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Topics in Peds > Pediatric Oncology > Flashcards

Pediatric Oncology Flashcards

1
Q

pediatric oncology considerations?

A

◦ Children react differently to treatments
◦ Children heal more quickly
◦ Children are undergoing periods of rapid growth and
development
- Children will be active if they feel up to it
- Family-centered care is crucial

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2
Q

Known risk factors (I dont think this is an objective)

A

◦ Exposure to ionizing radiation increases risk of childhood leukemia
◦ Solid organ transplant recipients – increased risk for non-Hodgkin lymphoma secondary to use of
immunosuppressants
◦ Cancer risk is increased in children with certain genetic syndromes (Down syndrome, Li Fraumeni syndrome)
◦ Accelerated fetal growth and higher birth weight associated with increased risk of acute lymphocytic leukemia, CNS tumors, NHL, rhabdomyosarcoma

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3
Q

Carcinoma

A

◦ Malignant neoplasm of epithelial origin; accounts for 80-90% of all cancers
◦ Adenocarcinoma – develops in an organ or gland
◦ Squamous cell carcinoma – originates in the squamous epithelium

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4
Q

sarcoma

A

◦ Originates in supportive and connective tissues – bone, tendon, cartilage, muscle, fat

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5
Q

Myeloma

A

originates in the plasma cells of bone marrow

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6
Q

leukemia

A

cancer of the bone marrow, considered “liquid cancer” or “blood cancer”

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7
Q

lymphoma

A

develops in the glands and nodes of the lymphatic system

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8
Q

general signs and symptoms

A
  • Unusual mass or swelling
  • Unexplained paleness or loss of energy
  • Sudden increase in tendency to bruise or bleed
  • Persistent, localized pain or limping
  • Prolonged, unexplained fever or illness
  • Frequent headaches, often with vomiting
  • Sudden eye or vision changes Excessive, rapid weight loss
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9
Q

when does leukemia occur?

A
  • when defective, nonfunctional leukocytes are produced in large numbers
  • Defective leukocytes migrate from the bone marrow into the bloodstream, displacing the healthy leukocytes
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10
Q

common signs and symptoms of leukemia

A

◦ Lymphadenopathy, hepatosplenomegaly, fever, easy bleeding or bruising, night sweats, weight loss

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11
Q

characterizations of leukemia

A
  • acute or chronic
  • lymphoid or myeloid
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12
Q

what is the most common pediatric cancer?

A

acute lymphoblastic leukemia (ALL)

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13
Q

characteristics of acute lymphoblastic leukemia

A
  • Defined by rapid proliferation of immature, nonfunctional leukocytes
  • If left untreated, death occurs quickly in these patients
  • Survival is 90% with chemotherapy (sometimes for 2 to 3 years)
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14
Q

neuromuscular and musculoskeletal complications of ALL

A

◦ Pain, paresthesia, muscle weakness, ROM deficits, impaired gross and fine motor performance, decreased energy expenditure, avascular necrosis, osteopenia, osteoporosis, learning disabilities

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15
Q

acute myeloid leukemia

A
  • Characterized by the presence of defective and nonfunctional granulocytes or monocytes
  • AML compromises the body’s immune system
  • Occurs most frequently in the 1st 2 years of life
  • Survival is ~63% with chemotherapy
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16
Q

lymphocytes include:

A
  • B cells: synthesize antibodies
  • T cells: activate phagocytes and inflammatory process
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17
Q

where do lymphomas occur?

A

in lymphatic structures: lymph nodes, spleen, bone marrow, thymus, lymphatic structures in the brain, GI tract and liver

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18
Q

common signs and symptoms of lymphomas

A

◦ Lymphadenopathy, fever and chills, night sweats, unexplained weight loss, persistent fatigue, anorexia,
pruritus

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19
Q

definitive diagnosis of lymphoma

A

made by examining a biopsy of lymph tissue for the presence of abnormal tissue architecture and lymphocytes

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20
Q

Non-Hodgkin’s Lymphoma

A
  • Heterogeneous group of blood cancers that adversely affects both B and T lymphocytes
  • Occurs more frequently in children over age 3
  • Survival rate 87%
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21
Q

signs and symptoms of non-hodgkins lymphoma

A

◦ Painless supraclavicular or cervical adenopathy, nonproductive cough, fatigue, anorexia and
pruritus

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22
Q

risk factors for non-hodgkin’s lymphoma

A

◦ Medical conditions or treatments that result in immune suppression, inherited
immunodeficiency diseases, and HIV infection

