Transcript Alterations in Cellular Growth

Alterations in
Cellular Growth
Neoplasm
Benign
Malignant
Variable Etiology
Alterations in cellular growth
Single or Combination of factors
External stimuli
Innate immune system & gene
abnormalities
Chromosomal abnormalities
Incidence of Childhood Cancer
2012 Statistics
Estimated 12, 060 new cases in children
under the age of 14
Estimated 1, 340 cancer deaths to occur
in children under age 14
(1/3 of those deaths from leukemia)
Cancer Facts & Figures 2012 American Cancer Society
Prevention
Smoking Prevention
Limit exposure to sun
Testicular self exams
Breast self exams
Pap smears
Cardinal Symptoms of Cancer
in Children
Unusual mass or swelling
Unexplained paleness & loss of energy
Sudden tendency to bruise
Persistent, localized pain or limping
Prolonged, unexplained fever/illness
Frequent headaches, often with vomiting
Sudden eye or vision changes
Excessive, rapid weight loss
Laboratory Tests
Complete blood count (CBC)
Serum chemistries
Liver function tests
Coagulation studies
Urinalysis
Diagnostic Tests
Lumbar puncture
Bone marrow aspiration
Bone marrow biopsy
Radiographic examinations
CT
MRI
Ultrasound
Biopsy of tumor
Treatment Modalities
Surgery
Chemotherapy
Radiotherapy
Biotherapy
Hematopoietic stem cell transplant
Palliative Care
Common Forms of Childhood
Cancer
Leukemia
Lymphoma
Brain & CNS tumors
Bone
Solid tumors
Soft tissue tumors
Leukemia
Most common form of childhood
cancer
Peak age is 4 with more boys than
girls affected
Classified by type of WBC that
becomes neoplastic & immaturity
of neoplastic cell
Leukemia
Unrestricted proliferation of
immature white blood cells
Infiltration & replacement of body
tissues with nonfunctioning leukemic
cells-most effected are bone marrow,
spleen, liver
CNS at risk-can have leukemic
infiltration of the meninges
Acute Lymphoctyic
Leukemia
Most common form of cancer
Better Prognosis-current survival rates
about 80 %
Acute Myelogenous
Leukemia
Poorer prognosis
Current cure rates approximately
40-50%
Diagnostic Evaluation
CBC
Bone Marrow Aspiration or Biopsy
(definitive test)
Lumbar puncture
Treatment
Chemotherapy-IV & Intrathecal
Radiation –Cranial
Bone marrow transplant
Phases of Chemotherapy
Induction: achieves complete
remission or disappearance of leukemic
cells
Intensification: further decreases
number of leukemic cells
Maintenance: preserve remission &
reduce number of leukemic cells
Reinduction after relapse
Nursing Care Priorities
Manage symptoms
Prevent/ treat side effects chemo
Neutropenic precautions
Protect from injury/trauma due to
anemia & low platelet count
Nutrition
Communication
Lymphomas
Hodgkin disease
Originates in lymphoid system-primarily
involves lymph nodes
Can metastasize to spleen, liver, bone
marrow, lungs, mediastinum
Excellent prognosis for localized disease
Mostly adolescents affected
Signs & Symptoms
Painless enlargement of lymph nodes
(most commonly in supraclavicular or cervical area)
Mediastinal lymph nodes-persistent dry
cough
Systematic symptoms-fevers, night
sweats, anorexia, nausea, weight loss,
pruritus
Diagnostic Evaluation
Blood work-CBC, Uric acid levels, Liver
function tests, C-reactive protein,
alkaline phosphatase, UA
CXR
CT of neck, chest, abdomen, pelvis
Gallium scan
Bone scan (looking for metastasis)
Lymph node biopsy
Treatment
Chemotherapy
Radiation
Lymphoma
Non-Hodgkin
Diffuse disease
Dissemination occurs earlier &
more rapidly
Mediastinal & invasion of meninges
are typical
Diagnostic Evaluation
Surgical biopsy
Bone Marrow Aspiration
CXR
CT- lungs, abdomen
Lumbar puncture
Blood work
Treatment
Treatment tailored to staging
Chemotherapy
Radiation
CNS prophylaxis with intrathecal
chemo
Brain Tumors
Signs & Symptoms
Increased signs ICP
Personality changes
Seizures
Ataxia
Visual disturbances
Delayed or precocious puberty &
growth failures
Diagnostic Evaluation
MRI
CT
Biopsy done during surgery
Treatment
Surgery
Radiation
Chemotherapy
Nursing Care Priorities
Nutrition
Frequent assessment of mental
status
I & O/ Fluid regulation
Head positioning post op
Monitor surgical site
Prepare family
Promote return to optimum
functioning
Neuroblastoma
Tumors originate in cells that
normally give rise to the adrenal
medulla and sympathetic nervous
system
Primary site is within abdomen but
also could include head/neck, chest, and
pelvis
Signs & Symptoms
Depend on stage/location
Abdominal tumors-firm mass in
abdomen-crosses midline
Urinary frequency/retention
Widespread metastasis- pallor,
weakness, irritability, anorexia,
weight loss
Diagnostic Evaluation
CT of abdomen, pelvis, chest
Bone scan /MIBG scan
Bone marrow aspirate & biopsy
Urinalysis to evaluate for excretion
of catecholamines
Treatments
Surgery
Chemotherapy
Radiation
HSCT
Bone Tumors
Osteosarcoma
Most common bone cancer in
children affects metaphysis
Ewing Sarcoma
Tumor originates in shaft of bones
(pelvis, femur, tibia, fibia, humerus, ulna,
vertebra, scapula, ribs, skull)
Wilms Tumor
(Nephroblastoma)
Most common kidney tumor of
childhood
80% diagnosed under age 5
Signs & Symptoms
Painless swelling/mass in
abdomen-confined to one side
Hematuria
Anemia
Hypertension
Diagnostic Evaluation
Abdominal ultrasound
CT/MRI abdomen
CT chest to look mets to lung
Blood work-CBC, Chemistries
UA
NO ABDOMINAL
PALPATIONS
Treatment
Treatment based on staging
Surgery
Chemotherapy
Radiation
Rhabdomyosacroma
Most common soft tissue sarcoma
in children
Skeletal muscle is most everywhere
so tumors can occur throughout
body
Most common site head/neck
especially the orbit
Signs & Symptoms
Initial signs/symptoms related to
site of tumor and compression of organs
Many signs & symptoms vague
frequently passes off as common
childhood illness- Primary tumor site
rarely identified
Diagnostic Evaluation
Careful history and physical
CT/MRI
Bone scan
Bone marrow aspirate & biopsy
Lumbar puncture
Biopsy or surgical resection of
tumor
Treatment
Complete removal of tumor if possible
Chemotherapy
Radiation
Retinoblastoma
Arises from retina
Hereditary & Nonhereditary
Signs/Symptoms
White pupil-Leukocoria
Treatment
Radiation, Chemotherapy, Removal
of eye in advanced disease
Cancer Survival
Long-term effects of chemotherapy,
radiation, and surgery
Neurocognitive impairment
Endocrinopathy
Second malignancy
Organ dysfunction-kidney/liver
failure