Children's Cancer Flashcards
(139 cards)
1
Q
The etiologies of childhood cancer
A
1) External stimuli that cause genetic mutations
2) Immune system and gene abnormalities
3) Chromosomal abnormalities
2
Q
What is an example of external stimuli that can cause childhood cancer?
A
Radiation
3
Q
What is an example of immune and gene abnormalities that can cause childhood cancer?
A
Down’s Syndrome can get leukemia, rabdo, etc
Leukemia secondary to chemo for Brian cancer
4
Q
What is an example of chromosomal abnormalities that can cause childhood cancer?
A
Down’s Syndrome and familial.
5
Q
With a cancer diagnosis, what is the first reaction from a parent?
A
Disbelief, shock. The parents like to blame the nurse.
6
Q
With a cancer diagnosis, what are the reactions of the parents?
A
1) Disbelief, shock.
2) Must gather resources, make treatment decisions.
3) Travel often required for treatment
4) Financial strain, potential job loss
5) Adaptation
7
Q
How can the nurse help the parents gather resources?
A
Suggest ways that others can help them such as religious organizations. let them know that it is ok to accept help from others.
8
Q
The reaction of a child to cancer depends on what?
A
Depends on the child’s age.
9
Q
How would an infant and/or a toddler handle a cancer diagnosis?
A
They would have a limited understanding. They don’t know that it is not normal.
10
Q
When does a child develop a conscious?
A
Preschool age.
11
Q
How would a preschooler handle a cancer diagnosis?
A
They may believe that they caused the illness. Assure them that it is not their fault. They are also going to be concerned with pain.
12
Q
How would a school-age child handle a cancer diagnosis?
A
They have an improved understanding and like to talk about it. Such as with the doctor who told them, the nurses, etc.
13
Q
How would an adolescent handle a cancer diagnosis?
A
They would like to talk to other adolescent teens that have cancer, NOT to the doctors, nurses, parents, etc.
14
Q
What psychosocial area would an adolescent, possibly a school age child be concerned with?
A
Body image.
15
Q
What can a toddler use to deal with stress and how to cope?
A
They can use a doll.
16
Q
What are some common presenting symptoms of childhood cancer?
A
1) PAIN
2) Cachexia
3) Anemia
4) Infection
5) Bruising
6) Neurologic symptoms
7) Palpable mass
17
Q
What does cachexia mean?
A
The child looks like they are wasting away due to the illness.
18
Q
What would be the reasons for pain in a child with cancer?
A
Result of neoplasm either directly of indirectly affecting nerve receptors through obstruction, inflammation, tissue damage, stretching of visceral tissue, or invasion of susceptible tissue.
19
Q
How does the book define cachexia?
A
Syndrome characterized by anorexia, weight loss, anemia, asthenia, and early satiety.
20
Q
What does asthenia mean?
A
weakness
21
Q
When would a child with cancer experience anemia and why?
A
Experienced during times of chronic bleeding or iron deficiency. In chronic illness the body uses iron poorly. Anemia is also present in cancers of the bone marrow when the number of red blood cells id reduced, in part because of the presence of large numbers of other bone marrow products. Treatment of cancer often promotes further anemia.
22
Q
Why would child with cancer get an infection?
A
Result of altered or immature immune system. Occurs when bone marrow cancers inhibit maturation of normal immune system cells. Infection may also occur in children treated with corticosteriods. Because their immune response is altered, the normal signs of infection may not occur.
23
Q
Why does bruising occur in children with cancer?
A
If the bone marrow cannot produce enough platelets; bleeding after even a minor trauma can lead to ecchymosis.
24
Q
Why would a child with cancer have neurological symptoms?
A
Result from impingement on the brain or nervous system. Signs of ICP, decreased or altered consciousness, eye abnormalities, or other neurologic or behavior changes may be evident.
25
Where would a palpable mass be in children with cancer?
Most commonly in abdomen but may be mediastinal, in the neck, or at other sites.
26
Subcutaneous nodules may appear why?
If leukocytosis is present.
