Child with Cancer

Question 1

Most common childhood cancer

Answer 1

Leukemia

Question 2

What Causes Cancer

Answer 2

Carcinogens
Immune Disorders
Chromosome abnormality

Question 3

History Assessment

Answer 3

Presenting illness
Previous illnesses
Family history or cancer
Present state of health of immediate family
Developmental milestones
Psychosocial or family concerns
ASK ABOUT ANY DEATH UNDER 50

Question 4

Cardinal Symptoms of Cancer

Answer 4

Unusual mass or swelling
Unexplained paleness or loss of energy
Sudden tendency to bruise
Persistent, localized pain or limping 
Prolonged unexplained fever or illness
Frequent headaches and vomiting
Eye or vision changes
Excessive and rapid weight loss

Question 5

Staging

Answer 5

Diagnoses of cancer
Type, severity and spread of cancer cells at the time of diagnosis
All tests are painful – use sedation
Diagnosed at a later stage – poor prognosis

Question 6

CBC with ANC

Answer 6

CBC with Absolute Neutrophil count
Degree of anemia and infection
<500 IS CRITICAL
**Leukemia

Question 7

Electrolyte Panel

Answer 7

Type of diagnostic test
Look at renal and liver function
Disruption of healthy cells
Elevated uric acid in leukemia

Question 8

Tumor Markers

Answer 8

Type of diagnostic test
Metabolities or part of the cancer cells detected in serum or urine
**Neuroblastoma

Question 9

Lumbar Puncture

Answer 9

Type of diagnostic test
Conscious sedation
Lie still and flat after – to decrease spinal headahce
Monitor site for bleeding and infection!
Routinely used for metastasis in the brain for leukemia

Question 10

Bone Marrow Aspirate

Answer 10

Type of diagnostic test
Conscious sedation
Prep children! They will not feel it but could be awake
Large band aide on their hip
Monitor for bleeding
Detective test for leukemia and solid tumors
Aspirate the bone marrow – fatty not red

Question 11

CT and MRI

Answer 11

Type of diagnostic test
CT, MRI and PET
Being used to visualize tumors and begin the diagnostic
Do not hurt but you have to stay still

Question 12

Treatment: Surgery

Answer 12

Used to remove all the tumor or debulk it

Most successful when the tumor is encapsulated and has not spread

Question 13

Treatment: Radiation Therapy

Answer 13

Curative or relief of symptoms by shrinking the tumor
Radiation sickness is the anorexia and NV that occurs most with GI irradiation
Antiemetic prior to procedure may help
Skin is tender!

Question 14

Treatment: Chemotherapy

Answer 14

Primary form of treatment
Need a central line – lessons the chance of skin or tissue damage and irritation
Anticipate pt symptoms!!
Look at ANC counts

Question 15

Treatment: Biotherapy

Answer 15

Use remodeled antibiodies to target cancer cells only

Limits side effects of the therapy

Question 16

Treatment: Bone Marrow & Stem Cell Transplant

Answer 16

Treatment choice for some cancers (Leukemia)
Total body irradiation and intensive chemo to kill all cancer cells and all bone marrow cells
Need a good match!!
At risk for Graft VS. Host
Use cord blood for hematopoietic stem cell is on the rise

Question 17

Leukemia

Answer 17

Most common childhood cancer
Disease of the bone marrow and lymphatic system
Unrestricted proliferation of immature WBC’s in the blood
AML and ALL are the most common
ALL has a better prognosis
Can infiltrate CNS via blood or lymph system – neuro signs and symptoms
Frequent LPs to monitor for cells in the CSF

Question 18

Leukemia Goals

Answer 18

Remission
Considered “cured” if no cancer cells after 5 years
Harder to achieve remission if cancer cells reappear within 5 years

Question 19

Leukemia Treatment

Answer 19

Primary chemo, some radiation

Bone marrow and stem cell transplant to consider

Question 20

Hodgikn’s Lymphoma

Answer 20

Neoplastic disease originating in the lymphoid system and primarily affects the lymph nodes
Spread to spleen, liver, bone marrow, lungs and eventually the CNS
High degree of metastasis because next to blood vessels
Look into sperm banking and ovarian tissue

Question 21

Hodgkin’s Lymphoma Symptoms

Answer 21

Anorexia, malaise, night sweats, weight loss, fever, one painless cervical lymph node
+ Reed Sternberg Cells

Question 22

Hodgkin’s Lymphoma Treatment

Answer 22

DX: Lymph node biopsy
Chemo and radiation
Possible bone marrow transplant

Question 23

Non- Hodgkin’s Lymphoma

Answer 23

Malignant disorder of the lymporectiular system
Caused by T-cell abnormalities
Highly aggressive and malignant cancer
Fever, pallor, weigh loss, new onset of respiratory distress, recent transplant
HIV – high risk

Question 24

Non- Hodgkin’s Lymphoma Treatment

Answer 24

Diagnosed at a later stage– through biopsy
More treatment over a longer period of time
Aggressive chemo and radiation per protocol
6-24 months of drugs
Intrathecal chemo due to high rate of CNS metastasis
Symptom management
Treat patient and family as a whole

