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Cancer Flashcards

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1
Q

What is Leukemia?

What systems does Leukemia affect?

A

Over production of immature WBC that don’t function as they should (blast) and use up all the space/energy of others cells

Anemia & thrombocytopenia
Infection risk rt Neutropenia

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2
Q

What is a sign of anemia with Leukemia?

A

Bruising very easily

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3
Q

Acute Lymphoblastic Leukemia

What age ?

A

Most common cancer in kids (ALL)

3-5 year olds (younger kids)
- it can be in older kids too though

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4
Q

Acute Myelogenous Leukemia
What age?
What association?

A

Most commonly found in adolescents

Associated with genetic disorder (down syndrome, degeorge syndrome)

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5
Q

Why does joint pain happen?

A

Lack of room for cells and bone marrow

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6
Q

Hyper-metabolism of Leukemia?

A

Weight loss & anorexia leading to fatigue due to rapid cell growth.
Metabolic starvation then occurs.
Uric acid increases from cell destruction and plugs renal tubules.

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7
Q

What is leukemia’s effect on CNS?

A

CSF may have blasts cells and this can increase ICP and affect cranial nerves.
- usually doesn’t happen but it can

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8
Q

Reticuloendothelial effects of Leukemia?

A

Clean up of body systems in organs in spleen and liver try to take care of cell destruction by products and so they enlarge.

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9
Q

Biggest bone marrow concerns?

A

Neutropenia = infection
Anemia
Thrombocytopenia = bleeding

The WBC are the problem but it affects all the cells.

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10
Q

How do we piece together leukemia?

A

Bruising and hx of illness being frequent accompanied by weight loss and exhaustion.
- they just won’t feel well.

You may even just pick it up on the blood work though.

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11
Q

Leukemia diagnosis steps

A

1) Bone marrow aspiration to analyze bone marrow and cells to see the type
2) Lumbar puncture to get CSF to see if there’s infiltration into the CNS
3) Labs for CBC, liver, and renal functioning

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12
Q

What is the purpose of doing the lumbar puncture in the CNS for treatment?

A

It can help you see if the CSF is affected & if you need treatment or prophylactic treatments

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13
Q

Why do labs for liver and renal in Leukemia diagnosis?

A

Treatment can cause toxicity in these organs so we need the baseline to gauge off any change in treatment

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14
Q

What is the Induction of Remission stage of treatment for leukemia?

What outcomes do you want

A

First and immediate treatment with high dose chemotherapy to destroy as many cancer cells as possible

Less than 5% blast present at least
Less cancer symptoms

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15
Q

CNS prevention of Intrathecal meds

A

Second stage

Med catheter administers meds into CSF to prevent infiltration of cancer cells in to the column

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16
Q

Consolidation or intensification period

Goal?

A

Third stage where you just continue to try to kill the cancer cells that is periodic

We want to destroy all cells and get them to state of remission (no malignant cells)

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17
Q

Delayed intesnifcation

A

fourth stage but similar to third stage

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18
Q

Maintenance stage

How can family be involved?

A

Fifth stage
Preserve the remission of cancer
Family can really help out with this and give meds and injections.
Lasts 2-3 years

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19
Q

Off treatment

A

Sixth stage or last stage
You go off cancer treatment but you still monitor for cancer because relapse can happen
- and you have to start over

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20
Q

Relapse considerations

A

Combination of remission treatment and using meds from research trials
Stem cells transplant if they can make it to maintenance stage again

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21
Q

Will they do stem cell treatment for Acute Lymphoblastic Leukemia?

What about Acute Myelogenous Leukemia?

A

No because it responds to chemo

Not responsive to chemo as much so stem cell treatment is quick BUT they need the chemo and radiation to wipe out abnormal cells before the stem cells can work

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22
Q

How are drugs used in treatment?

A

Combinations are commonly used

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23
Q

Vincristine Medication

BMD?

A

Very common

Yes BMD

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24
Q

BMD

Concerns?

