Alterations in Cellular Growth

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Alterations in Cellular Growth
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NeoplasmBenignMalignant
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Variable Etiology Alterations in cellular
growth Single or Combination of
factors External stimuli Innate immune system
gene abnormalities Chromosomal
abnormalities
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Incidence of Childhood Cancer 2012
StatisticsEstimated 12, 060 new cases in
children under the age of 14Estimated 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
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Prevention Smoking Prevention Limit
exposure to sun Testicular self exams Breast
self exams Pap smears
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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
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Laboratory Tests Complete blood count
(CBC) Serum chemistries Liver function
tests Coagulation studies Urinalysis
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Diagnostic Tests Lumbar puncture Bone
marrow aspiration Bone marrow biopsy Radiographi
c examinations CT MRI Ultrasound Biopsy of
tumor
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Treatment Modalities Surgery Chemotherapy Rad
iotherapy Biotherapy Hematopoietic stem cell
transplant Palliative Care
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Common Forms of Childhood Cancer Leukemia Lympho
ma Brain CNS tumors Bone Solid tumors Soft
tissue tumors
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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
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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
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Acute Lymphoctyic LeukemiaMost common form of
cancerBetter Prognosis-current survival rates
about 80
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Acute Myelogenous LeukemiaPoorer
prognosisCurrent cure rates approximately
40-50
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Diagnostic Evaluation CBC Bone Marrow
Aspiration or Biopsy (definitive test) Lumbar
puncture
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Treatment Chemotherapy-IV
Intrathecal Radiation Cranial Bone marrow
transplant
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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
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Nursing Care Priorities Manage
symptoms Prevent/ treat side effects
chemo Neutropenic precautions Protect from
injury/trauma due to anemia low platelet
count Nutrition Communication
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Lymphomas Hodgkin diseaseOriginates in
lymphoid system-primarily involves lymph nodes
Can metastasize to spleen, liver, bone marrow,
lungs, mediastinum Excellent prognosis for
localized disease Mostly adolescents affected
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Signs SymptomsPainless enlargement of
lymph nodes(most commonly in supraclavicular or
cervical area) Mediastinal lymph
nodes-persistent dry coughSystematic
symptoms-fevers, night sweats, anorexia, nausea,
weight loss, pruritus
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Diagnostic EvaluationBlood work-CBC, Uric acid
levels, Liver function tests, C-reactive protein,
alkaline phosphatase, UACXRCT of neck, chest,
abdomen, pelvisGallium scanBone scan (looking
for metastasis)Lymph node biopsy
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Treatment Chemotherapy Radiation
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Lymphoma Non-Hodgkin Diffuse disease
Dissemination occurs earlier more
rapidly Mediastinal invasion of meninges are
typical
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Diagnostic Evaluation Surgical biopsy Bone
Marrow Aspiration CXR CT- lungs,
abdomen Lumbar puncture Blood work
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Treatment Treatment tailored to
staging Chemotherapy Radiation CNS prophylaxis
with intrathecal chemo
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Brain Tumors
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Signs Symptoms Increased signs
ICP Personality changes Seizures Ataxia Visual
disturbances Delayed or precocious puberty
growth failures
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Diagnostic Evaluation MRI CT Biopsy done
during surgery
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Treatment Surgery Radiation Chemotherapy
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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
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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
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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
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Diagnostic Evaluation CT of abdomen, pelvis,
chest Bone scan /MIBG scan Bone marrow
aspirate biopsy Urinalysis to evaluate for
excretion of catecholamines
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Treatments Surgery Chemotherapy Radiation HSC
T
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Bone TumorsOsteosarcoma Most common bone
cancer in children affects metaphysisEwing
Sarcoma Tumor originates in shaft of
bones(pelvis, femur, tibia, fibia, humerus,
ulna, vertebra, scapula, ribs, skull)
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Wilms Tumor (Nephroblastoma) Most common
kidney tumor of childhood 80 diagnosed under
age 5
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Signs Symptoms Painless swelling/mass in
abdomen-confined to one side Hematuria Anemia
Hypertension
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Diagnostic Evaluation Abdominal
ultrasound CT/MRI abdomen CT chest to look mets
to lung Blood work-CBC, Chemistries UANO
ABDOMINAL PALPATIONS
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Treatment Treatment based on staging Surgery
Chemotherapy Radiation
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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
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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
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Diagnostic Evaluation Careful history and
physical CT/MRI Bone scan Bone marrow aspirate
biopsy Lumbar puncture Biopsy or surgical
resection of tumor
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Treatment Complete removal of tumor if
possibleChemotherapyRadiation
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Retinoblastoma Arises from retina Hereditary
NonhereditarySigns/Symptoms White
pupil-Leukocoria Treatment Radiation,
Chemotherapy, Removal of eye in advanced disease
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Cancer Survival Long-term effects of
chemotherapy, radiation, and surgery
Neurocognitive impairment Endocrinopathy Seco
nd malignancy Organ dysfunction-kidney/liver
failure