Nursing Care of the Child With Cancer

NeoplasiaCell growth in cancerous tissue proliferates in

disorderly and chaotic waysNeoplasm- literally “new growth,” but usually

refers to abnormal new growth

ASSESSING CHILDREN WITH CANCERS

History Physical and laboratory examination

Biopsy Bone marrow aspiration

OVERVIEW OF CANCER TREATMENT MEASURES USED WITH CHILDREN

Radiation therapy Immediate side effects Long term side effects

OVERVIEW OF CANCER TREATMENT MEASURES USED WITH CHILDREN

Chemotherapy Chemotherapy protocols…no ASA, no live

viruses, no folic acid Side effects & toxic reactions

Hair loss and N&V are common Also malnutrition, stomatitis, constipation, and diarrhea

OVERVIEW OF CANCER TREATMENT MEASURES USED WITH CHILDREN

Bone Marrow transplantation Can be autologous or allogenic

Hematopoitic Stem Cell transplant Autologous, peripheral Stored umbilical cord blood Embryonic?

THE LEUKEMIAS

Leukemia-uncontrolled proliferation of WBCs and the most common childhood cancer

Acute Lymphocytic Leukemia 75% of leukemias fall into this category Overproliferation of lymphocytes S/S

Pallor, low-grade fever, lethargy Goal

Total cure, 95% of children will have a first remission but if they experience a relapse, the prognosis is less favorable

THE LEUKEMIAS

Acute Myelogenous Leukemia Accounts for 20% of leukemias Overproliferation of granulocytes S/S are the same as with ALL but may also have

had recent URIs Goal

Remission is harder to achieve than in ALL and tends to be shorter

THE LYMPHOMAS

Malignancies of the lymph or reticuloendothelial system

Hodgkin’s Disease Reed-Sternberg cells S/S

One painless, enlarged, rubbery-feeling lymph node, usually cervical

Therapeutic Management Chemo and radiation 90% 5-year survival rate and relapses respond well the

further therapy

THE LYMPHOMAS

Non-Hodgkin’s Lymphoma Proliferation of lymphocytes Spread through the bloodstream rather than by

lymph flow S/S

Enlargement of lymph nodes of neck and chest Therapeutic Management

Chemo and autologous bone marrow transfusion 80-90% of those with minimal symptoms will achieve

remission

Non-Hodgkin’s Lymphoma Burkitt’s lymphoma

Rare form of Non-Hodgkins Associated with the Epstein-Barr virus that causes

mononucleosis S/S

• Enlarged lymph node in the neck or abdomen Therapeutic Management

• Surgery, then chemo

NEOPLASMS OF THE BRAIN

Types of Brain Tumors Astrocytomas Medulloblastomas Brain stem tumors

S/S Symptoms of increased ICP

Headache, vomiting, vision changes, enlarging head circumference

Therapeutic management Surgery, then chemo and radiation

BONE TUMORSOsteogenic Sarcoma-malignant tumor of the

long bone S/S

Pain and swelling, esp. around the knee Therapeutic Management

Surgery, usually amputation, then chemo60-65% of those rigorously treated can be cured

Ewing’s Sarcoma-occurs most often in the bone marrow of long bones S/S is pain Therapeutic Management is surgery, radiation,

and chemo

OTHER CHILDHOOD NEOPLASMS

Neuroblastoma Tumors that arise from the cells of the

sympathetic nervous system The most common abdominal tumor in childhood S/S

Palpable abdominal mass Therapeutic Management

Depends on staging Surgery, chemo, bone marrow transplant Overall survival rate is 70-90%

OTHER CHILDHOOD NEOPLASMS

Rhabdomyosarcoma Tumor of striated muscle S/S depend on site Therapeutic Management

Surgery, then chemo Prognosis depends on size and location of tumor

OTHER CHILDHOOD NEOPLASMS

Wilm’s tumor- malignant tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney Accounts for 20% of solid tumors in childhood Associated with aniridia, cryptorchidism, hypospadias S/S

Firm, nontender, abdominal mass Therapeutic Management

Abdominal palpation seems to increase metastasis Surgery, radiation, chemo

OTHER CHILDHOOD NEOPLASMS

Retinoblastoma-malignant tumor of the retina of the eye Accounts for only 1-3% of childhood

malignancies Associated with an alteration of chromosome 13

and also an inherited autosomal dominant pattern S/S

Absence of red reflex in the pupil then later, strabismus Therapeutic Management

Cryosurgery for small tumors, enucleation for large ones