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23
Q

Hodgkin’s lymphoma

A
  • Less common
  • Identified by the presence of abnormal B lymphocytes called Reed Sternberg cells
  • Incidence increases in adolescence; most common in 15- to 19-year-old age group
  • Survival rate 97%
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24
Q

common signs and symptoms of Hodgkin’s Lymphoma

A

◦ Painless lymphadenopathy (cervical,
supraclavicular, axially, inguinal), mediastinal mass, fatigue, weight loss, anorexia, fever, drenching night sweats, hepatic and/or splenic enlargement

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25
Q

Brain and CNS tumors

A
  • Tumors are classified by the type of cell or tissue in which they originate OR by the tumor’s location within the CNS
  • Benign tumors can cause significant adverse effects –> growth may cause compression of adjacent healthy functioning tissue
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26
Q

Brain and CNS Tumors signs and symptoms

A

◦ Dependent on tumor location, developmental stage of the child, and presence of increased intracranial pressure ◦ Headache; vomiting (especially in the AM); vision, speech and hearing changes; worsening balance; unsteady gait; unusual sleepiness; weakness

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27
Q

Astrocytoma

A
  • Most common type of glioma - Arise in astrocytes (neural support cells)
  • Can be found in the brain and spinal cord
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28
Q

look at the signs and symptoms of astrocytomas slide if you want to

A

but we did just have a whole test on that sooooooo

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29
Q

meduloblastomas

A
  • Highly invasive embryonal tumor
  • Rare in adults but common in children (under the age of 10)
  • Typically arise in the cerebellum but can spread throughout the entire CNS via CSF
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30
Q

signs and symptoms of medulloblastomas

A

◦ Headache, vomiting, nausea, lethargy, dizziness, double vision, poor coordination, unsteady gait
◦ Can be related directly to the tumor or due to increased
intracranial pressure

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31
Q

Ependymomas

A
  • Tumors that arise from the glial cells lining the ventricular system of the brain or the central canal of the spinal cord - Can range in severity from low to high grade
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32
Q

What do ependymomas do

A
  • directly damages the brain tissue
  • can disrupt normal flow of CSF resulting in increased ICP and further CNS damage
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33
Q

signs and symptoms of ependymomas

A

◦ Headaches, seizures, nausea and vomiting, pain or stiffness in the neck, loss of balance, difficulty walking, weakness in legs, blurry vision, back pain, changes in bowel and bladder,
confusion
◦ Tend to vary from child to child

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34
Q

Neuroblastoma

A
  • Neuroendocrine tumors that arise from neuroblasts
  • Most commonly arises in and around the adrenal glands –> Can also develop in the abdomen, chest, neck and near the spine
  • Found throughout the developing sympathetic nervous system
  • Most commonly affect children under the age of 5, but can occur later
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35
Q

signs and symptoms of neuroblastoma

A

◦ Mass under skin, proptosis, periorbital hyperpigmentation, back pain, fever, unexplained weight loss, bone pain
◦ Neuroblastoma in abdomen: abdominal pain, non-tender mass, changes in bowel habits ◦ Neuroblastoma in chest: wheezing, chest pain, changes to the eyes incl. ptosis and anisocoria

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36
Q

retinoblastoma

A
  • Tumors that originate in the retina, can affect one or both eyes
    ◦ Arise when immature retinoblasts mature into
    cancerous cells Most frequently diagnosed in children younger than 4 years of age, 40% arise from a heritable gene defect
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37
Q

Retinoblastoma

A
  • Tumors that originate in the retina, can affect one or both eyes
    ◦ Arise when immature retinoblasts mature into
    cancerous cells
  • Most frequently diagnosed in children younger than 4 years of age, 40% arise from a heritable gene defect
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38
Q

signs and symptoms of retinoblastoma

A

◦ Pupil that appears red or white instead of black,
crossed eye, vision changes, enlarged pupil

39
Q

Wilms Tumor/ Nephroblastoma

A
  • Most common form of kidney cancer in children
  • Most frequently diagnosed in children younger than 5 years old
  • Tumors tend to be unilateral and large when diagnosed
40
Q

signs and symptoms of Wilms Tumor/Nephroblastoma

A

◦ Asymptomatic, unilateral abdominal lump or mass,
blood in the urine, fever, diarrhea, urogenital infections, systemic symptoms including fever and malais

41
Q

Osteosarcoma

A
  • Tumors found in the bone that arise from inappropriate growth and development of immature bone cells
    ◦ Bone tissue is weaker than normal bone tissue and more
    susceptible to fracture
    ◦ Typically affect the distal femur, proximal tibia or proximal humerus
42
Q

Signs and symptoms of osteosarcoma

A

◦ Pathologic fracture = typically first presenting sign
◦ Long-term bone or joint pain that worsens at night; pain in
the lower femur or just inferior to knee in active youth, visible swelling (if osteosarcoma is large enough)

