eye

• 1. 1st chemo
• 2. 2nd focal therapies:  cryotherapy or photocoagulation (laser to retina)
• 3. 2nd radiation
• 4. last resort -

• 1. post-op care of enucleated orbit
• 2. assess for s/s infection, hemorrhage, and edema
• 3. conformer is placed in orbit for 5 to 6 weeks to preserve shape of orbit for prosthesis
• 4. remove, clean, and reinsert

combo of surgical resection (nephrectomy) & chemo

OR

radiation, surgical resection, and chemo

white reflex- light shined in eye makes pupil glow white instead of red

eyes point in different directions - not focused on same thing

freeze tumor to destroy microcirculation to the tumor -> no nutrients

removal of the eye

laser beam to retinal blood supply to stop nutrition to retinoblastoma tumor

• 1. fatigue
• 2. anorexia
• 3. NV
• 4. skin irritation:  erythema and tenderness

destroy cells:  will destroy cancer and normal body cells

area being radiated will be red, swollen, and tender

do not remove radiation markings

can cause radiation burns and can cause scarring

goes all the way through the body

do not need to take long tub baths - no more than 10 minutes

no perfumed soaps - mild soaps only

if it is radiation on scalp - mild shampoos

skin can be broken r/t numerous radiation therapy

pat dry & avoid dry towels

loose fitting clothes

No creams and lotions b/c have metal in them & will block some of the radiation from the tumor (are some that can use)

have metal that will block the radiation from the tumor

can put it on areas away from radiation area

nutrition

antiemetics - zofran and atarax

30 minutes before then q 4 to 8 h during

don't want high calorie or high sugar food - don't tolerate very well

can sprinkle wheat bran on food to increase calories or put a lot of butter in their food

Main thing is to get as much calories as possible:  let them eat whatever they will eat

don't need sharp foods b/c can break lining of GI tract and cause bleeding that they are at risk for already b/c they have low platelets & chemo kills the MM lining already -> stomatitis

take the top off the food outside the room so the smell won't be so strong

they usually prefer cold or room temp foods esp meats

bowel will get edematous, erythematous, irritated

high cellulose veg/fruits will stick to the gut and can cause infection - don't give these

whole wheat, carrots, celery, sunflower seeds

tired and fatigued

allow to rest and provide sedentary activities that don't tire and/or stress bones

distraction - teach parent

• 10 friends to take camping
• 10 activities to do
• 10 favorite games to play

chemo

will also occur with radiation to the scalp

moon face/weight gain caused by chemo augmented with steroids

• augments action of chemo
• decreases nausea
• stops body from rejecting stuff

mucocitis, diarrhea, constipation

kills WBC, RBC, and platelets

peak of when will suppress all blood cells

usually occurs 2 weeks after starting therapy

risk for bleeding and infection

• chicken over beef/pork
• brown sugar over white
• high calories snacks

• 1. wigs/scarfs
• 2. playing with dolls with no hair
• 3. family/friends cutting their hair

• 1. soft foods
• 2. non acidic
• 3. local anesthetics (lozengers) before meals
• 4. meticulous mouth care qid - mix 1 quart lukewarm water, tsp baking soda, tsp salt and give after eating and in b/t eating qid
• 5. 1/2 str peroxide rinse tid or lukewarm water
• 6. viscous lidocaine swab (not rinse)
• 7 no alcohol containing mouthwash

can decrease gag reflex

• 1. wash hands
• 2. provide meticulous oral hygiene
• 3. no visitors with infections
• 4. no fresh fruits or veg - can have processed only
• 5. no honey - botulism
• 6. no live virus vaccinations- MMR, varicella, nasal flu
• 7. monitor temp - no rectal temps
• 8. may use profilactic abx
• 9. neupogen

colony stimulating factor - stim WBC to be produced

filgrastim

When chem destroys WBC this will replace them so they can keep getting TX

• 1. soft toilet paper
• 2. no sharp foods
• 3. avoid IM & rectal if poss.
• 4. do not give NSAIDS
• 5. soft toothbrush
• 6. stool softeners
• 7. check urine and stool for blood
• 8. eval menstrual flow in adol girls

lean forward and pinch nose together and breathe through nose

leaning back can cause aspiration

determines type and quantity of cells

CH- iliac crest or spines

infants - anterior tibia

• 1. assess platelet count - under 20,000 will give platelets before procedure
• 2. - apply cream and leave on 30 min-h to numb

• 1. treatment table not hospital bed
• 2. prone position
• 3. conscious sedation and local anesthesia to reduce pain
• 4. instruct they will feel considerable pressure when needle inserted and then sharp pain when marrow is aspirated
• 5. apply pressure dressing to puncture site to prevent bleeding and hold pressure

• 1. monitor vs and pressure dressing q 15 minutes for the first hour
• 2. assess: pain, bleeding, and infection
• 3. keep child quiet - may play quiet games
• 4. allow young CH to play with a doll and syringe to help them express their feelings aobut such a painful, invasive procedure

will need frequent platelet transfusion r/t platelets having a short life

q 1 to 3 days

• 1. provide frequent rest periods b/t care
• 2. provide stimulating but not physically tiring activities
• 3. cluster care to prevent exhaustion

• 1. antiemetics
• 2. high calorie, high protein, high Fe
• 3. provide fave foods
• 4. room temp food
• 5. extra fluids
• 6. small frequent snacks
• 7. chicken instead of beef or pork - chicken is less bitter
• 8. sprinkle brown sugar on food - tolerated better than white
• 9. daily weights

• 1. use only approved lotions/creams
• 2. avoid excessive scrubbing of skin
• 3. DO NOT remove radiation marks
• 4. loose clothing, soft material
• 5. turn q 2 h if immobile