1. pediatric cancer def.
    a group of chronic diseases characterized by uncontrolled growth and spread of abnormal cells which, if not treated adequately, results in the death of the child
  2. what is cancer
    • genetic mutation
    • permanent DNA alteration
  3. where does cancer begin
    in a single cell
  4. cancer (the genetic mutation part of it) results in (4)
    • lack of differentiation
    • loss of contact inhibition
    • unregulated growth
    • cellular immortal
  5. cure rate of children vs adults w/ cancer
    • children: more than 70% cured
    • adults: less than 60% cured
  6. origin of children vs. adult cancers
    • children: primitive embryonic origin
    • adults: epithelial origin
  7. genetic or envtal (children vs adult cancers)
    • children: genetically-linked
    • adults: stronger link to envt
  8. cancer screening in adults vs children
    • children: no screening
    • adults: screening is routine
  9. prevention in adult vs child cancer
    • children: few preventative measures
    • adult: many adult cancers are preventable
  10. metastasis present at dx (adult vs child cancer)
    • children: metastatic disease present at diagnosis
    • adult: many do NOT present w/ metastasis
  11. adult vs. child cancer response to treatment
    • children: more responsive to treatment
    • adult: less responsive to treatment
  12. national collaborative study group for children's cancers
    Children's Oncology Group
  13. clinical trials are more strict for children. what are 4 things re: the strictness of these trials
    • imrove therapy
    • decrease morbidity
    • increase survival
    • stress impt.ance of follow-up
  14. goal of treatment of child cancer
    rid body of ALL malignant cells
  15. typed of treatment of child cancers: combination? same as adults?
    • yes, combination
    • yes, same as adults
  16. 5 child cancers
    • leukemias (AML and ALL)
    • lymphomas (Hodgkin's and Non-Hodgkin's)
    • brain tumors (the most common ones)
    • neuroblastomas
    • Wilms tumors
  17. desc leukemia
    group of malignant diseases of bone marrow and lymphatic system
  18. #1 cancer in children under 15?
  19. bone marrow physiology of leukemias
    normal bone marrow replaced by blast cells, causing marrow to produce immature WBCs
  20. 2 most common types leukemia in children and their survival rates
    • Acute Lymphocytic Leukemia (80%)
    • Acute Myelogenous Leukemia (40-50%)
  21. Acute Lymphocytic Leukemia is what % of all child leukemias
  22. Acute Lymphocytic Leukemia is what % of all child cancers
  23. peak incidence age of Acute Lymphocytic Leukemia
    2-5 yrs
  24. factors increasing risk of Acute Lymphocytic Leukemia
    • virus
    • genetic predisposition (Downs, Bloom Immunodeficiency states)
    • exposure to toxins (exposure in utero)
  25. how long are s/s Acute Lymphocytic Leukemia present
    1-2 weeks
  26. 3 main s/s leukemia
    • fatigue
    • fever, infection
    • petechiae, bleeding
  27. how confirm dx of leukemia
    bone marrow aspirate
  28. how treat Acute Lymphocytic Leukemia, and what's the procedure over how long a time
    • systemic chemotherapy
    • 4 step process
    • up to 30 months
  29. step 1 of 4-step process for Acute Lymphocytic Leukemia treatment: what? how long? goal?
    • induction therapy
    • 4 weeks
    • goal - complete remission
  30. step 2 of 4-step process for Acute Lymphocytic Leukemia treatment: what? goal?
    • CNS prophylactic therapy
    • goal - prevent leukemic cells from invading CNS
  31. step 3 of 4-step process for Acute Lymphocytic Leukemia treatment: what? how long? goal?
    • consolidation or intensification therapy (high dose chemo)
    • 6 months
    • goal - rid any lasting leukemia cells and prevent emerging resistant leukemic clones
  32. step 4 of 4-step process for Acute Lymphocytic Leukemia treatment: what? how long? goal?
    • maintenance
    • 17 to 30 months
    • goal - maintain remission
  33. % reach remission in Acute Lymphocytic Leukemia
  34. % have 5-yr survival in Acute Lymphocytic Leukemia
  35. if child relapses w/ Acute Lymphocytic Leukemia, prognosis?