A

BMD = Bone marrow depression
- this can make the cell aspect of Leukemia worse

Bleeding , oxygenation, infection risk goes up with meds that have BMD
- kids are even hospitalized bc the drugs harm them

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25
Neurotoxic drugs? Side effects?
Vincristine Cytrabine Radiation treatment (affects nerves) - Jaw pain complaints due to tri-geminal nerve
26
G-CSF medication indication? 29:30
Increases neutrophil production and maturation. | in order to balance the offset of other meds
27
Can we do rectal temps or suppositories on leukemia patients?
No due to risk of bleeding
28
What do we need to keep in mind for infection prevention?
Hand washing Sterile technique and PPE Low bacteria diet
29
What type of diet for Leukemia patients? And why?
Low bacteria diet - no raw veggies Prefer an orange as opposed to an apple bc you peel off the orange and this decreases risk of infection
30
What are environmental risk factors for leukemia?
Plants and flowers that have bacteria
31
Likely med leukemia patient will be on for prevention of infection
antibiotics
32
What do we need to consider for development with leukemia?
We need to treat them but support their development
33
Why do we need to provide mouth care for leukemia frequently?
Due to mucosa being affected and having ulcerations | - use sponge bc it is soft
34
Neurotoxicity's affect on the body
Constipation Foot drop, weakness, and numbness Jaw pain Post radiation somnolence
35
Constipation neurotoxicity
fiber in diet | stay hydrated
36
Nerve neurotoxicity
Watch for the extremely signs and be aware for falls bc that causes bleeding
37
Post radiation somnolence neurotoxicity
Know what is fatigue and what may bee alterations in level of consciousness
38
What is Lymphoma? What are the types?
Affects lymphatic and hematpoetic systems Hodgkins and Non-hodgkins
39
Hodgkins differentiating characteristics
Reed Sternburg cells are present with Hodgkins.
40
Hodgkins Lymphoma age
Adolescents and young adults
41
What is a big sign of Hodgkins Lymphoma?
Large lymph nodes that are not painful in supraclavicular or cervical area
42
Hodgkins Lymphoma Diagnosis
Lymph angiogram with dye to see the node drainage Biopsy to see exact cells Laparotomy to see if there is metastasis to spleen - this can indicate prognosis to tx
43
Hodgkins Lymphoma treatment
Chemo and radiation in combination with one another
44
Hodgkins Lymphoma outcomes What are the risks?
If found early, can be very successful. New cancer development with age can occur though from radiation and chemo
45
What developmental considerations do we need for Hodgkins Lymphoma pateints?
Remember they are adolescents and young adults. - body image - reproduction - relationships - plan for side effects is very important
46
What can we do for reproduction issues with Hodgkins Lymphoma treatment complicatoins?
Males can store sperm With both females and males you need to educate them up front as to not have shock down the road
47
How to care for skin in Hodgkins Lymphoma treatment ?
Keep skin clean with mild sop No lotions The skin is burning essentially for chemo and radiation
48
Possible nursing needs after Hodgkins Lymphoma diagnosis/treatment?
Wound care Pain Fluids
49
When does Non-Hodgkins Lymphoma occur?
In younger kids
50
Non-Hodgkins Lymphoma characteristics
Diffuse Less differentiated cells (no reedsternburg) More metastasis bc it is rapid Medialstinal area
51
Non-Hodgkins Lymphoma | Medialstinal area concern
Lungs heart thyroid behind sternum this area can be most affefcted with metastisis
52
Diagnosis of Non-Hodgkins Lymphoma
Biopsy Bone marrow aspirate Xray Lumbar puncture - for CSF presence
53
Treatment of Non-Hodgkins Lymphoma
``` Radiation Chemo (induction, consildation, maintence - very similar to leukemia) ```
54
Main focus of Non-Hodgkins Lymphoma ?
Symptoms treatment for whatever needs - skin - nerve damage - side effects of chemo
55
Brain tumors stats