27
What can occur with mediastinal tumors (neuroblastomas)?
Superior vena cava syndrome or respiratory difficulty.
28
What are common with lymphomas?
Enlarged lymph nodes.
29
What are some common diagnostic tests for childhood cancer?
1) Laboratory tests - WBC count, ANC, etc
2) Imaging Studies - MRI, x-ray, CT
3) Tumor biopsy
30
Bone Marrow Aspiration - Purpose, Normal Lab Value, Diagnostic Value
Purpose - Examines bone marrow
Normal Lab - Less than 5% blast cells (immature)
Diagnostic Values - Greater than 25% blast cells in acute lymphoblastic leukemia, most with hyper cellular marrow
31
Lumbar puncture - Purpose, Normal Lab Value, Diagnostic Value
Purpose - Examines cerebrospinal fluid
Normal Lab - Cell count (microliters)
Polymorphonuclear leukocytes 0
Monocytes 0-5
RBCs 0-5
Diagnostic Values - Presence of malignant cells indicates CNS involvement
32
Complete blood count and differential - Purpose, Normal Lab Value, Diagnostic Value
Purpose - Examine cellular components of blood
Normal Lab - WBC less than 10,000/microliter
Platelets 150,000 - 400,000/microliter
Hemoglobin 12 - 16 g/dL
Diagnostic Values - WBC greater than 10,000/microliter
Platelets 20,000 - 100,000/mL
Hemoglobin 7-10 g/dL
33
Absolute Neutrophil Count (ANC) - Purpose, Normal Lab Value, Diagnostic Value
Purpose - Blood component ratio: % of segmental neutrophils times % of bands (immature neutrophils) times WBC count
Normal Lab - ANC greater than 1000
Diagnostic Values - ANC less than 500 = risk of infection
34
Staging a cancer refers to what?
Labeling type of cancer cells, severity, and spread.
35
What are some Lab tests that can be done for childhood cancer?
Blood work, Bone marrow aspiration/biopsy, and lumbar puncture.
36
What are some Imaging Studies that can be done for childhood cancer?
CT, MRI, Ultrasound, Nuclear medicine scans, and PET.
37
What does an ultrasound allow the viewer to see?
The function of the organ.
38
What are the 3 things to know about a tumor biopsy?
1) Invasive test
2) May be done during surgery to remove or debunk tumor
3) Section of tumor examined microscopically
39
What are the purposes of diagnostic tests?
1) Identify initial source of cancer (primary site)
2) Determine if cancer has metastasized
3) Stage cancer
40
What are some options for clinical therapy for cancer?
1) Surgery
2) Chemotherapy
3) Radiation
4) Biotherapy
5) Bone marrow/stem cell transplantation
41
What are some considerations in choice of therapy for cancer?
1) Type of cancer
2) Location
3) Degree of metastasis
4) Goal of therapy
42
What are the three types of goals for therapy?
1) Curative - Look for a cure.
2) Palliative - Get treatment in hopes of extending life, but not curing.
3) Supportive - The cancer is too bad. Look to keep child comfortable til death.
43
What are the reasons for surgery?
1) Remove or debulk tumor
| 2) May determine stage and type of cancer
44
What is an example of a tumor that would require surgery?
Wilms' tumor
45
Chemotherapy
1) Drugs that kill both normal and cancerous cells
2) Must be chemo certified before giving chemotherapy drugs
3) CPON - Certified Pediatric Oncology Nurse
4) Timed for maximum cellular destruction
5) Different drugs work on different phases of cell growth
46
What are the potential Long-Term effects of chemotherapy? (5 years)
1) Cardiomyopathy
2) Lung, renal toxicity
3) Neurological changes
4) Infertility
5) Hearing loss, vision changes
47
Radiation.
1) Energy destroys DNA and cells
2) Used for local and regional control of cancer
- may be used in combination with surgery and chemotherapy
3) May be curative or palliative
48
What would be an example of a cancer that would receive radiation?
Hodgkin's disease.
49
What are the nursing care considerations with radiation therapy?
1) Assessing skin were radiation occurs.
