Transcript CH. 52 - Chipola College

Nursing Care of the Child
With Cancer
Neoplasia
Cell growth in cancerous tissue proliferates
in disorderly and chaotic ways
Neoplasm- 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 TUMORS
Osteogenic Sarcoma-malignant tumor of the
long bone
S/S
Pain and swelling, esp. around the knee
Therapeutic Management
Surgery, usually amputation, then chemo
60-65% 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