Pediatrics Exam 2: Cancer in Children

Pediatrics Exam 2

• Cancer in Children:

  • Difficult to diagnose; symptoms mimic other common illnesses
  • Overt signs (visible): bruising, bleeding, weight loss, vomiting, skin changes
  • Covert signs (not visible): white blood cell count (WBC), labs, masses

• Cancer Therapies:

  • Encourage a second opinion
  • Chemotherapy: targets rapidly dividing cells (skin, gastrointestinal tract (GI))
  • Surgery: removal
  • Radiation therapy: destroys nearby cells. Avoid exposed areas, and use loose clothing
  • HSCT (Hematopoietic Stem Cell Transplant): bone marrow-replacing radiation treatment
  • Steroid Therapy: suppress the immune system
  • Biologic agents: specific cancer-targeting treatments
  • Complementary/alternative therapies: discuss all with doctor

• Assessment and Implementation

  • Emotional support for the entire family, comfort, nutrition, coping mechanisms, monitor vital signs, encourage patient participation
  • Prevention of complications (for example, handwashing, soft toothbrushes, clear floors)
  • Address drug toxicity (nausea and vomiting, anorexia, mouth sores); manage side effects with medications, and feeding adjustments.

• CNS Tumors:

  • Second most common childhood cancer (solid tumors)
  • 60% infratentorial (cerebellum, brainstem); 40% supratentorial (cerebrum)
  • Symptoms depend on tumor location and size (vision changes, headaches, seizures, behavioral changes).

• Neuroblastoma:

  • Most common malignant extracranial solid tumor in childhood
  • Majority develop in adrenal glands or retroperitoneal sympathetic chain.

• Wilms Tumor (Nephroblastoma):

  • 80% of diagnoses are under age 5; peak between ages 2-3
  • Associated with congenital abnormalities (such as hypospadias) and genetic links
  • Symptoms include swelling/mass in abdomen, pain during urination, frequent urination, hematuria (blood in urine).

• Diagnosis and Management (Neuroblastoma, Wilms Tumor):

  • Use imaging (MRI, CT), biopsies, lab tests (24 hr urine collection for catecholamines) to confirm
  • Management includes surgery, chemo, radiation. The earlier the diagnosis, the better the prognosis

• Spina Bifida:

  • Neural tube defect; requires significant support.

• Myelomeningocele: sac protruding outside of the spinal cord.

• Hydrocephalus: Abnormal buildup of cerebrospinal fluid(CSF) in the brain.

  • The build up will place pressure on the brain in potentially harmful way.

• Infant ER Visit:

  • ABC's (Airway, Breathing, Circulation) assessment—priority first; Neurological assessment follows
  • Infections are very possible during this time

• Post-Partum Hemorrhage (PPH)

  • Hemorrhage, any loss greater than 1000cc.
  • Usually occurs within 24 hours.
  • May use uterine massage, medication, blood transfusions, D&C or hysterectomy
  • Uterine atony (lack of contraction) a common cause

• Mastitis:

  • Breast infection; often caused by improper breastfeeding.
  • SGA (Small for Gestational Age):
    • Weight is below the tenth percentile for their gestational age.
  • LGA (Large for Gestational Age):
    • Weight is above the 90th percentile for their gestational age.

• Preterm Infants:

  • Born before 37 weeks gestation; impaired oxygenation, difficulties with feeding or breathing.

• Infant of a Diabetic Mother (IDM):

  • Often large for gestational age.

• Alcohol & Drug Abuse in Infants:

  • Developmental effects and withdrawal symptoms due to abuse.

• Neonatal Absence Syndrome:

  • Characterized by early withdrawal problems.

• Phototherapy:

  • Important in treating hyperbilirubinemia (jaundice) to prevent kernicterus. Helps prevent brain damage, too much bilirubin

• Comfort measures for newborns:

  • Warm blankets, pacifiers and skin-to-skin contact

• Other important topics:

  • Head circumference measurement
  • Nutritional considerations (feeding problems/special needs formulas)
  • Monitoring complications and side effects/treatment (including infection and wound care)
  • Educational/support services needed for the family
  • Emotional support