Transcript Childhood Cancers

Elizabeth Allen RN, MSN
» Learning Outcomes
» Describe Incidence, Etiologies, and Manifestations
of Pediatric Cancers
» Categorize different types of cancer prevalent in
the pediatric population
» Identify the types of isolation and precautions
needed for immunocompromised patients
» Synthesize Information about Diagnostic Tests and
Clinical Therapies to create a plan of care
» Identify nursing care unique to pediatric patients
with cancer and their families
» Neoplasm = “New Growth”
˃ Benign = no danger to life or health
˃ Malignant = can grow and spread
+ Metastasis = spread of malignancy
» Incidence
˃ US- approximately 11,000 children diagnosed per year
˃ US- approximately 1,500 die per year (American Cancer Society
(ACS))
» Overall survival rate is 80% (ACS)
˃ Varies depending on type of cancer
» Etiology
» Neoplasms caused by
1. Carcinogens
˃ Chemicals, radiation
˃ Cause of more adult cancers
2. Immune system and Gene Abnormalities
˃ Congenital or triggered by virus
3. Chromosomal Abnormalities
˃ Congenital risk for specific cancers
+ For example, leukemia and Down syndrome link
» Pediatric Cancers
˃ Much rarer
˃ Faster growing
» Pathophysiology Process is similar to adult
cancers
» Pain
» Cachexia
˃ Fatigue, weakness and significant loss of appetite in someone who
is not actively trying to lose weight.
» Anemia
» Infections
˃ Bacterial, Viral, Fungal
» Bruising or Petechiae
˃ Without consistent injury
» Neurologic Changes
» Palpable Mass
˃ Once found do not continue to palpate
Cell Visualization
˃ Direct biopsy
˃ CBC
˃ Bone marrow
aspiration
˃ Lumbar puncture
Internal Imaging
˃ Radiograph
˃ Ultrasound
˃ MRI
˃ CT
Figure 23–3 Computed tomography (CT) can be a frightening procedure for
children. This 2-year-old boy is comforted by his father before the procedure.
(London et al., 2014)
» Remove the Cancer
˃ Surgery
» Inhibit Growth of Rapidly Growing Cells
˃ Chemotherapy and radiation
» Assist Immune System to Destroy Cancer
˃ Biotherapy
» Replace Cancerous Bone Marrow
˃ Hematopoietic stem cell transplant (Bone Marrow Transplant)
» Treatment Goal may be curative, supportive or
end of life care
» Metabolic
˃ Electrolyte imbalance from tumor lysis
˃ Septic shock due to infection toxins
˃ Hypercalcemia from bone breakdown
» Hematologic
˃ Pancytopenic effects: bleeding, anemia, infections
» Space-Occupying Lesions
˃ Pressure on: spinal cord, circulation, nerves, organs
» Wilm’s Tumor (Nephroblastoma)
» Discussed with Elimination Disorders
» Congenital Renal tumor
˃ Fast Growing
˃ Peak incidence 2-3 years
˃ Do not palpate! Careful handling of patient
˃ Nephrectomy and staging
» “White Blood”
˃ Nonfunctioning WBC
˃ Proliferation of immature WBC
˃ Diagnosis confirmation with bone marrow aspiration
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Affects bone marrow
Anemia
Neutropenia
Decreased platelet production
» Classification
˃ Lymphoblastic
˃ Acute Lymphoblastic Leukemia (ALL)
+ 25% of all cancers in children
+ 78% of leukemias in children
+ Peak age 2-3 years
˃ Acute Myelogenous Leukemia (AML)
+ 17% childhood leukemias
+ Most common <2 years & adolescents
˃ Nonlymphoblastic (ANLL)
Figure 23–17 Acute lymphoblastic leukemia is the most common type of
leukemia in children and the most common cancer affecting children under 5
years of age.
» Risk Factors for Leukemia
» Genetic
» Viral infection
» Environmental (Carcinogens)
˃ Radiation
˃ Chemicals
˃ Medications
Assessment
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Fever
Fatigue, lethargy
Pallor
Anorexia
Petechiae, bleeding
Large joint/bone pain
Hepatosplenomegaly
Lymphadenophathy
Assessment
» CNS infiltration by
Leukemia
» Signs of Increased ICP
˃ Headache, vomiting
» Papilledema
» Sixth Cranial Nerve
Palsy
WBC (Increase in Leukocytes)
H/H Decreased
Platelet count Decreased
Leukemic blast (immature) phase cells – fill the
bone marrow
» CXR
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» Bleeding Control
˃ Platelet transfusion
˃ Packed RBC’s
» Nutrition
˃ Age appropriate
˃ Nasogastric
˃ TPN/ IL
» Chemotherapy (4 Phases)
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Induction
Intensification or consolidation
Central nervous system prophylactic
Maintenance
» Retinoblastoma
˃ Retinal malignancy
+ White pupil, changes in red reflex
˃ 40% of cases are autosomal dominant gene
» Pathophysiology
˃ Intraocular malignancy of the retina
˃ Leukokoria
˃ Red reflex absent
˃ Strabismus
˃ Glaucoma
˃ Heterochromia
» Usually diagnosed between 1-2 years
˃ Family history- frequent ophthalmologic examinations
» Treatment
˃ Cryotherapy
˃ Photocoagulation
˃ Radiation
˃ Chemotherapy
» Assessment
˃ Height/Weight/Tumor area
˃ No palpation
˃ GI/GU
˃ Surgery for removal of the eye
+ Conformer
» Nursing Care
» Reduce Fear through
Education
˃ Cancer, treatment,
treatment effects
˃ Coping skills
» Resource
» http://www.cancer.gov/cancertop
ics/coping/children-with-cancer
» Psychosocial Support
» Developmental Level
˃ Child
˃ Siblings
˃ Family
˃ Resource:
http://www.cancer.org/treatment/childrenandcancer/whenyourc
hildhascancer/
Figure 23–9 One of the most common threats to a child’s body image at any age
is hair loss induced by chemotherapy. Use of hats can improve self-concept.
(London, et. al., 2014)
» Infection control
˃ Skin
˃ Respiratory
˃ IV contamination
What type of isolation
do these kids need?
» ANC: Absolute Neutrophil Count
(London, et. al., 2014)
» Protective Isolation
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Neutropenic Precautions, Reverse Isolation
Reverse Isolation
Positive Pressure Room
Daily Cleaning of Surfaces
No live plants or fresh foods