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Pediatrics > Pediatric Oncology > Flashcards

Pediatric Oncology Flashcards

1
Q

Etiology

A
  • Radiation
  • Chemicals
  • Genetic disorder
  • Embryological origins
  • Cancers staged from I (least severe) to IV (worst)
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2
Q

Leukemia

A
  • Most common pediatric cancer
  • Malignant disease of blood
  • Originates in bone marrow
  • Characterized by immature white blood cells (leukocytes) that inhibit normal blood cells
  • Invades organs causing enlargement or dysfunction
  • Most common pediatric leukemias:
    • ALL
    • AML
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3
Q

Acute Lymphocytic Leukemia (ALL)

A
  • >75% of pediatric leukemias
  • Most common 2-3 yo
  • Survival >90%
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4
Q

Acute Myeloid Leukemia (AML)

A
  • More common in teenagers
  • 41% survival for 5 years
  • Can become chronic (CML) <2% of leukemias
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5
Q

Signs/Symptoms (Leukemias)

A
  • Fatigue
  • Fever
  • Bone/jt pain
  • Bleeding
  • Abnormal CBC
  • Detected via bone marrow biopsy
  • Thrombocytopenia
  • Neutropenia
  • Bruising
  • Infection
  • Enlarged lymph nodes
  • Enlarged spleen
  • Night sweats
  • Weight loss
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6
Q

Medical mgmt

A

Chemotherapy

Stem cell transplant

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7
Q

Stages of Treatment for Leukemia

A

Induction phase: attempt to eradicate all malignant cells of body

Remission: patient asymptomatic

Consolidation/maintenance therapy: continue rx even in remission as prophylaxis

Relapse: signs and symptoms reappear and leukemic cells found in bone marrow

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8
Q

PT and Leukemia

A
  • Depending on age of child:

◦Developmental delay

◦Weakness

◦Decreased endurance

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9
Q

CNS Tumors

A
  • Most common solid tumor in pediatrics
  • 2nd most common type of pediatric cancer
  • 1-10 yo
  • Astrocytoma-almost half of all CNS tumors (cerebellar and supratentorial)-neural support cells: 70-90% cure rate
  • Medulloblastoma- usually cerebellar: highly invasive tumors-50% cure rate
  • Brainstem glioma -poor cure rate
  • Ependymoma- cells lining ventricular system- 50% cure rate
  • Craniopharyngioma-benign- derived from pituitary gland embryonic tissue
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10
Q

S/S of CNS Tumors

A

Headaches

Nausea

Vomiting

Irritability

Balance disturbances

Dysphagia (swallowing)

Dysphasia (speech)

Paresthesia

Behavioral changes

Ataxia

Hemiparesis

Visual disturbances

Seizures

Lethargy

Weakness

Poor coordination

Head tilt

anorexia

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11
Q

Medical Mgmt of CNS Tumors

A
  • Surgical resection or tumor debulking
  • Chemo
  • Radiation
  • XRT or proton beam
  • Side effects: decreased IQ, learning problems, growth retardation
  • Shunt for hydrocephalus
  • 65% 5 year survival rate
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12
Q

Post-op Posterior Fossa Syndrome

A
  • Delays 1-5 days post surgery most common in medulloblastoma
    • Decreased cervical ROM
    • Hemiparesis
    • Ataxia
    • Dysmetria
    • Weakness
    • Speech disorder
    • Visual disorder
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13
Q

General PT Intervention Post-opBrain Tumor Resection

A
  • Positioning
  • Progress HOB slowly
  • PROM
  • Stretching
  • Progress to gym as soon as able
  • Increase mobility – may need w/c, wagon, trike to allow for change in environment and increased independence
  • Transfers, walking with fall prevention
  • Patient/family education
  • Developmental activities

Ball

Bikes

Run

Jump

Mini-tramp

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14
Q

Embryonal Tumors-arise from embryonal tissues

A

Neuroblastoma-sympathetic NS:

◦75% cure rate <1yo

◦50% cure rate >1yo

–Arises in sympathetic nervous system and especially in adrenal glands or paraspinal ganglion

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15
Q

Neuroblastic Tumors

A
  • S & S
    • Painful abdominal, chest, neck, pelvis mass
    • Lumps of tissue under skin (lymph nodes)
    • Bulging eyes with dark circles
    • Bone pain
  • Medical management
    • Surgical resection
    • XRT
    • Chemo
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16
Q

Retinoblastoma

A
  • Tumor of eye
  • May be hereditary (infants)
  • Nonhereditary forms too
  • 0-2 yo
  • S & S: enlarged pupil that appears red or white, crossed eye, vision changes
17
Q