Most common solid tumor in kids | Second most common cancer in children
56
Brain tumor age Where are most brain tumors at
1-10 years old In brain stem and cerebrum (not cerebellar ) (infratentoria)
57
Brain tumor plan is based off of..
Location, size, tissue access , ability to remove it
58
T/F | Brain tumors are always malignant
false. But they do get treatment bc it is in the brain and has an effect and trying to prevent secondary injury from even occurring
59
Brain tumor concerns dictating treatment
Pressure ICP Location (if its in the middle, can we remove it?)
60
S&S of braintumor
``` Headache Atoxia Motor weakness - from pressure on surrounding tissue N/V - pressure & ICP in general Cranial enlargement Papilla edema of eyes - pressure Seizures - pressure VS changes Hormonal changes - pressure on pituitary ```
61
Will they always surgically remove a brain tumor? How do they know?
Depends on size and location Radiology to make sure
62
Post op brain tumor concerns
``` Edema Neuro assessments for ICP, MAP - LOC - PERRLA Head circumference ``` Meds can impact assessment response as well
63
How do we figure positioning for brain tumor patients?
Size and location of tumor By removing the brain tissue, if you position the brain you can cause shifting of tissue to empty space. - edema, inflammation, tissue damage from this due to no perfusion possibility
64
What precautions do brain tumor patients need to begin? | Meds?
Seizure precautions bc of relationship with the brain And give anticonvulsants
65
Fluid balance concerns for brain tumor?
Want to give fluid to get perfusion but also not too much bc of the ICP concern - very careful I&O - know the amount of fluids of surgery and if they were ahead or behind .5-1 cc/kg/hr then 1-2 its never normal to have no urine output
66
What if the brain tumor is too large before surgery? What can this cause?
They can shrink it with radiation and chemo bc that way , they don't have to hurt surrounding tissue. Parent's anxiety bc they want that tumor out but they need to be educated on the shrinking process being good
67
What if they can't access the brain tumor with surgery?
Shrink it with chemo and radiation here
68
If your patient is recieving radiation, and you see a marking of sharpie or marker should you wipe it off?
NO do not remove it. This is marked for a specific purpose which is the locaiton of radiation
69
What are Neuroblastomas?
tumors on tissue of the neural crest - adrenals - sympathetic ns that are found in abdominal/retroperitoneal area usually
70
What are Neuroblastomas like?
Very solid
71
Symptoms of Neuroblastoma's? Adrenal location?
Depends on where the tumor is adrenal - Catecholime release impacting BP
72
Why are Neuroblastoma often found too late?
They are a silent tumor bc they don't develop symptoms.
73
Neuroblastoma diagnosis
MRI Pet scan Liver and renal function 24 hours urine for catecholamines (VMA/HVA)
74
Neuroblastoma primary treatment
Surgical removal - depends on metastasis Chemo/radiation followed up - due ot metastasis Bone marrow transplant - if they feel it can help
75
Neuroblastoma symptoms
Aniridia = absence of iris Mass in abdomen that crosses midline Mediastinal - dyspnea and obstruction Spinal cord - paralysis below level of tumor Pallor, anemia, weakness, wt loss
76
What will post op care be like of Neuroblastoma's?
Depends on the surgical site
77
What to monitor for Neuroblastoma rt adrenal?
Hypertension so do BP carefully | Administer antihypertension meds
78
Teaching with Neuroblastomas?
Chemo side effects | Blood counts?
79
Prognosis of Neuroblastomas?
5 years after diagnosis younger than 1 yr is 90% Older children advanced stage so less chance of cure
80
What is Wilms Tumor?
Nephroblastoma in one or both kidneys that compresses | - does not cross the midline
81
Wilms tumor signs
hypertension rt to pressure in adrenal abdominal distention UA shows rbc in urine Anemia and pallor
82
Wilms tumor metastis
Lungs | - SOB, coughing, chest pain