Question 25

Brain Tumors

Answer 25

``` Astryocytoma, Medulloblastoma or Brain stem glioma (Least to most severe) Symptoms are rare and overlooked Presentation based on tumor location Parent guilt for lack of early treatment ```

Question 26

Brain Tumors Treatment

Answer 26

CT is the first step for diagnosis Surgery and biposy -- try to remove all if possible Possible long term neuro defects not seen before surgery -- infection, seizures, neuro defects, hydrocephalus, G/D issues, endocrine problems Radiation to decrease the size of the tumor Chemo does not cross the blood brain barrier well

Question 27

Pre- op Brain Tumors

Answer 27

GOOD NEURO ASSESSMENTS! Need to know the baseline | Teaching r/t loss of hair, large bandage on head, close monitoring, not all symptoms disappear after surgery

Question 28

Post- Op Brain Tumors

Answer 28

Monitor VS, temperature, neuro checks, pain, I/O's, positioning Look for increased ICP Hypertonic fluid to decrease edema Foley for urine output Decrease stimulation, cooll compresses and opiods Teach SE of radiation and chemo

Question 29

Neuroblastoma

Answer 29

Most common malignant EXTRA-CRANIAL solid tumor Majority of the tumor develops in the adrenal gland or retro-peritoneal sympatheitc chain "Silent tumors Metastasis has occurred before the diagnosis

Question 30

Neuroblastoma Symptoms

Answer 30

Firm, non-tender, irregular mass in the abdomen that crosses the mid-line Irritable, pallor, refusal to eat, weight loss Urine frequency or retention

Question 31

Neuroblastoma Treatment

Answer 31

``` DO NOT PALPATE THE ABDOMEN Treatment depends on stage Surgery to remove the tumor Radiation doe high stages Chemo is thee mainstay of therapy Poor prognosis -- usually around stage 4 Parent guilt not recognizing symptoms ```

Question 32

Osteosarcoma

Answer 32

Malignant bone tumor Distal femur or tibia near growth plate Metastasis is high b/c of high vascular nature of bone Lungs are the most common site

Question 33

Osteosarcoma Symptoms

Answer 33

``` Hip and leg pain Limping Limited physical activity Unable to hold heavy objects Fever Respiratory distress Palpable mass possible ```

Question 34

Osteosarcoma Treatment

Answer 34

``` Rule out trauma and infection Dx with bone biopsy Chemo before surgery Leg saving surgery or amputation **Body image, phantom pain, good stump care (permanent prosthesis 6-8 weeks post op), talk to teen with amputation ```

Question 35

Ewing's Sarcoma

Answer 35

Malignant small, round cell tumor of the long bones From marrow space of the bone Whites>

Question 36

Ewing's Sarcoma Symptoms

Answer 36

Leg/hip pain | Difficulty walking

Question 37

Ewing's Sarcoma Treatment

Answer 37

Rule out trauma and infection Diagnosis with bone biopsy -- looks like an onion skin (outer layers are dry and flaky) Chemo to reduce the tumor High dose radiation to the site Leg saving surgery is performed -- amputation is rare Education r/t to care of radiation site Physical therapy to maximize function

Question 38

Nephroblastoma

Answer 38

Malignant renal and intra-abdominal tumor Mass on ONE side of the abdomen HTN In one or both kidneys

Question 39

Nephroblastoma Treatment

Answer 39

Surgery is preformed to remove effected kidney and look for metastasis (occurs through the blood) If in both kidneys -- save the least effected one Possible follow up chemo and radiation DO NOT PALPATE THE ABDOMEN

Question 40

Nephroblastoma Pre-op

Answer 40

Monitor BP -- HTN | Little time between diagnosis and surgery -- coping

Question 41

Nephroblastoma Post- op

Answer 41

``` Fluid management Watch function of remaining kidney Dialysis if both kidneys removed Look for UTI's, medication contradiction AVOID CONTACT SPORTS ```

Question 42

Rhabdomyosarcoma

Answer 42

Highly malignant fast growing soft tissue sarcome Primitive muscle cells Grow out of control Metastasis to lungs, bones, bone marrow and lymph nodes

Question 43

Rhabdomyosarcoma Symptoms

Answer 43

pg 1499

Question 44

Rhabdomyosarcoma Treatment

Answer 44

``` Careful staging Surgical removal of the primary tumor Wide filed radiation and chemo next Lower survival rate :/ **Anticipatory Grieving** ```

Question 45

Retinoblastoma

Answer 45

Congenital intraocular malignant tumor Aries from retina, could be one or both eyes Hereditary component Monitor health eye!!

Question 46

Retinoblastoma Symptoms

Answer 46

Whitish glow of the pupil - cat's eye reflex Strabismus -- cross eyed Blindness is a late sign

Question 47

Retinoblastoma Treatment

Answer 47

Early stage needs unilateral irradiation and cryotheray Attempt to preserve vision in affected eye Bilateral disease -- attempt to preserve least effected eye Removal of the eye -- place a glass eye

Question 48

Retinoblastoma Education

Answer 48

If eye removal teach about socket care and use a conformer to help keep the sock shape while waiting for the glass eye Teach about cleaning the glass eye and what to do if it falls out Later the child can do these tasks Support the family! Guilt from genes, follow ups for those at risk for second tumors, eye care for whole family