2) Possible sedation during radiation therapy
3) Wash irradiated area daily with mild soap and water or only water.
4) No powders, ointments, lotions, or creams unless prescribed by radiologist.
50
What does the child and/or parent need to be educated on about radiation therapy?
1) Dont wash of indelible marks
2) Children cannot go into the sun after radiation therapy.
3) If they are going to go outside, MUST wear sun protective clothing.
51
What are CoolMagic Hydrogel Sheets?
Light-weight, see-through polymer sheet provides instant cooling to burns, abrasions, skin tears, radiation reactions and sensitive wounds, effectively reducing pain.
52
What does a CoolMagic Hydrogel Sheet do?
1) This sterile hydrogel polymer sheet consists of 90% water, 10% inactive cross-linked polyethylene oxide matrix and it transfers heat away from the wound, providing a cooling effect.
2) Cooling action relieves pain of burning, itching, or sore throat.
3) Allows oxygen flow while preventing bacteria or foreign material from entering wound.
53
Can the CoolMagic Hydrogel Sheet be refrigerated?
Yes. This allows it to have greater cooling capacity.
54
What are the potential long-term effects of radiation?
1) Impairs growth of bones and teeth - can lead to scoliosis, dental problems.
2) Hypothyroidism
3) Delayed puberty, sterility
4) Secondary cancers
55
What is the goal of bone marrow/stem-cell transplant?
Kill cancer with chemotherapy or radiation, then resupply the body with stem cells.
56
What are some sources of stem cells?
1) Child's own bone marrow (autologous transplant)
2) Compatible donor (allogenic transplant)
3) Umbilical cord blood
57
What are some Complementary Therapies?
1) Nutritional supplements
2) Herbal supplements
3) Touch therapy
4) Mind/body interventions
58
What is the goal of palliative care?
To provide comfort and emotional support.
59
What does palliative care address?
1) Pain
2) Dyspnea
3) Nutrition
4) Elimination
5) Fatigue
60
Palliative care team offers ______ approach.
holistic
61
What to tell children about cancer?
1) Hiding the truth takes a lot of energy
2) Parents need to explain cancer and its treatment in words that a child can understand.
3) Watch the child's behavior for expression of distress
4) Assistance from family and friends is helpful.
62
Is it better for the parent to explain the situation to the child?
Yes.
63
A space-occupying lesion can cause a lot of ____ which can lead to a ______.
pain; quicker diagnosis.
64
Rapid tumor growth can cause what?
1) Spinal cord compression
2) ICP
3) Brain herniation
4) Seizures
5) Hepatomegaly
6) Superior vena cava syndrome
65
What is the most common solid tumor in children?
Brain Tumor.
66
Over half of brain tumors are what kinds?
Cerebellum and Brainstem.
67
What is the likely cause of brain tumors?
Unknown, but radiation and environmental factors have been implicated.
68
What are some risk factors for brain tumors?
Radiation exposure and other diseases.
69
Brain tumor symptoms depend on what?
Depend upon the location of the tumor and the age of the child.
70
What can infants have that would cause a concern for a potential brain tumor?
Bulging fontanel.
71
What is the double-edged sword with using a bulging fontanel as a clinical manifestation for a brain tumor?
It is easier to diagnosis, but the infant can develop hydrocephaly and will probably have a shunt after brain surgery.
72
How can brain tumor be diagnosed by?
CT scan, MRI, and possibly a biopsy.
73
Symptoms for a brain tumor can come _____ or _______.
rapidly or slowly.
74
Symptoms can also include what?
Behavioral and/or nervous system changes.
75
What are some common symptoms for a brain tumor?
1) Headache (especially upon awakening)
2) Nausea and/or vomiting (unrelated to eating)
3) Dizziness
4) Change in vision or hearing
5) Fatigue
6) Slight uncoordination or abnormal gait
76
Treatment for a brain tumor depends on what?
The type of tumor.
77
What three treatments can be considered for a brain tumor?
1) Surgery
2) Radiation
3) Chemotherapy
78
What is the most common form of treatment for a brain tumor?