83
Diagnosis of Wilms tumor
``` CT/MRI Renal Liver CBC UA ``` Cardiac eval - ECHO Chest CT/MRI - both for metastisis
84
Treatment of Wilms tumor Prognosis?
Depends on size - chemo and radiation can shrink it Large abdominal incision surgery Follow up with chemo again If diagnosed early , things go well.
85
Pre-op WIlms tumor Palpation monitor abdomen parent education
Do not palpate and disrupt monitor BP before and after wound of abdomen - drainage and care what comes after
86
Rhabdomyosarcoma
soft tissue solid tumor that can be found anywhere with striated muscle - common in head and eyes orbits
87
Signs and symptoms
Depends on location
88
Rhabdomyosarcoma diagnosis
``` CT/MRI Chest x ray Bone liver scan Biopsy kidney/liver functioning ```
89
Rhabdomyosarcoma treatment
Shrink if they can - radiation , chemo REsection follow up with radtion and chemo
90
Rhabdomyosarcoma prognosis
depends on if it metastized
91
Bone tumors
Osteosorcoma | Ewing sarcoma
92
Osteosorcoma
peak incident 10 years - adolescent Long bones - femur, humerus
93
Ewings sarcoma
School aged kids - adolescent long bones as well - femur, humerus
94
Prognosis of bone tumors?
Bones supply cells into blood system and metastization is high
95
where do bone tumors metastize
lungs
96
bone tumor symptoms
pain, weakness in limb - may even avoid walking warm to touch edema
97
Osteosarcoma
xray renal/liver scans ct/mri
98
amputation for Osteosarcoma
remove and use plates and screws to preserve the limb - might have to do this there's also prosthetics
99
Why do Osteosorcoma need chemo
bc the metasitization is high
100
Osteosorcoma prognosis
not great
101
Limb salvage criteria
no neurovascular to spare nerves no contamination no infection no patho fractures done to improve quality of life
102
Ewings sarcoma
found in the soft marrow of the long bones
103
Ewings sarcoma signs
tenderness, swelling, erythema fractures pleural effusion if in ribs - breathing is compromised
104
Ewings sarcoma diagnosis
imaging skeletal survey to find other tumors serum LDH Chest c ray for metastizaiton
105
Ewings sarcoma in young or old , male or female has better prognosis? LDH?
young female high ldh means poor prognosis
106
treatment of Ewings sarcoma ?
radiation chemo amputation of area with malignancy
107
Acute tumor lysis sydrome labs
from rapid lysis of cells from chemo - a oncological emrgenciues cells are lysed and they release their content into body - increase uric acid - increase phosphate (decreases calcium) - increased potassium
108
Acute tumor lysis | develops
flank pain lethargy renal failure due to products blocking of tubules of cell contents lack of perfusion
109
Acute tumor lysis managment
hydration - give chemo in monring for this alkalinzation - acidodic from cell break down allopurinol - reduces uric acid exchange transfusion to pull of products from cell breakdown - crrt to suuport renal function?
110
Hyperleukocytosis
wbc count over 100k and causes micro-occlusion and infarctions
111
Hyperleukocytosis effects
respiraotry distress neuro changes - LOC< visual distubrances, agitation, confusion, atoxia, delierum
112
Hyperleukocytosis management
``` cytroreduction hydratoin urinary alkalinazaiton allopurinal leukophersis or echange transfusion ```
113
infection risk rt sepsis
change in clotting so look for abnormal bleeding and clotting we want to prevent infections
114
Hemorrhagic cystitis from cytoxan
chemical burn to the lining of bladder that can cause pain and bleeding - give this med in morning to keep the bladderlfushed to prevent this - void frequently - mesna to decrease inflammation of the chemical as it gets excreted through the body
115
how to prevent hemorrhage
know platelets and report hem IV and IM can be a problem oral sponge
116
Alopecia
loss of hair - help them know the resources and educate them on getting it before - head covering options - hygiene is important - protect from sun

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