The Child with Cancer James Chapter 24 Signs of Cancer in Children Symptoms resemble those seen in common illnesses

es o Bone pain, headache, fatigue, malaise o Persistent lymphadenopathy Overt signs o Mass o Purpura, pallor, whitish reflex in eye

Change in gait, balance, or personality Early morning vomiting, weight loss !ecurrent or persistent fever

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Management "in general# Chemotherapy !adiation $herapy o !E%&E' common side effects of chemo and radiation ( Box )* + Surgery ,ematopoietic Stem Cell $ransplantation o -llogeneic ( matched related or unrelated donor o -utologous ( bone marrow, peripheral, or umbilical cord blood Steroid $herapy Biological -gents Complementary and -lternative Medical "C-M# $herapies Leukemia Proliferation of immature 'BCs in bone marrow Crowd out normal cells .ecreased !BCs / anemia "wea0ness, pallor# .ecreased lymphocytes / immunosuppression "infection, fever# .ecreased platelets / bleeding, 1 clotting "petechiae, bruising, purpura, epistaxis# &nfiltrate other sites Mostly brain, testicles -lso lymph nodes, liver, spleen, 2oints Most common cancer in children 3 +4 Pea0 incidence of -55 ( ) 4 year olds .iagnosis Bone marrow aspiration and biopsy Manifestations 6ever Pallor Excessive bruising Bone or 2oint pain ,istory, physical manifestations 5ymphadenopathy Malaise ,epatosplenomegaly 5abs ( high or low 'BC, low ,7,, low plt

$reatment ( chemo &nduction ( goal is to induce remission "1 immature blast cells in bone marrow to 348# 'BCs release uric acid when exposed to chemo9 uric acid "poor water solubility# can compromise 0idney function "tumor lysis syndrome# $reat with allopurinol and &% fluids with sodium bicarbonate or parenteral urate oxidase prior to chemo Consolidation &ntrathecal chemo prophylactically to prevent relapse in C:S !adiation if testes are involved Maintenance ;irls treated for ) more years Boys treated for < more years :ursing considerations Explain tests=procedures to child !elieve pain Prevent infection Provide ade>uate nutrition Monitor for bleeding -dhere to chemo precautions Manage side effects Provide emotional support

!eview :ursing Care Plan ( ?ames pgs @AB @++ :ursing diagnoses Expected outcomes &nterventions -:. rationales Brain Tumors .efined by tissue of origin, location, rate of growth +C brain tumors confined to brain=spinal cord Clinical symptoms depend on siDe and location than on aggressiveness of tumor M!& most commonly used diagnostic tool Children 3@ usually need sedation ,allmar0 symptoms ,=- and morning vomiting Other symptoms -taxia "unsteady gait#, poor coordination %isual changes $orticollis Symptoms associated with E &CP o ,=-, vomiting, lethargy o &rritability, poor feeding, bulging fontanel Management Surgery Chemo 7 radiation o !adiation avoided in children 3 < b=c of toxic effect on the developing brain :ursing Care Controlling acute symptoms Pre and post op care

Malignant Lymphomas :eoplasms of lymphoid cells "a component of the immune system# ) main typesF :on ,odg0inGs lymphoma ,odg0inGs lymphoma Non- odgkin!s Lymphoma !apid onset, widespread involvement Children with immune system disturbances at greater ris0 .iagnosis Exam ( enlarged lymph nodes, hepato splenomegaly, Chest x ray ( mediastinal disease C$ scan ( chest, abdomen, pelvis $reatment Chemo -t high ris0 for tumor lysis syndrome Symptoms -bdominal disease o Cramping, constipation, obstruction, pain o -norexia, weight loss o %omiting is a late sign 5ymph nodes odgkin!s "isease ",odg0inGs 5ymphoma# More common in the adolescent 7 young adult CauseH Possibly infectiousI :eoplasm originates in lymphoid system MetastasiDes to spleen, liver, bone marrow, lungs More localiDed than non ,odg0inGs lymphoma .x C$ scan Biopsy of an involved lymph node $reatment Chemo 7 radiation Manifestations Painless enlargement of lymph nodes "cervical# Cough, abdominal pain "r=t metastasis# Systemic problems o :ights sweats o 6ever o 'eight loss Neuro#lastoma 6ound exclusively in infants and children Jsually seen in children 3 ) KSilentL tumor ( metastasis present at time of dx Primary site ( abdomen "flan0 area# .x C$ scan Bone marrow aspiration=biopsy $reatment Chemo, radiation Clinical signs -bdominal mass with protuberant, firm abdomen Jrinary retention, fre>uency 5ymphadenopathy ;eneraliDed wea0ness, malaise &mpaired !OM 7 mobility, pain 7 limping

Painless enlarged cervical or axillary nodes

Mediastinal disease o Cough, respiratory distress, bronchitis type symptoms o $racheal deviation

$steosarcoma Most common primary bone malignancy in children &ncidence pea0s in teenage years during rapid bone growth Manifestations Progressive, intermittent pain Palpable mass 5imping, limited !OM Pathologic fractures at tumor site .xF C$=M!&, s0eletal scintigraphy $xF surgery and chemo - pediatric nurse specialist is providing a teaching session to the nursing staff regarding osteosarcomaM 'hich of the following would not be a component of the information provided during this sessionH -M $he symptoms of the disease in the early stage are almost always attributed to normal growing painsM BM $he femur is the most common site of this sarcomaM CM 5imping, if a weight bearing limb is affected, is a clinical manifestationM .M $he child does not experience pain at the primary tumor siteM %ilms! Tumor &Nephro#lastoma' Most common renal cancer in chilren Swelling, mass in abdomen $umor is encapsulated o :o biopsy or palpation ( could KseedL tumor .xF C$ scan, M!&, labs $reatment :ephrectomy=adrenalectomy Chemo 7 radiation $ther Tumors EwingGs Sarcoma Bone tumor Pain, soft tissue swelling, fever (ha#domyosarcoma Muscle tumor ( head, nec0, eye orbit most common Mass may be mista0en for a traumatic hematoma (etino#lastoma $umor of eye found only in children