Peds Flashcards
Peds Stats
leading cause of death in kids 0-14
84% of kids live 5+ years
top cancer is brain and CNS cancer and the leukemia
Every year there are more survivors than the year before
Acute Lymphoblastic Leukemia
ALL is cancer of blood and bone marrow, most common childhood malignancy.
Malnutrition can affect disease response, infection risk, toxicities and tx delays
Kids are at risk for developing obesity during the maintenance and continuation phases but this can be prevented.
Studies show RD intervention is key
reduced bone mineral density may be caused by tx, relapses may require HCT
Acute Myeloid Leukemia (peds)
2nd most common childhood cancer
tx initially with chemo, but kids may need HCT.
Nutritional status affects outcome- kids with BMI at either end of the percentiles have lower survival rates
pts are more prone to anorexia, wt loss, N/V, mucositis, and malnutrition due to intense chemo
cardiomyopathy is a late effect of tx
Peds- CNS tumors side effects
dysphagia is a common potential complication for patients with posterior fossa tumors after resection, or those with progressive disease that effects the cerebellum or brainstem
long term complications include cognitive and motor skill deficits, wt gain, central adiposity, or feeding difficulties
RT may interrupt grehlin and leptin cues causing excessive intake.
Hodgkin Lymphoma
lymphoma is 3rd most common- can be HL or NHL. Significant weight loss may be a presenting symptom - great supportive care helps mitigate malnutrition risk.
frequent steroid use may lead to wt gain.
overall survival is 95%, but significant late effects. mediastinal RT can cause abnormal thyroid, heart, and lung function. anthracyclines further inc cardiac risk. Also increased risk for secondary primary cancers
Kids can have inc fat mass and dec LBM after tx
Neuroblastoma
most common solid tumor in kids, usually diagnosed in 1st yr of life, often observation for kids <6 months. Typically much more aggressive in older kids- often includes hard tx like myeloablative chemo and allo stem cell rescue
20-50% are malnourished which persists through tx r/t NIS like N/V, taste changes, anorexia and abdominal discomfort
late effects include underweight status, decreased growth and development after HCT, musculoskeletal complications, neuro complications and endo complication
Rhabdomysosarcoma
soft tissue tumor- often occurs in H&N area, genitourinary tract, extremities and occasionally in the trunk
short terms side effects: anorexia, constipation and jaw pain, high risk disease has higher risk of malnutrition
late effects may include SBO, esophageal strictures, renal tubular dysfunction, and secondary malignancies. RT to the H&N can lead to dental issues and growth hormone deficiency
Wilms Tumor
most common kidney malignancy in kids. pts present with large abdominal masses and sometimes HTN. malnutrition comes from early satiety and anorexia. mid upper arm circumference may be better than wt or BMI
surgery, chemo and RT are tx. side effects include constipation, jaw pain, N/V/D. RT might lead to radiation enteritis
late effects: cardiotoxicity and secondary malignancies . ESRD may happen in pts with bilateral disease
Osteosarcoma
most common bone tumor in kids- commonly occurs in periods of rapid growth. pain is the common presenting symptoms
Tx inc chemo and complete resection
common NIS: N/V, anorexia, hypomagnesemia, metallic taste changes and mucositis
late NIS: cardiotoxicity and nephrotoxicity
Ewing Sarcoma
2nd most common bone tumor. most often occurs in lower extremities, pelvis and chest wall
tx includes chemo, RT or surgery. NIS: N/V, anorexia, and wt loss.
Surgery and RT may significantly effect functional status, mobility, and growth
Hepatoblastoma
most common liver malignancy in children, usually occurring in kids <3 yo. Risk factors includes prematurity and familial cancer syndrome.
Tx includes chemo and complete resection if possible. Chemo may cause anorexia, N/V, mucositis, diarrhea, renal toxicity, and electrolyte wasting
CAR-T therapy
approved for tx of kids with relapsed or refractory B-cell ALL.
can cause cytokine release syndrome which includes fever, nausea, vomiting, vascular leakage, renal complication, and seizures
Hyperthermic intraperitoneal chemotherapy (HIPEC)
an approach to treating extensive peritoneal disease and involving administering heated chemo into the peritoneal cavity.
Post-op pts may require nutrition support because of the difficulty of feeding after extensive debulking surgery
Low nutritional risk for malnutrition (peds)
Nonmetastatic tumors
favorable prognosis at diagnosis
Adv diseases in remission during maintenance treatment
High nutritional risk for malnutrition (peds)
Depletion of body stores at diagnosis adv disease at diagnosis solid tumor w/ unfavorable histology stages III and IV neuroblastoma, especially with unfavorable biology adv stage at diagnosis acute leukemias during induction multiply relapsed leukemia HCT especially with GVHD
