Cancer

Question 1

define leukocytosis

Answer 1

• WBC > 10,000
  
  • usually indicates infection, inflammation, tissue necrosis, or leukemic neoplasia

Question 2

define leukopenia

Answer 2

• WBC <4,000
  
  • occurs in many forms of bone marrow failure

Question 3

how to determine the absolute neutrophil count (ANC)

Answer 3

• tells us the ability to fight infection
• first add the total percentage of “neutrophils”–“polys” or “segs” or “bands”
  
  • then change that total percent to a decimal and multiply by the total # of WBCs
  • so if WBC is 2000, and there are 10% neutrophils and 7% bands, then we have 17% (0.17) total neutrophils
    
    • 0.17*2000=340
• if ANC is <500, then the pt is at risk for:
  
  • infection (sepsis)
  • general malaise
  • dehydration
  • seizures (young infants and children)
  • invasion of organisms producing secondary infections
    
    • we would put these clients in protective isolation–limit visitors, tell them to avoid crowds

Question 4

leukemia

Answer 4

• S/S: child growing and thriving, then all the sudden dec in status
  
  • anemia, dec WBC, dec plt, bone/joint pain, thinning/weakening of bones, hepatosplenomegaly, LN involvement, petechiae/bruising
• confirm dx by:
  
  • bone marrow biopsy: wear a mask, sterile procedure, go into big bone in hip, monitor O2 sats
  • CBC with diff
  • LP: allows us to see if leukemia has infiltrated the CNS
• tx: chemo and radiation
  
  • SEs: alopecia (teach that hair may grow back different than pre illness), bone pain, diarrhea, dry skin, ulceration of mucosa
  • tx protocol is individualized based on the pt’s numbers

Question 5

what is complete remission determined by?

Answer 5

• absence of clinical S/S
• <5% blast cells in the bone marrow

Question 6

chemo drugs

Answer 6

• these meds destroy cells
  
  • have to use a cocktail of drugs inorder to attach the cells at different stages
  • ie. vincristine: neurotoxic–>can develop foot drop
  • ie. corticosteroids

Question 7

tumor lysis syndrome

Answer 7

• destruction of lots of tumor cells leads to electrolyte problems
  
  • hyperuricemia
  • hypocalcemia
  • hyperphosphatemia
  • hyperkalemia
  • uremia
• the crystallization of uric acid in the renal tubules can lead to acute renal failure and death

Question 8

tx of tumor lysis syndrome

Answer 8

• early identification of pts at risk
• serum chemistry and urine pH frequently
• strict I & O
• aggressive IV fluids
• meds:
  
  • allopurinol–dec uric acid production and promote excretion of by products of purine metabolism

Question 9

complications of cancer

Answer 9

• tumor lysis syndrome
• anemia
• thrombocytopenia
• leukopenia and infection
• pain

Question 10

Wilm’s tumor (nephroblastoma)

Answer 10

• malignant tumors of the kidney
• most often affects young children
• can be u/l or b/l
• possible genetic inheritance
  
  • autosomal dominant
• also assoc with other congenital anomalies
  
  • aniridia: absence of the iris in the eye
  • hemihypertrophy and GU anomalies

Question 11

clinical manifestations of Wilms’ tumor

Answer 11

• hallmark sign: abdominal swelling
• painless swelling or mass w/in tumor
• hematuria
• anemia
• HTN: tumor in kidney so affecting renin release
• weight loss
• fever
• metastasis to lungs–>dyspnea, cough, SOB, and pain in the chest

Question 12

diagnostics with Wilms’ tumor

Answer 12

• x ray: abdominal u/s
• MRI, CT scan
• bone marrow aspirate: looking for infiltrates
• hematological studies
• urinalysis

Question 13

what would be tx therapy if Wilms’ tumor was u/l?

Answer 13

• take out the kidney with the tumor!

Question 14

preop care for a child with wilms’ tumor–palpation of abdomen

Answer 14

• place sign over bed: “Do not palpate abdomen”–>can rupture tumor and spreads tumor cells
  
  • also keep child from falling and rupturing
  • S/S of rupture:
    
    • pain: acute and localized in abdomen
    • hemorrhage:
      
      • cardiac: inc HR, widening PP, pallor
      • abdomen: acute localization of pain, distention, guarding tummy area
      • neuro: changes in LOC, irritability, restlessness, disorientation

Question 15

preop care for Wilms’ tumor

Answer 15

• take care in bathing and handling of child
• obtain necessary blood work
• monitor BP
  
  • use appropriate BP cuff
  • monitor urine output
  • daily weight
• assess child for HTN:
  
  • bounding pulses
  • inc irritability and HAs
  • changes in behavior
  • flushing

Question 16

postop care for after resection of Wilms’ tumor

Answer 16

• same as any child after abdominal surgery
  
  • maintain IV
  • accurate I & O
  • possible NG for decompression
  • pain mgmt
  • frequent eval of V/S, esp BP
  • pulmonary hygiene
    
    • IS, cough, deep breathe, chest physio
• prepare for administration of chemo/radiation
• long term:
  
  • only have one kidney–avoid contact sports
  • prevent UTIs–esp in little girls

Question 17

osteogenic sarcoma/osteosarcoma

Answer 17

• osseous bone tumor that arises in the mesenchyme
  
  • most common malignant tumor in childhood
  • most often in lower extremities, in areas that have rapid growth
  • often discover tumor due to fx b/c the bones have thinned
  • metastases most commonly occurs in lungs and other bones
    
    • lymphatic system and liver may also be involved
• occurs in preadolescence through young adulthood

Question 18

diagnostics for osteosarcoma

Answer 18

• H&P
• xray
• biopsy

Question 19

therapeutic mgmt of osteosarcoma

Answer 19

• amputation: amputate above site of tumor
• limb salvage: w/ cadaver bone
• chemo
• phantom limb pain
  
  • mirror therapy
  • narcotics
• PT: to learn about crutches, prosthesis
• often we will cure initial dx, but another cancer (like lymphoma most frequently) may show up

Question 20

cured vs truly cured

Answer 20

• cured:
  
  • cessation of therapy
  • continuous freedom from clinical and lab evidence of cancer
  • minimal or no risk of relapse
• truly cured:
  
  • free of dz
  • developmentally commiserate w/ their age
  • well adjusted despite having had cancer