Download Children with Cancer

Children with Cancer
NUR 264
Pediatrics
Julianna Maynor, RN, MSN
Developmental Differences
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Childhood malignances arise from embryonic tissue
Environmental factors do not play as large a part in
childhood cancers as they do in adult cancers
Diagnosis of cancer in children is usually made when
symptoms warrant a diagnostic work-up
Few preventative strategies are known for childhood
cancer
Metatstatic disease is often present at diagnosis of
childhood cancers
Childhood cancers are more responsive to treatment
Childhood cancers have a greater than 70% cure rate
Cardinal Symptoms of Cancer
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Unusual mass or swelling
Unexplained paleness and loss of energy
Sudden tendency to bruise
Persistent, localized pain or limping
Prolonged, unexplained fever or illness
Frequent headaches, often with vomiting
Sudden eye or vision changes
Excessive, rapid weight loss
Diagnostic Assessment
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History and physical exam
Lab tests: CBC (decreased H&H, increased immature
cells), chemistry (abnormal renal &liver function,
electrolyte balance), UA, lumbar puncture
Imaging studies: x-rays, IVP, CT scans, US, nuclear
scan, MRI
Biopsy
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Classification –biological characteristics of tumor
Staging – extent of disease at time of diagnosis (higher the
stage, poorer the prognosis)
Diagnostic Assessment
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Bone marrow studies: when concern for
metastasis or when primary site is blood
forming organ to determine extent of
involvement by malignant cells
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Aspiration – obtain marrow through needle
Biopsy – obtain piece of bone through special
needle
Cancer Treatment
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Goal of treatment is to remove all malignant
cells from the body. Therapy may include:
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Surgery
Chemotherapy
Radiation therapy
Bone marrow transplant
Biological response modifiers
Cancer Treatment: Surgery
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Obtain biopsy
Aids in tumor staging by noting the presence
and extent of metastasis
Remove tumor
Restore body function
Cancer Treatment: Chemotherapy
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Primary form of treatment or adjunct to
surgery and/or radiation
Used for systemic cancers that cannot be
managed by surgery or radiation
Combination of drugs – for optimum cancer
cell cycle destruction with minimum toxic
effects
Cancer Treatment: Chemotherapy
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Use access ports to minimize multiple
venipunctures
Use continuous infusions over extended period
via syringe pumps for decreased toxicity, such
as when intermittent dosages are given
Healthy cells are susceptible to damage
Causes bone marrow suppression – fatigue,
anemia, bleeding tendencies, increased risk of
infection
Chemotherapy: Three phases
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Induction: Initial therapy
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Consolidation: Given after remission is complete
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Goals: To eliminate as many cancer cells as possible
To obtain a complete remission
Goal: To ensure complete eradication of disease
Maintenance: Given for several months to years
after consolidation, depending on disease
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Goals: To maintain a complete remission
To minimize late effects
To prevent drug resistance from developing
Cancer Treatment: Chemotherapy
Potential Complications
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Vesicants: severe cellular damage if infiltrate
Side effects affecting almost every body system
Anaphylaxis: cyanosis, hypotension, wheezing,
severe uticaria. Can be fatal – discontinue drug,
flush IV with saline and monitor VS
Hypersensitivity: rash, itching, flushing,
hypotension, angioedema. When administering –
wear gown, gloves, mask, goggles to prevent any
physical contact. Discard ampules and syringes in
special containers
Chemotherapy Side Effects
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Hematopoietic effects
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Myelosuppression (transient decrease in blood cell production)
Anemia: may require blood transfusions
Thrombocytopenia
Immunosuppression
Neutropenia (abnormal decrease in number of WBC)
Gastrointestinal effects
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Stomatitis (inflammation of the oral mucosa. May be mild to
severe and may affect the entire GI tract)
Nausea
Vomiting
Anorexia
Chemotherapy Side Effects
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Hepatic effects
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Renal effects
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Renal toxicity
Hemorrhagic cystitis
Integumentary effects
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Liver toxicity
Hair loss
Reproductive effects
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Sterility
Delayed puberty
Cancer Treatment: Radiation
Therapy
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Used to deliver a therapeutic dose of ionizing
radiation to a a tumor with minimal effects to
the healthy surrounding tissue
Causes breaks in DNA molecules to destroy
the cancer cells
Many side effects
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Radiation pneumonitis
Somnolence syndrome
Cancer Treatment: Bone Marrow
Transplant
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Allows lethal doses of chemotherapy and radiation to
be given
After chemotherapeutic agents are given, bone
marrow or stem cells are transfused to patient to
allow nonmalignant blood cells to function
Types of bone marrow transplant
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Autologous: patient receives own marrow
Allogenic: patient receives donor marrow, must match as
close as possible
Syngeneic: patient receives marrow from identical twin
Umbilical cord blood stem cells: may use unmatched donor
Cancer Treatment: Biologic
Response Modifiers
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Stimulate immune system to respond
aggressively to tumor or to attack tumor cells
with antibodies
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Monoclonal antibodies: early cancer detection, to
reduce graft vs. host disease, destroy malignant
cells from autologous bone marrow for
retransplant
Immune stimulants: interferon, interleukin
Complications of Cancer Treatment
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Acute tumor lysis syndrome: Occurs when a
large number of tumor cells are destroyed
quickly in response to chemotherapy or
radiation. As tumor cells die, nucleic acids and
intracellular metabolites are released and
exceed the excretory capacity of the kidneys.
Nucleic acids are converted to uric acid in the
liver and may crystallize leading to obstruction
of the kidneys and acute renal failure.