43
Q

Treatment for Osteosarcoma

A

◦ Surgical excision of tumor; limb sparing
◦ Rotationplasty – in the event of an amputation
–> Use the foot/ankle as the knee joint in order to
assist with increasing functional mobility and
giving the child a functional, neurovascularly
intact knee joint
–> Greatly improves function and decreases energy
expenditure with a prosthesis

44
Q

Ewing sarcoma

A

Malignant cancer found in both bone and soft tissue
◦ Typically begins in the long bones of the pelvis, legs or
arms, but can occur anywhere - Most common in adolescents and young adults

45
Q

Signs and symptoms of Ewing sarcoma

A

◦ Pain and swelling near the affected area, bone pain
that worsens at night and with activity, fatigue, fever,
unintended weight loss, pathologic fracture

46
Q

flow cart of Ewing sarcoma

A

When it arises in the soft tissue –> greater chance of metastatic spread –> reduces the chance of cure and survival

47
Q

What is rhabdomyosarcoma

A
  • Soft tissue sarcoma that arises from the mesenchymal cells destined to become striated muscle cells
  • Tumors occur most frequently in head and neck region, urinary system, reproductive system, arms and legs
48
Q

Signs and symptoms of rhabdomyosarcoma

A

◦ Head and neck: headache, bulging or swelling of eyes,
bleeding in the nose, throat or ears
◦ Urinary or reproductive system: difficulty urinating,
blood in urine, constipation, mass or bleeding from
rectum or vagina
◦ Arms and legs: swelling or lump, pain in affected area

49
Q

what is cancer treatment dependent on

A

type of tumor present, location, and extent of disease

50
Q

why is it important to understand disease severity and treatment protocols

A

◦ Allows PT to better anticipate adverse effects of treatment
◦ Enables PT to develop plans consistent with current and ANTICIPATED impairments and activity
limitation

51
Q

Curative surgery

A

gross total resection
clear margins

52
Q

palliative surgery

A

relieve pain, minimize symptoms, QoL

53
Q

Implications for PT - need to understand

A

◦ Tumor location
◦ Impact to tissue – both healthy and cancerous

54
Q

Implications for PT - knowledge of

A

◦ Surgical procedure –> aids in identifying impairments and possible impairments
◦ Presence of indwelling devices –> caution not to dislodge during PT treatment

55
Q

Implications of PT - Anesthesia

A

◦ Pediatric patients may undergo anesthesia or light sedation for procedures, imaging studies and
radiation
◦ Following anesthesia, a child is at risk for falls –> consider this with scheduling your PT sessions

56
Q

do we really have to learn radiation again

A
57
Q

radiation implications for PT

A

fibrosis –> tissue injury

58
Q

review chemo if you want

A
59
Q

what is chemo most effective against

A

rapidly dividing cells

60
Q

Bone Marrow, Stem Cell and Cord Blood Transplants

A

Healthy marrow or stem cells are infused into a patient’s blood stream
- Goal of transplant is engraftment

61
Q

indications for Bone Marrow, Stem Cell and Cord Blood Transplants

A

◦ Patients with relapsed ALL and AML
◦ Patients with life-threatening disease
◦ Patients with neuroblastoma
◦ Some patients with brain tumors

62
Q

pre-transplant conditioning

A

◦ High doses of chemo and/or radiation (Total body irradiation for some patients)
◦ Leaves patients severely myelo- and immune suppressed

63
Q

post-transplant process

A

◦ Await engraftment
◦ Usually 12-17 days
◦ Patients are at higher risk of infection during this time b/c they are severely immunosuppressed

64
Q

Side Effects of Bone Marrow and Stem Cell Transplant

A

Graft versus Host Disease (GVHD) Mucositis Nausea/vomiting Venous Occlusive Disorder Steroid induced myopathy Sterility Cardiac and pulmonary disease High risk of life threatening infection Secondary malignancies

65
Q

theres a whole chart on impact of anticancer therapies on function

A
66
Q

cancer rehabilitation across the continuum

A

diagnosis –> IP admission –> OP follow up –> re-admissions –> clinic visits –> end of treatment –> survivorship

67
Q

lab values

A
  • know the Childs values and adjust as necessary
68
Q

2 most important ways to prevent infection spread

A

Cleaning all toys and mats prior to use and managing appropriate hand hygiene

69
Q

limitations in cardiopulmonary system

A

– identified through observation
◦ Increased work of breathing, nasal flaring, changes in skin color during activity
◦ Decreased willingness to walk – need to use stroller or be carried

70
Q

impairments in cardiopulmonary system

A

◦ Deconditioning
◦ Cancer-related fatigue
◦ Treatment related pulmonary complications