    prognosis is poor
  36. w/ Acute Lymphocytic Leukemia, what are 2 NOT recommended courses of treatment during first remission
    • stem cell transplant
    • bone marrow transplant
  37. Acute Mylegenous Leukemia makes up what % all child leukemias
    15 to 25 %
  38. Acute Mylegenous Leukemia or ALL have poorer prognosis
    Acute Mylegenous Leukemia
  39. etiology Acute Mylegenous Leukemia
  40. s/s Acute Mylegenous Leukemia
    • flu-like symptoms
    • hemorrhage
    • chloromas
  41. how dx Acute Mylegenous Leukemia
    bone marrow aspirate
  42. what % of Acute Mylegenous Leukemia cases are malignant myeloid blasts
    more than 25%
  43. 2 treatments for Acute Mylegenous Leukemia
    • systemic chemotherapy
    • bone marrow/stem cell transplant
  44. systemic chemo for Acute Mylegenous Leukemia may also require what 3 treatments
    • platelet transfusion
    • FFP (fresh frozen plasma)
    • cryoprecipitates (to control bleeding)
  45. the character of systemic chemo for Acute Mylegenous Leukemia
    • intense
    • hospitalizaton required
  46. who is best donor for bone marrow/stem cell transplant for Acute Mylegenous Leukemia pt
  47. when do you do a bone marrow/stem cell transplant for Acute Mylegenous Leukemia
    once remission is achieved
  48. chemo and leukemia both cause what, which puts child at risk for infection
    • myelosuppression
    • implement and edu re: handwashing
  49. Acute Mylegenous Leukemia - nurse keep in mind what
    • infection - handwashing
    • bleeding - may need blood prods
    • n/v - treat before s/s appear
    • anorexia
    • mucosal ulceration - pain w/ eat, may need rehydration d/t lack of oral fluids
    • alopecia
    • emotional support!
  50. 2 types lymphomas and who gets them more
    • hodgkins - 15-19 yrs
    • nonhodgkins - under 14 yrs
  51. hodgkins usually originates where
    cervical lymph nodes
  52. etiology hodgkins
    may be assoc w/ Epstein-Barr Virus
  53. hodgkins prevalence boys vs girls
    boys more than girls
  54. hodgkins is what % child malignancies
  55. hodgkins s/s acute or no?
    non acute
  56. hodgkins s/s
    • enlarged, painless cervical nodes (MOST COMMON)
    • malaise
    • fever
    • night sweats
    • usually localized at dx
  57. hodgkins can metastasize to where usually
    • spleen
    • bone marrow
    • lungs
  58. how long chemo for hodgkins
    6 months, intense
  59. hodgkins - radiation?
    yes, in addition to chemo, radiation to lymph node chain
  60. w/ adolescents who have hodgkins, as RN, be concerned re: what
    sterility, handwashing, infection, etc.
  61. more common: hodgkins or nonhodgkins
  62. 3 types of nonhodgkins
    • Burkitts
    • Lymphoblastic
    • Large B Cell
  63. nonhodgkins desc.
    • disseminated disease
    • no single foci of origin
    • rapid onset
    • widespread environment
    • aggressive cancer
  64. age and boys vs girls: more nonhodgkins
    • peak 7 to 11 yrs
    • more boys than girls
  65. nonhodgkins etiology
    • viral
    • genetic
    • immunologic
    • environmental
  66. how does nonhodgkins manifest (what will person c/o)
    • w/ pain, swelling
    • acute onset
  67. s/s nonhodgkins
    • mediastinal mass
    • pleural effusion
    • lymphadenopathy
    • petechiae
    • bruising
    • bleeding
    • bone pain
  68. how to dx and stage nonhodgkins
    • dx: biopsy of enlarged lymph node
    • staging: bone marrow aspirate and biopsy; lumbar puncture (to see CNS involvement)
  69. how do you check/test for CNS involvement of nonhodgkins
    lumbar puncture
  70. many nonhodgkins are dx'ed at what stages?