Wilm’s Tumor

A
  • AKA nephroblastom
    • Genetic component
    • <2 yo
  • S & S
    • Abdominal mass
    • Fever
    • Anemia
    • Hypertension
  • 92% survival rate for 5 years
  • Medical management
    • Surgical resection
    • Chemo
    • XRT
18
Q

Lymphomas

A

Malignant disease of lymphatic system-cancers involving blood cells like leukemias

Hodgkin’s (adolescents)

Non-Hodgkin’s (younger children)

19
Q

Hodgkin’s

A
  • More common in adolescence
    • Boys > girls
    • 91% survival
  • S & S
    • Painless swelling of neck, groin, axilla
    • Non-productive cough
    • Fatigue
    • Anorexia
    • Weight loss
20
Q

Non-Hodgkins

A
  • More common in young children
  • Boys > girls
  • 4 categories of types of lymphoma
  • 72% survival
  • S & S
    • Swelling of face, neck, UEs
    • Difficulty swallowing
    • Changes in bowel habits
    • Nausea
    • Vomiting
    • Painful swallowing (dysphagia)
  • Medical management
    • XRT
    • Chemo
21
Q

Sarcomas-solid tumor arising in connective tissue

A
  • Bone Tumors
    • Ewing’s sarcoma
    • Osteogenic sarcoma or osteosarcoma
  • Soft Tissue Tumors
    • Rhabdomyosarcoma
22
Q

Osteosarcoma
S & S

A

Mass

Decreased ROM

Pain

Pathologic fractures – child has injury that wouldn’t normally appear serious but with significant pain that doesn’t improve or resolve

CA found on radiograph

23
Q

Osteogesarcoma
Medical Management

A

Amputation

Limb salvage procedure with bone graft and/or hardware

Rotationplasty – primarily for femur

Chemo

75% survival without mets

30% survival with mets

24
Q

Ewing’s Sarcoma

A
  • Originates in neural crest cells
  • Tumor in vertebral column, rib, sternum, clavicle, pelvis, sacrum, coccyx
  • 2nd most common malignant bone tumor in kids
  • Birth-14 yo
  • 58% survival rate
  • S & S

◦Pain or tenderness at site of tumor

◦Swelling

25
Q

Rhabdomyosarcoma

A
  • Tumor of soft tissue of muscle cells of head, neck, pelvis, or extremities
  • 0-14 yo
  • urinary tract and reproductive tract also common
  • 45-79% survival rate – the younger the child, the better
  • Signs & symptoms: mass
  • Medical management

◦Surgical resection

◦XRT

◦Chemo

26
Q

PT and Oncology: Tips

A
  • Blood counts – check regularly and modify intensity of ex accordingly
  • Bone marrow aspiration/aspiration – painful
  • Lumbar puncture – often on bed rest for 6-24 hours post procedure
27
Q

Critical Platelet Counts

A
  • Platelets
    • >50,000 resistive ex OK
    • 20,000-50,000 light aerobic ex only
    • <20,000 no aer. Ex
  • WBC
    • >5000 resistive ex OK
    • <5000 no aerobic ex
  • Hemoglobin
    • >10 resistive ex OK
    • 8-10 light aer. ex only
    • <8 no aer. ex

***remember, MMT is considered resistance**

Platelets: helps blood to clot

Hemoglobin: protein molecule in red blood cells that carries oxygen from the lungs to the body’s tissues and returns carbon dioxide from the tissues back to the lungs

WBC: fight infection

28
Q

Bone Marrow Transplant

A
  • Allogenic compatibility based on Human Leukocyte Antigen (HLA)
  • Stages

◦Pre-transplant

◦Transplant

◦Post-transplant

29
Q

Stages:
Pre-transplant

A
  • One week
  • Total body irradiation and chemo to eradicate disease and immunosuppression to prevent rejection of transplant.
    • This is called the “conditioning phase” and is not done in younger children due to SEs on rapidly growing body
30
Q

Stages:
Transplant

A

Donor marrow harvested surgically via ASIS and PSIS

Marrow is filtered, treated, replaced

31
Q

Stages:
Post-transplant

A
  • Time period until engraftment occurs and cell counts rise (WBC, platelets)
  • 10-17 days
  • Complications: graft-versus-host-disease (GVHD) mild to life threatening

◦Rash, itchy skin and/or discoloration, dry mouth and mouth ulcers, GI irritation, wt loss, joint contractures and liver involvement

Pediatrics (22 decks)

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