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PEDS FINAL > Cancers > Flashcards

Cancers Flashcards

1
Q

Causes of cancer

A

(1) Genetics
(2) Failure of immune system to distinguish between normal and abnormal cells
(3) Carcinogens

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2
Q

Incidence

A
  • About 16K new cases of pediatric cancer diagnosed in children 0 - 19
  • White children highest incidence
  • 5 year survival rate for all childhood cancers is 80%
  • 10 year survival rate is almost 75%
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3
Q

Most common childhood cancers

A

(1) Leukemia
(2) Brain & Spinal tumors
(3) Lymphoma

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4
Q

Chemotherapy

A

(1) Antineoplastic drugs (to destroy abnormal tissue / get several different drugs - so there isn’t a resistance developed to that chemotherapy) –> Since tumors possess ability to develop resistance to chemo, a variety of drugs are used
(2) Pretreatment evaluation –> physiological preparation & psychological preparation. Chemo causes organ specific damage, for instance: the kidneys (are always blasted)… Before giving Adriamycin check for any heart problems
(3) Psychological preparation: ALL treatment is 2 to 3 years. Families need to be prepared for that
(4) Route: Oral, IM, IV, subcutaneous, intrathecal (into the spine)

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5
Q

When do the side effects of chemotherapy peak?

A

Side effects peak at 7 - 10 days

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6
Q

Side Effects of Chemotherapy

A

(1) Non-selectively kills rapidly dividing cells
(2) Bone marrow suppression - neutropenia (a decrease in neutrophils & platelets), anemia & thrombocytopenia (deficiency in platelets, takes longer for blood to clot)
(3) Gastrointestinal - N/V, mucosal ulcerations, esophagitis & constipation
(4) Alopecia
(5) Organ damage - specific to certain chemotherapy

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7
Q

How do doctors’ connect “central line” to RA?

A

With either a BrovIac OR Portacath –> NEVER THRU PERIPHERAL VEINS (cannot handle chemotherapy)

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8
Q

Bone Marrow & Stem Cell Transplant

A

Two Types: (1) Autologous (from self) / (2) Allogenic (from donor)

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9
Q

Preparation for Allogenic Transplant…

A

Try to suppress the immune system so there isn’t graft vs. host

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10
Q

Preparation for Autologous Transplant…

A

Try to wipe out whatever residual cancer is there before they harvest stem cells

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11
Q

Preparation for Treatment

A

Conditioning: Before transplant happens, they have what is called a “conditioning phase” where they wallop child with chemo and radiation. Then receives bone marrow or stem cells by IV infusion.

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12
Q

Engrafting

A

Usually occurs 14 - 28 days after transplant. If engraphment is going well, you will start to see an increase in WBC, RBC, and platelets

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13
Q

Graft vs. Host

A

Donor’s WBCs begin to attack patients’ - MUST be biopsied to make sure. S&S of Graft vs. Host are:

(1) Rash
(2) Vomiting
(3) Diarrhea
(4) Fever
(5) Altered Liver Enzymes

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14
Q

Biotherapy

A
  • Using part of the human body to destroy cells and applies them to cancer cells (tumor specific antibodies)
  • Group of drugs that stimulate body’s own immune response (Inteferon: signaling proteins that say “I am infected”)
  • Vaccines (HPV) / Helping to prevent cervical cancer
  • Molecular targeting (interference with metabolic pathways through enzyme destruction)
  • Gene therapy (replace faulty gene with normal cell)
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15
Q

Absolute Neutrophil Count (ANC)

A

Multiply # of WBC by the total % of neutrophils
(“polys” or “sags” are MATURE neutrophils / “bands” are IMMATURE)
*Normal ANC are in the 1,000s
Kids need 500 to go back to school

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16
Q

Tumor Lysis Syndrome

A
  • Lysis (explosion) of tumor cells and rapid release of contents of tumor cells into the blood stream.
  • Can result from cancer itself (leukemia) or side effect of treatment.
  • High levels of uric acid, K+, and phosphate
  • Can cause cardiac arrhythmias and renal failure
  • ALL and Non-Hodgkin’s Lymphoma
  • Have to correct this before child gets chemo
  • Allopurnol (IV) reduces levels of uric acid
  • Bicarb (IV) lowers K+ (potassium) as well as phosphate
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17
Q

Leukemia

A
  • Most common cause of childhood cancer
  • Proliferation of immature WBCs in blood forming tissues of body
  • More common in males than females
  • Peak at 2 - 6 years of age
    Long term disease free survival rates of ALL is 80%
18
Q

Leukemia - Pathophysiology

A

Alteration in the genetic makeup of WBC
Prevents maturation of WBC
**Immature WBCs replicate very quickly, and crowd out platelets and RBCs –> Lack bio-feedback mechanism

19
Q

Leukemia - Pathophysiology (cont)

A
  • Replicates quickly forming immature or blast cells in bone marrow, crowding cells (WBCs, RBCs, and platelets)
  • Replicate in great #s and are released into circulation
  • Blast cells take over marrow. RBC & platelet cell production is altered –> anemia, thrombocytopenia
  • Cells compete… and normal cells are deprived of essential nutrients of metabolism
  • Infiltration of bone marrow causes: anemia, infection, bleeding, peticia (below nipples), fractures and bone pain - causes the expansion of the bone
  • Cells infiltrate extra medullary sites (CNS, Liver, Spleen, Testies, Lymph Nodes)
  • Classified as type of cell involved: T, B, early pre-B, or pre-B
20
Q

Does child have ALL?

