30 Questions
In acute lymphocytic leukemia (ALL) in children, which cells are involved?
Immature lymphocytes
Which age group has the highest incidence of ALL?
Children between 2 and 6 years
What is a common symptom of ALL in children caused by decreased RBC production?
Lethargy
What is the prognosis for children with ALL who have a WBC count higher than 50,000/mm3 at diagnosis?
Poor prognosis
What is the most frequently occurring type of cancer in children?
Leukemia
How are immature lymphocytes in ALL identifiable?
At the blast cell or stem cell stage
At what age does nephroblastoma (Wilms’ tumor) usually peak?
5 years
Which of the following is a common associated congenital anomaly with nephroblastoma (Wilms’ tumor)?
Cryptorchidism
What is the primary source of metastasis of nephroblastoma without therapy?
Lungs
Which of the following is not a symptom typically associated with nephroblastoma?
Hearing loss
What embryonic structure does nephroblastoma arise from?
Mesoderm
Which diagnostic tool can reveal the primary tumor and any points of metastasis in nephroblastoma?
CT scan
What is the main goal of maintenance chemotherapy in leukemia treatment?
To eliminate remaining leukemic cells and allow the immune system to complete the eradication
Which drug is often administered after systemic methotrexate to neutralize its action and protect normal cells?
Leucovorin
Which of the following is NOT a part of standard maintenance therapy for leukemia?
Intrathecal vincristine
What is the recommended duration of maintenance therapy in leukemia treatment?
2 to 3 years
What should be done if there is serious bone marrow depression during the maintenance phase of leukemia treatment?
Medication levels should be reduced or a transfusion may be necessary
Which type of stem cell transplant uses cells donated by someone who is immune compatible with the child?
Allogenic transplant
What type of transplant is possible between twins?
Syngeneic transplant
What is a possible complication of leukemia therapy?
Reproductive system disorder
What is a possible outcome of treating a child with methotrexate without checking for oral or IV methotrexate prescription at the same time?
Toxic reaction
What is the purpose of inserting an Ommaya reservoir?
Providing easy access to CSF for sampling or injection
What is a possible result of kidney involvement in leukemia?
Kidney enlargement
What is the significance of a lumbar puncture in leukemia diagnosis?
Detecting blast cells in the CSF
What is a potential consequence of renal involvement in chemotherapy treatment for leukemia?
Ineffective excretion of chemotherapeutic agents
What is the purpose of irradiating the testes in boys with leukemia?
To destroy a sanctuary site for leukemic cells
Why might sperm banking be suggested for boys past puberty undergoing chemotherapy and radiation for leukemia?
To preserve sperm for reproduction later in life
What is the main risk for children undergoing chemotherapy for leukemia?
Increased risk of infection
What are some common causes of death in children with leukemia?
Pneumonia, meningitis, and septicemia
Which organism is commonly an invading organism in children with leukemia?
Pseudomonas
Study Notes
Complications of Chemotherapy in Leukemia
- Renal involvement may limit the use of chemotherapeutic agents, as they cannot be excreted effectively due to kidney damage.
- In boys, leukemic cells tend to invade the testes, leading to the need for testicular irradiation to destroy this sanctuary site for cells, which results in sterilization.
Leukemia in Children
- Leukemia is the most frequently occurring type of cancer in children, and the highest incidence of ALL (Acute Lymphocytic Leukemia) is in children between 2 and 6 years of age.
- The prognosis in children younger than 1 year or older than 10 years at the time of first occurrence is not as good as in those between 2 and 10 years of age.
- The prognosis in children who have a WBC count higher than 50,000/mm3 in bone marrow at the time of diagnosis is not as good as in those with a lower WBC count at first diagnosis.
Symptoms of ALL in Children
- The first symptoms of ALL in children usually are pallor, low-grade fever, and lethargy (symptoms of anemia caused by decreased RBC production).
Nephroblastoma (Wilms’ Tumor)
- Nephroblastoma (Wilms’ tumor) is a malignant tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney.
- It accounts for 20% of solid tumors in childhood; there is no increased incidence based on sex or race.
- Some children with the disorder have a deletion on chromosome 11.
Assessment and Diagnosis of Nephroblastoma
- A nephroblastoma is usually discovered early in life (6 months to 5 years; peak at 3 to 4 years).
- Tumor is felt as a firm, nontender abdominal mass.
- Manifest with hematuria and a low-grade fever.
- Anemic from lack of erythropoietin formation by the diseased kidney.
Therapy and Management
- The third phase of therapy intensifies the assault against leukemic cells using chemotherapeutic agents.
- Maintenance chemotherapy aims to eliminate completely any remaining leukemic cells, so that the child’s immune system can complete the eradication.
- Standard maintenance therapy includes a combination of daily mercaptopurine, weekly methotrexate, sporadic vincristine and prednisone, and intrathecal methotrexate, and may be continued for 2 to 3 years.
Complications of Therapy
- Throughout therapy, the health care team and family need to be alert for complications of therapy, including CNS, renal, and reproductive system disorders.
- CNS involvement can become severe and intense, leading to blindness, hydrocephalus, and recurrent seizures.
- Kidney involvement, resulting from invasion of leukemia cells, is a second serious complication.
Test your knowledge on nursing care for pediatric leukemias including acute lymphocytic leukemia (ALL) and Wilm's tumor. Learn about the distorted and uncontrolled proliferation of white blood cells (leukocytes) in children and common health problems in preschoolers.
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