KID CANCER

Question 1

What are some reasons kids might develop cancer?

Answer 1

Unlike environmental factors in adults, many kid’s cancers occur in unexposed areas
Causes for kids include:

Exposure to harmful substances in utero (radiation)
Secondary smoke and asbestos
Cell mutation theory
Genetics- family history of cancers
Viruses
Previous treatment for cancer may cause secondary cancer

Question 2

What are the signs that a child may have cancer?

Answer 2

Often symptoms non specific in kids and vary depending on type of cancer sometimes cancer is growing for awhile before diagnoses (parental guilt)
Weight loss (cachexia)
Loss of appetite
Fever 
Fatigue
Easy bruising, petichae
Nose bleeds
Change in bowel or bladder habits
Skin changes

Question 3

Main cancers in kids

Answer 3

Leukemias (acute lymphocytic) = 75% of cancers (age 2 to 6 yrs)
Lymphomas- 15%
Neoplasms of brain
Neuroblastomas
Bone tumors: osteogenic sarcoma, Ewings (femur) metasteses often common at diagnosis: vasculature
50% survive 5 yrs or longer: better in older adolescents

Question 4

How to diagnose?

Answer 4

Leukemias (acute lymphocytic) = 75% of cancers (age 2 to 6 yrs)
Lymphomas- 15%
Neoplasms of brain
Neuroblastomas
Bone tumors: osteogenic sarcoma, Ewings (femur) metasteses often common at diagnosis: vasculature
50% survive 5 yrs or longer: better in older adolescents

Question 5

Chemotherapy principles

Answer 5

Mostly given by central line by trained nurses
Phases: can last up to a total of 3 or 4 years** lifestyle affects: age and stage
Induction phase: aims to provide complete remission
Consolidation phase
Maintenance phase
Vesicant effects
Protective measures
Think of your CTZ and antiemetics:
Ondansetron has revolutionaized cancer care
Many regimens require initial hospital admission X 1 month then aim to treat at home
So many cells destroyed = high build up of uric acid
Block kidneys- need allopurinol to reduce formation of uric acid and aid kidney function
Chemo drugs can’t cross blood brain barriers so need to give them intrathecally (via Lumbar puncture)

Question 6

Complications

Answer 6

Neutropenia and Septicemia
ACT fast: Temp?? cultures, IV antibiotics X 3, hemostasis
Fluid Volume Deficit/Nausea and Vomitting: IV hydration, ins/outs, assess
Stomatitis: great mouth care, bicarb, morphine?
Thromocytopenia: bloodwork, assess
Malnutrition: total parenteral nutrition sometimes needed (TPN), dietician, small meals, timing of anti-emetics, IV fluids with KCL
Cushingoid effects from steroids

If kids are on steroids as part to their chemo protocol they may not mount a fever- they will become lethargic, pale and you will get a sense that something is wrong- need to act very fast as onset of infection to full blown code from septic shock may be in a few hours: blood cultures from central line and also peripherally (you want both cultures as the infection may be limited to the central line or more importantly spreading systemically). We also do urine and throat cultures and most kids have standard orders for triple IV medications. Need to think about this- give some push, order of meds, speed and get moving fast.

Thrombocytopenia- kids platelet counts drop fast- they will need platelet transfusions- one hourly post platelet count drawn from the CVC- need to think about soft tooth brushes, checking for blood in urine, not straining for stools (stool softeners, high fiber diet, fluids etc), teen girls may hemorrhage with their menses so may be put on the pill.