Download The Child with Cancer

The Child with Cancer
Chapter 36
Christine Limann Dyer, RN, BS
APHON certified
Cancer in Children
• Childhood cancer is the second
leading cause of death in children
ages 1 to 14 years
• Incidence approximately 129 per
million
• Leukemia most common pediatric
cancer (Acute lymphoblastic
leukemia “A.L.L.”)
• Next most common are brain tumors
and lymphoma
• Greatly improved prognosis in past
30 years
As recently as the
1960’s childhood cancer
was a uniformly fatal
disease.
By the year 2000, the 5year disease-free
survival rate for
childhood cancer is
greater than 75%
(Reaman, 2002.)
Diagnostic evaluation
–
–
–
–
Labs
Biopsy
Imaging studies
Review of symptoms,
physical exam
Ewing's Sarcoma
Child with Leukemia Undergoing Bone
Marrow Aspiration
The definitive test for diagnosis of leukemia
Etiologic Factors
• Genetic basis for some types
– Wilms tumor, retinoblastoma,
neuroblastoma
• Chromosome abnormalities
– Down syndrome—leukemia
• Immunodeficient child more likely to
develop various cancers
• Environmental carcinogens
• Drug exposure as risk for cancer
Modes of Therapy
•
•
•
•
Surgery
Chemotherapy
Radiation therapy
Biologic response
modifiers (BRMs)
• Bone marrow
transplantation
Nursing priority: Do not remove skin markings for radiation.
Leukemias
• Most common form of childhood cancer
• Peak onset between 2 and 6 years old
• a broad group of malignant diseases of bone marrow and
lymphatic system
• Leukemia is an unrestricted proliferation of immature
WBCs in the blood-forming tissues of the body
• Liver and spleen most severely affected organs
• Although leukemia is an overproduction of WBCs, often
acute form causes low leukocyte count
• Cellular destruction takes place by infiltration and
subsequent competition for metabolic elements
Lymphomas
• Hodgkin disease
– More prevalent in 15 to 19 year olds
• Neoplastic disease originating in lymphoid system
• Often metastasizes to spleen, liver, bone marrow, lungs, and other
tissues
• Non-Hodgkin lymphoma (NHL)
– More prevalent in children younger than 14 years
• Approximately 60% pediatric lymphomas as NHL
• Clinical appearance
– Disease usually diffuse rather than nodular
– Cell type undifferentiated or poorly differentiated
– Dissemination occurs early, often, and rapidly
– Mediastinal involvement and invasion of meninges
Areas of Lymphadenopathy and Organ
Involvement in Hodgkin Disease
CNS TUMORS
• Brain tumors and neuroblastomas are
derived from neural tissue
• Account for approximately 20% of
childhood cancers
• Tumors are difficult to treat, with poor
survival rates
Diagnostic Evaluation
• Signs and symptoms are
related to anatomic
location, size, and child’s
age
• Presenting clinical signs
• Neurologic evaluation
• MRI, CT, EEG, LP
• Histologic diagnosis via
surgery
Neuroblastoma
• The most common
malignant extracranial
solid tumor of childhood
• Majority of tumors
develop in the adrenal
gland or retroperitoneal
sympathetic chain
• Other sites: head, neck,
chest, pelvis
• Metastasis may have
already occurred before
diagnosis is made
Bone Tumors
• Osteosarcoma and Ewing
sarcoma account for 85%
of all primary malignant
bone tumors in children
• Femur most common site
• Occur more commonly in
males, with highest
incidence during
accelerated growth rate of
adolescence
Rhabdomyosarcoma
• Malignant neoplasm originating
from undifferentiated
mesenchymal cells in muscle,
tendon, bursa, and fascia or in
fibrous, connective, lymphatic,
or vascular tissue
• Name reflects tissue of origin
– Myosarcoma (myo—muscle)
– Rhabdomyosarcoma (rhabdo—
striated muscle)
Wilms Tumor
• Also called nephroblastoma
• Malignant renal and
intraabdominal tumor of
childhood
• Three times more common in
African-American children
• Peak age of diagnosis is 3 years
• More frequent in males
Do not palpate the abdomen,
it may disseminate cancer cells to other sites
(Jakubik & Selekman, 2006).
Retinoblastoma
• Congenital malignant
tumor; arises from the
retina
– 60% are nonhereditary and
unilateral
– 15% are hereditary and unilateral
– 25% are hereditary and bilateral
• Cat’s-eye reflex—most
common sign
• Strabismus—second most
common sign
• Red, painful eye, often
with glaucoma
• Blindness—late sign
Testicular Tumors
• Tumors not common, but those appearing in
adolescence are generally malignant
• Most common form of cancer in males from ages
15 to 44 years
• Treatment: orchiectomy, followed by
chemotherapy and/or radiation depending on
metastasis
• Nursing considerations
• Importance of testicular self-examination
Nursing Considerations
– Prepare child and family for
procedures
– Pain management
– Nausea prevention
– Prevent complication of
myelosuppression
– Prevention of infection
-hand washing, reverse
isolation
- Central Line placement for
chemotherapy
Nursing Considerations
• Preoperative preparation
is crucial
• Support during
adjustment to concept of
amputation, surgical
resection
• Body image concerns—
issues of adolescents
• Pain management
– Phantom limb pain
rotationplasty
Managing Side Effects
of Cancer Treatments
•
•
•
•
•
•
•
•
•
•
Infection/neutropenia
Hemorrhage
Anemia
Nausea and vomiting
Altered nutrition
Mucosal ulceration
Neurologic problems
Hemorrhagic cystitis
Alopecia
Steroid effects
– Moon face
– Mood swings
Pain Management
• Oral or IV dosing preferred
• Appropriate dosage based on body weight
• Titrated to increase analgesia and minimize
side effects
Family Education
• “Cancer quackery”
• Communicating about feelings of
depression, helplessness, and
hopelessness
• Home care
• Support for siblings and family
• Create memory box if
appropriate
Death and Dying
• Toddler- Fears death only as an extesion of
primary fear of separation from parents
• Preschooler- Perceives death as only a temporary
departure
• School age- understands death’s permanence- Is
curious about death. May ask direct questions.
• Adolescent- Expresses anger because of inability
to be independent or plan future goals. May want
to complete projects such as tapes or books for
loved ones.
(Jakubik & Selekman, 2006)
References
• Hockenberry, M.J., & Wilson, D. (2007). Wong’s
Nursing Care of Infants and Children. (8th Ed.)
St. Louis, MO: Mosby Elsevier.
• Jakubik, L. & Selekman, J. (2006). Pediatric
Nursing Certification Review. Society of
Pediatric Nurses.
• Reaman, G.H. (2002). Pediatric oncology:
Current views and outcomes. Pediatric Clinics of
North America, 49, 1305-1318.