71
Q

deconditioning assessment

A

◦ General cardiopulmonary tests and measures
◦ HR, O2 saturation, BP
◦ Standardized test:
◦ 6 minute walk test
◦ Timed Up and Go
◦ RPE

72
Q

deconditioning intervention

A

◦ Aerobic
◦ Guidelines are the same as for typically developing children –> 60 minutes or more of physical activity per day at a moderate-to-vigorous
intensity
◦ Participation in sports and age-appropriate recreational
groups ◦ PE classes

73
Q

assessment of cancer related fatigue

A

parent fatigue scale
childhood fatigue scale
fatigue scale - adolescent

74
Q

intervention for cancer related fatigue

A

exercise
sleep hygiene
meditation

75
Q

why do pulmonary complications occur

A

Due to radiation therapy to chest or total body irradiation; complication of bone marrow transplant
Common diagnoses: radiation pneumonitis, pulmonary fibrosis, lung graft versus host disease, bronchiolitis obliterans

76
Q

assessment of pulmonary complications

A

◦ Chest wall measurements in various positions
◦ Posture
◦ Shoulder ROM
◦ Strength assessment specifically of core and proximal musculature

77
Q

integument changes

A
  • Bruising, pale complexion –> decreased platelets and RBC
    ◦ Poor wound healing, edema, open sores
78
Q

common integument impairments associated with treatment

A

◦ Scar adhesion
◦ Graft versus Host Disease (GVHD)
◦ Radiation changes/burns
◦ Poor wound healing

79
Q

graft versus host disease

A
  • Occurs when the transplanted stem cells give rise to blood cells, which recognize tissue of the recipient as foreign and reject those tissues
  • Antirejection drugs are given prophylactically during engraftment to prevent
  • Allogenic transplant
80
Q

Acute GVHD

A

◦ Rash, itchy skin, skin discoloration, dry mouth, mouth ulcers, diarrhea and weight loss, joint contracture, malabsorption
◦ Liver, skin and GI tract severely impaired
◦ Treated with high doses of glucocorticoids (side effects include infection, diabetes,
sleep disorders, osteoporosis, hyperglycemia and water retention)

81
Q

chronic GVHD

A

◦ Occurs ~ 1 year or more post-transplant
◦ Presents similarly to acute

82
Q

GVHD management

A

Skin injury prevention ROM Positioning Posture Mobility Joint play Flexibility

83
Q

common MSK impairments

A
  • steroid myopathy
  • avascular necrosis
  • post op ortho conditions
  • bone instability
84
Q

steroid myopathy

A

◦ Causes weakness to the proximal muscles of the upper and lower extremities
◦ S and S: symmetric, proximal muscle weakness, malaise, fatigue, absence of sensory complaints

85
Q

Late effects of MSK system

A

Stunted growth Bone pain Joint stiffness Decreased bone density Gait alterations

86
Q

When are neuromuscular symptoms notes in a child?

A

when they avoids movement of a particular body part, refuses to bear weight on an
extremity, does not respond due to not hearing, does not understand due to neurocognitive delay

87
Q

Common neuromuscular impairments

A

◦ Chemotherapy Induced Peripheral Neuropathy
◦ Ataxia
◦ Spasticity
◦ Hemiplegia

88
Q

Vincristine induced CIPN

A

can occur at any age, occur at within a week of receiving the 1st dose of vincristine or only after multiple doses have been administered

89
Q

CIPN Assessment

A

◦ Ankle DF ROM
◦ Achilles reflex
◦ Sensation/vibration
◦ Foot positioning/alignment
◦ Gait
◦ Pediatric modified Total Neuropathy Score (peds-mTNS)

90
Q

Pediatric modified Total Neuropathy Score (peds-mTNS)

A

◦ An assessment scale to measure CIPN in children with non-CNS cancers
◦ Assess sensory symptoms, functional symptoms, autonomic symptoms, light touch sensation, pin sensibility, vibration sensibility, strength
and deep tendon reflexes
◦ Most sensitive tool for assessing CIPN in peds

91
Q

Treatment for CIPN

A

◦ Focus on fine motor dexterity, gait and balance stability, ongoing parent education
◦ Use of AFOs
◦ No treatment can cure or reverse nerve damage

92
Q

Neurologic late effects

A

Neurocognitive impairments
◦ Lower IQ scores
◦ Poor attention/memory
◦ Poor eye hand coordination
◦ Behavioral problems Developmental delay
Pituitary issues
Seizures Headaches

93
Q

bottom line

A
  • Get to know your patient and their family – Build RAPPORT
  • Understand the medical treatment and the organ systems impacted by the treatment, identify impairments and functional limitations, treat accordingly!

Topics in Peds (15 decks)

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