    stage II or IV
  71. how treat nonhodgkins
    • chemotherapy
    • irradiation
    • bone marrow transplant (for relapse)
  72. if nonhodgkins pt relapses, what add'l therapy treatment will you use
    Bone marrow transplant
  73. things nurse should look for in nonhodgkins pt
    • infection
    • thrombocytopenia
    • tumor lysis syndrome
    • anorexia (wt loss)
    • n/v (wt loss)
    • mucositis
    • pain
  74. most common brain tumor and %
    astrocytomas 50%
  75. brain tumor etiology
  76. how are brain tumors classified (2 things)
    • histology
    • location
  77. brain/CNS tumors are how common
    • 2nd most common childhood cancer
    • most common solid cancer in children
    • 3rd leading cause of death in children under 16
  78. s/s brain tumor in infants
    raised or tense fontanel
  79. s/s brain tumor
    • headache
    • vomiting
    • hemiparesis
    • spastic gait
    • seizures
    • ataxia
    • visual changes
  80. s/s of brain tumor happen as a result of what
    increased ICP
  81. 4 tests to dx brain tumor
    • MRI
    • CT
    • EEG
    • angiography
  82. avoid radiation in children w/ brain tumor of what age
    less than 3 yrs old
  83. how treat brain tumor in children
    • surgery (remove all or part of tumor)
    • radiation to shrink tumor (avoid in less that 3 yrs old)
    • chemo (if tumor can't be removed w/ radiation and surgery)
  84. nurse remember what re: brain tumor children
    • neuro checks - observe for s/s increased ICP
    • pain control
    • post op, avoid increased ICP (watch for vomitting, give steroids, I/O, freq VS)
  85. neuroblastomas are how common
    • 4th most common tumor in children
    • 8-10% all childhood cancers
  86. why is neuroblastoma called the "silent" tumor
    b/c 70% of all cases, metastasis has occurred already by the time of diagnosis
  87. neuroblastomas originate from where
    • ebryonic origins
    • neural crest cells of the adrenal medulla, sympathetic ganglia
    • "an embryonal malignancy of the sympathetic nervous system arising from neuroblasts (pluripotent sympathetic cells). In the developing embryo, these cells invaginate, migrate along the neuraxis, and populate the sympathetic ganglia, adrenal medulla, and other sites"
  88. what % of children ar dxed at what age for neuroblastomas
    • 39% at less than 1 yr old
    • 79% at less than 4 yrs old
  89. s/s neuroblastomas - remember what
    vary according to location of tumor
  90. most common site for neuroblastoma? most common method of detecting this?
    • abdomen
    • palpating abd
  91. s/s neuroblastoma (4)
    • respiratory (mediastinal tumor)
    • edema face/neck (mediastinal tumor)
    • altered b/b fx (retroperineal mass)
    • pancytopenia (bone marrow involvement)
  92. test to dx neuroblastoma
    tissue biopsy
  93. tests to stage neuroblastoma
    • skeletal survey
    • xray of lungs
    • bone marrow biopsy
    • CT of skull, neck, chest, abd
    • abd ultrasound
    • urine test measuring vanillylmandelic acid VMA and homovanillic acid HVA
    • Int'l Neuroblastoma Staging System
  94. treatment of neuroblastomas depends mostly on what 2 things
    • age
    • stage
  95. how treat stage 1 and 2 neuroblastoma
    biopsy and resect tumor only
  96. how treat stage 3 and 4 neuroblastoma
    multiagent chemo and radiation
  97. is bone marrow transplant curative for neuroblastoma
  98. another name for Wilm's tumor
    intra-renal tumor
  99. how common is Wilm's tumor and when are you most likely to get it
    • fifth most common cancer
    • highest incidence between 2 and 3 yrs old
  100. etiology Wilm's tumor
    genetic link/congenital anomalies
  101. Wilm's tumors growth rate
    • rapidly
    • double in size in 11 to 14 days
  102. Wilm's tumor is d/t what physiologically
    • embryonic malformation
    • undifferentiated primitive cells
  103. prognosis for Wilm's tumor
    good: 92%
  104. do you use radiation with Wilm's tumor
    only in metastasis, or if residual tumor after surgery, or for recurrence
  105. what to know re: chemo and Wilm's tumor
    may used be pre or post op
  106. re: Wilm's tumor surgical removal - what do you remove and what should you remember about this surgery
    • remove mass and/or kidney
    • ctrl hypertension during surgery
  107. What to remember about palpation and Wilm's tumor
    • don't palpate abdomen!
    • manipulation of the mass may cause seeing of tumor to other sites
  108. late effects of child cancer treatment w/ brain radiation
    slowed growth and cognitive impairment
  109. late effects of child cancer treatment re: musculoskeletal
    • soft bone tissue and teeth
    • scoliosis
    • atrophy
    • osteoporosis
  110. late effects of child cancer treatment re: reproductive
  111. late effects of child cancer treatment re: thyroid
  112. late effects of child cancer treatment re: skin
    radiation permanent hyperpigmentation
  113. late effects of child cancer treatment re: lungs
    pulmonary fibrosis
  114. late effects of child cancer treatment re: heart
  115. late effects of child cancer treatment re: risk of second malignancies (are they common and what types to watch for)
    • COMMON--
    • leukemia
    • soft tissue sarcomas
    • thyroid cancer
    • brain cancers
  116. the pediatric oncology nurse must be/do what
    • physical presence
    • communicative and understanding
    • empathetic with child, parents, siblings
    • become intuitive w/ experience and reflection
Card Set
Pediatric Oncology - 3/23