Complications of Cancer Treatment
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Graft versus host disease (GVHD): immune response
resulting from disparities in the match between donor
and recipient bone marrow. The donor white cells
perceive the child’s body as foreign material to be
attacked and destroyed. Graft versus host disease is
usually restricted to certain organs such as the skin,
GI tract, liver, and other organs. The symptoms of
GVHD can be minimal or life-threatening and
include skin rash beginning on the hands and feet,
spreading to other parts of the body, diarrhea,
jaundice and infection. These symptoms are
managed with symptomatic support and
immunosuppressive drugs.
Complications of Cancer Treatment
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Hypercalcemia: when large amounts of bone are destroyed by
treatments
Hyperleukocytosis: increased WBC count leads to capillary
obstruction, micorinfarction, and organ dysfunction
Obstructions: from space-occupying lesions, masses, tumors,
catheters
Overwhelming infection: sepsis, septic shock – due to protein
malnutrition and other dietary deficiencies and immune
suppression
Life-threatening hemorrhages: from DIC, thrombocytopenia,
leukocytosis, intracranial bleeding
Death: due to high energy demands and nutrient needs of
cancer cells – take over nutrients and O2 supply needed by
normal cells to survive
Types of Cancers in Children
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Leukemia: group of malignant diseases of the
bone marrow and lymphatic system. Normal
bone marrow elements are replaced by abnormal
immature lymphocytes, known as blast cells –
most common form of childhood cancer
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Acute lymphocytic leukemia: accounts for 80% of
all childhood leukemia. Peak incidence occurs
between the ages of two and five years old. CNS
prophylaxis.
Acute myelogenous leukemia: accounts for 15 to
25% of all childhood leukemia. Prognosis is
poorer than for those with ALL.
Types of Cancers in Children
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Brain tumors: most common solid tumor.
Second most common form of childhood
cancer. Third leading cause of death in
children under 16 years of age. Prognosis
varies depending upon the age of he child at
diagnosis, pathology and location of the tumor.
Astrocytoma: most common type of CNS
tumor in children
Types of Cancer in Children
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Lymphomas: malignancy that arises from the
lymphoid system. Lymphomas are the third
most common type of childhood cancer
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Hodgkin’s disease: usually originates in a cervical
lymph node and spreads to other lymph node
regions. Accounts for approximately 5% of
childhood malignancies.
Non-Hodgkin’s lymphoma: no single focal origin,
malignant cells are rarely localized. Has a rapid
onset and presents with widespread involvement
Types of Cancer in Children
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Neuroblastoma: nervous system tumors arising
from adrenal gland or retroperitoneal
sympathetic chain (brain, adrenal medulla,
pelvis, mediastinum, and sympathetic ganglia)
Fourth most common childhood malignancy
Most common malignant tumor of infancy
“silent tumor” – poor prognosis
Types of Cancer in Children
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Wilm’s Tumor: most common type of renal
cancer in children
Usually presents as an abdominal mass.
A large flank mass is usually found in a
healthy child by a family member
The mass is present on one side and seldom
crossing the midline, as does neuroblastoma
Types of Cancer in Children
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Bone tumors
Osteogenic sarcoma: tumor of the bone that usually occurs in
the growth metaphysis or the end of the long bones
Ewing’s sarcoma: can present in any bone of the skeleton, but
is often seen in the bones of the pelvis, tibia, fibula, and femur
Types of Cancer in Children
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Rhabdomyosarcoma: soft tissue sarcoma
arising primarily from the connective tissues of
the body, such as fibrous, adipose, or muscle
tissue.
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Embryonal: most common type. Usually affects
infants and young children in the area of the
genitourinary tract and the head and neck area.
Alveolar: occurs in the large muscles of the trunk,
arms, and legs
Types of Cancer in Children
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Retinoblastoma: malignant tumor arising from
the retina. Seen only in children. Usually
found in infants and very young children.
Detected by presence of cat’s eye reflex
instead of red reflex
Testicular tumor: most common form of cancer
in males age 15 - 34
Nursing Care of Children with
Cancer
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Thorough Assessment
History
Manage side effects of treatment
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Infection
Hemorrhage and anemia – administer transfusions as ordered
Nausea / vomiting – administer antiemetics
Altered nutrition – monitor daily weight, strict I&O
Mucosal ulceration – offer bland, moist soft diet, sot toothbrush
Neurologic problems – warn parents of somnolence syndrome
Hemorrhagic cystitis – provide adequate hydration
Alopecia
Steroid effects
Nursing Care of Children with
Cancer
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Nursing care during Bone Marrow Transplantation
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Hospitalization 3-6 weeks, isolation
Risk of infection
Numerous procedures
Side effects & complications of cytotoxic treatments
Monitor for graft vs. host disease GVHD & treat
Monitor skin breakdown, wound healing
Sensitive & supportive attitude
Nursing Care for Children with
Cancer
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Prepare for procedures
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IV’s
Labs, imaging studies
Bone marrow studies
Lumbar puncture
Surgery
Conscious/unconscious sedation
EMLA cream
Emotional support
Nursing Care of Children with
Cancer
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Pain Management
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Opoids
NSAIDs
Health promotion
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Dental care
Immunizations
Nutrition
School
Discipline
Vision & hearing screenings
Nursing Care of Children with
Cancer
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Family education
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Home care
Referrals
Cessation of therapy
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Assess for delayed growth, secondary
malignancies, body system disturbances
Follow-up care
Questions?