Surgery
79
When would radiation not be advised as a form of treatment? Why?
If the child is younger than 3 years old because radiation closes the epiphyseal plate and will stunt bone growth.
80
How would chemotherapy be given for a brain tumor?
Intrathecally due to the blood-brain barrier.
81
Why would a child need a VP shunt with a brain tumor?
To maintain ventricle patency.
82
A nurse is going to monitor a child with a brain tumor for what?
For complications such as Seizures or hydrocephalus, ICP.
83
After a craniotomy, what would a child need to due?
Wear a helmet all the time.
84
What are the nursing management responsibilities?
1) Coordinate care
2) Monitor neurological status.
3) Postoperative care
4) Administer medications
85
In whom would a neuroblastoma be found?
Almost always found in children, usually infants, rarely greater than 6 years of age.
86
Slightly more cases of Neuroblastoma are seen in ____ than in _____.
Boys than in girls.
87
What are symptoms of Neuroblastoma dependent upon?
Location and stage of the disease.
88
After a diagnosis, what would then be done?
CT scan of the skull, neck, chest, abdomen, and bone to locate tumor.
89
What some general symptoms of Neuroblastoma?
1) Diarrhea
2) Fever
3) Anemia (weakness or tiredness due to a low number of red blood cells)
4) Hypertension (due to a tumor on the kidneys)
5) Loss of appetite
90
How would a Neuroblastoma feel?
Smooth, hard, nontender mass.
91
A neuroblastoma can occur anywhere along what?
Along the sympathetic nervous system chain.
92
What are some common locations for a neuroblastoma?
1) Abdomen
2) Thoracic area
3) Adrenal area
4) Cervical area (around the back of the neck)
93
The clinical manifestations of a neuroblastoma depend upon what?
Upon location of the mass.
94
What are the symptoms of a neuroblastoma via a retroperitoneal mass?
1) Altered bowel or bladder function
2) Weight loss
3) Abdominal distention
4) Enlarged liver
95
What are the symptoms of a neuroblastoma via a mediastinal mass?
1) Dyspnea
| 2) Infection
96
What would be the treatment for a neuroblastoma?
1) Surgical removal of mass
2) Follow with chemotherapy - multiple drugs used
3) Radiation often used when tumor not responsive to chemotherapy.
97
What is the nursing care for a patient with a neuroblastoma?
1) Monitor surgical site for hemorrhage and infection (fever)
2) Monitor skin integrity at radiation site
3) Monitor mucous membranes
4) Infection precautions
5) Administer medications
6) Child and family teaching
98
What precautions would a child be on after a surgery to treat a neuroblastoma?
Neutropenic precautions - Positive pressure room.
99
What is Wilm's tumor?
A cancerous tumor of the kidney that occurs in children.
100
What are the three points that are important about Wilm's tumor?
1) It is a cancer of the kidney.
2) Do not palpate the abdominal area to prevent rupturing of the capsule of tumor cells.
3) It only occurs in little children.
101
A Wilm's tumor is what type of tumor?
An intrarenal tumor AKA nephroblastoma.
102
What is the most common age for child to develop a Wilm's tumor?
41 to 47 months.
103
A Wilm's tumor is rarely found in children older than _____.
6 years old.
104
What are the clinical manifestations of a Wilm's tumor?
1) Abdominal mass, usually confined to one side.
2) Mass maybe noticed by parent
Firm, lobulated mass
Located to one side of the midline of abs
3) Abdominal distention, abdominal pain
4) Hypertension due to renin release
5) Hematuria - noticed by parent
6) Weight loss r/t anorexia
7) Fever r/t to infection - no source of fever.
105
What is the treatment for a Wilm's tumor?
1) Surgical removal of the affected kidney, look for metastasis
2) Radiation and chemotherapy
3) Pain management - Priority
106
What are the child and parents going to be taught after surgery?
Protect the kidney by avoiding contact sports and to look for S & S of a UTI for immediate treatment.
107
What is the nursing management for Wilm's tumor?