A

Check for % of “blasts” in bone marrow (“blasts” are immature). If there are 30% or more WBCs that are blasts - indicates child has ALL

21
Q

Favorable Prognostic Factors for ALL

A

(1) Leukocyte count of less than 50,000
(2) Older than 2, less than 10
(3) CALLA positive
(4) Pre-B cell
(5) Female

22
Q

Nursing a child with leukymia

A

(1) Do not give them any live vaccines, vircella (chicken pox) or MMR
(2) Never take rectal temps
(3) Make sure they are really, REALLY well hydrated

23
Q

Brain Tumors

A

Most common: solid tumor
Confined to brain & spine
Classified according to cell histology & rate of tumor proliferation

24
Q

Hallmark Symptoms (Brain Tumor)

A
  • Headache with morning vomiting related to child rising

- Ataxia, Visual disturbances, Fatigue, Loss of milestones, Poor school performance

25
Q

Brain Tumor (Management)

A

CT scan or MRI
Surgery
Chemotherapy
Radiation - avoided in children less than 3

26
Q

Brain Tumor (Post Op)

A

(1) Vital Signs - fever post op could be due to stimulation of hypothalamus. If it persists for longer than 48 hours, then start to think about infection
(2) Neuro - FIRST sign something is wrong is a change in the patient’s LOC

27
Q

Brain Tumor (Medications)

A

(1) Opioids - but need to make sure you are not masking their LOC
(2) Manitol - osmotic diuretic
(3) Dextametadone - steroid to decrease inflammation
(4) Antibiotics

28
Q

Neuroblastoma

A
  • Most common malignant extra-cranial solid tumor of childhood
  • Occur in 1 / 10,000 live births
  • 1/2 of all cases under 2 (2+ already have metastasis)
  • Under 12 months, may experience spontaneous remission
  • Males > Females
  • More common in whites
  • 80% present with metastasis with symptoms in non-primary sites.
29
Q

Neuroblastoma (Pathophysiology)

A

(1) Originate from neural crest cells which normally develop into sympathetic nervous system and adrenal medulla
(2) Most common sites: Adrenal gland (on top of kidneys) and Retroperitoneal Sympathetic Chain (bottom of lower back)

30
Q

Neuroblastoma (Clinical Manifestations)

A

65% have abdominal mass & protuberant firm abdomen
Impaired ROM & mobility
Pain & Limping
Impaired bladder & bowel functions
Chest: cough & respiratory compromise
Neck: facial, periorbital edema & bruising
Spinal Chord: inability to walk
Fever & Hypertension

31
Q

Cause of Neuroblastoma

A

Chromosome #1

Amplification of oncogene called MYCN, which causes uncontrolled cell growth

32
Q

How do we diagnose Neuroblastoma?

A 
Chest X-Ray
CT of chest, abdomen, and pelvis
Bone marrow aspirations & IVP
Skeletal survey
Tumor samples
** Urinary excretions of catecholamines. VMA as well as HVA will be in urine
33
Q

Hodgkins Disease

A

Most common in adolescence and young adult (15)
Originates in lymphoid system
Can spread from lymph nodes to non-nodular sites, including: liver, spleen, bone marrow, LUNGS)

34
Q

Hodgkins Disease - Staging

A

Dependent on:

(1) # of lymph node sites
(2) extra nodular disease
(3) history of symptoms

Staged 1 - 4

35
Q

Hodgkins Disease - Clinical Manifestations

A
  • Asymptomatic, enlarged cervical or supra-clavicular lymphadenopathy (NON TENDER)
  • Persistant non-productive cough
  • Abdominal pain
  • Low grade, intermittent fever
  • Weigh loss, night sweats (if stage B)
  • Nausea
  • Pruritus - itching
36
Q

How do you diagnose Hodgkins Disease?

A

Biopsy of lymph nodes: Sternberg-Reed cells (“owl eyes”)
CT scan & Gallium scan
X-ray with chest, abdomen, & pelvis
Bone Marrow

37
Q

Hodgkins Disease - Survival?

A

**Chemo, radiation either alone or combined. Nothing to surgically remove except sometimes the spleen

Stages I & II –> 90%
Stage III –> 80%
Stage IV –> 70%

38
Q

Osteogenic Sarcoma

A 
Most common bone cancer
Peak at 10 - 25 years of age
Primary sites: more than 1/2 in femur
9% of all childhood cancers
In about 20% disease has spread by time kid is diagnosed
39
Q

Osteogenic Sarcoma - Clinical Manifestations

A

(1) Progressive, insidious, or intermittent pain at tumor site relieved by position change (flexion makes it feel better!)
(2) Palpable mass
(3) Limited ROM
(4) Pathologic fracture at tumor site

40
Q

How to diagnose Osteogenic Sarcoma?

A 
Rule out other causes
History regarding the pain
CT scan or MRI
Bone Scan
Needle or surgical bone biopsy
**CBC serum Alkaline Phosphate (ALP) & Lactase Dehydrogenase (LDH). The higher these #s, the POORER the patient responds to treatment
41
Q

Osteogenic Sarcoma - Management & Prognosis

A

Surgery & Chemo

UNRESPONSIVE to radiation

PEDS FINAL (5 decks)

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