1) Monitor the child for hypertension
2) Do not palpate the abdomen
3) Provide post-op care: Monitor bowel sounds
Preventing infection
Monitor daily weight; I&O
4) Administer chemotherapy agents
108
What is the nursing management for Wilm's tumor?
1) Monitor the child for hypertension
2) Do not palpate the abdomen
3) Provide post-op care: Monitor bowel sounds
Preventing infection
Monitor daily weight; I&O
4) Administer chemotherapy agents
109
What are the types of bone cancer?
1) Osteosarcoma
| 2) Ewing's sarcoma
110
Osteosarcoma is cancer of what part of the bone?
Outside.
111
Ewing's sarcoma is cancer of what part of the bone?
Inside. Not in the bone marrow.
112
Which bone tumor peaks during the adolescent growth spurt?
Osteosarcoma.
113
Which bone tumor manifests as a small, malignant tumor?
Ewing's sarcoma.
114
Which bone tumor occurs in the shaft of the long bones (femur, tibia, etc)?
Ewing's sarcoma.
115
Which bone tumor can manifest in any bone?
Ewing's sarcoma.
116
Which bone cancer can manifest in any bone?
Ewing's sarcoma.
117
What are the clinical manifestations of bone tumors?
1) Pain, especially pain that awakens the child during sleep
2) Swelling
3) Limp
4) Lab abnormalities
118
What could be a potential psychosocial problem for parents of children with bone tumors?
They may feel guilty for not addressing the pain and/or symptoms sooner.
119
What is the nursing management of bone tumors?
1) Postoperative care and monitoring
2) Body image concerns - Prosthesis
Support group, other
adolescents with
amputations
School age access
120
What is the last resort as far as treatment for bone tumors?
Amputation. Doctors will try to save the tumor.
121
Osteosarcoma is cancer of the ______ ______.
long bones.
122
Which bone tumor is the most common type of bone cancer?
Osteosarcoma.
123
What does osteosarcoma develop from?
Osteoblasts (cells that manufacture growing bone)
124
When does osteosarcoma most commonly develop?
During the growth spurt.
125
What are the clinical manifestations of osteosarcoma?
1) Pain and swelling in a leg or arm
2) Pain may worsen during exercise or at night
3) Weakening of bone structure may lead to a broken bone.
126
How can a parent miss the clinical manifestations of Osteosarcoma?
Parents do not physically inspect they children during adolescence because of privacy of the child when child complains of pain.
127
What is the treatment for osteosarcoma?
1) Limb-salvage surgery to remove tumor
2) Bone graft to fill in the bone
3) May have to amputate a limb
4) Aggressive chemotherapy is given prior to and after surgery
128
In what bone cancer is metastasis very common?
Osteosarcoma
129
What are the survival rates of osteosarcoma if the cancer has metastasized?
60 to 80%.
130
Ewing's sarcoma is a cancre that affects what?
The internal bone shaft.
131
Where does a Ewing's sarcoma tumor arise?
In marrow spaces.
132
Ewing;s sarcoma affects what bones?
Long bones - Femur, pelvis, tibia, fibula, ribs, scapula, humerus, and clavicle.
133
When does Ewing's sarcoma occur?
During growth spurts around ages 10 to 20.
134
What are the clinical manifestations of Ewing's sarcoma?
1) PAIN
2) Soft tissue mass
3) May also have: anorexia, malaise, fever, fatigue, & rapid weight loss.
135
How does Ewing;s sarcoma get diagnosed?
X-rays of affected area.
136
Why would a bone scan and CT scan be needed for Ewing's sarcoma?
Scans to assess chest for metastasis.
137
What is the nursing care Ewing's sarcoma?
1) Pain management
2) Skin care r/t radiation therapy
3) Emotional support by allowing open communication with child and family.
138
Wich bone cancer has a poor prognosis?
Ewing's sarcoma.
139
What is the therapy for Ewing's sarcoma?
1) Chemotherapy to reduce tumor size
2) Surgery: limb-salvage most common
3) Amputation only if necessary
4) Follow-up chemo or radiation
5) Metastasis is common.
