The child with cancer

Childhood Cancer Overview

• Topics covered include epidemiology, etiology, risk factors, and prevention.

Diagnostic Evaluation

• Includes laboratory tests, diagnostic procedures, diagnostic imaging, and pathologic evaluation

Treatment Modalities

• Includes surgery, chemotherapy, radiotherapy, and bone marrow transplantation (HSCT).

Autologous Bone Marrow Transplantation (BMT)

• Uses the patient's own marrow, collected from disease-free tissue, frozen, and sometimes treated to remove malignant cells.
• Treats neuroblastoma, Hodgkin disease, non-Hodgkin lymphoma, Wilms tumor, rhabdomyosarcoma, and Ewing sarcoma.

Allogeneic Bone Marrow Transplantation (BMT)

• Requires matching a histocompatible donor with the recipient to prevent graft-versus-host disease (GVHD).
• Cells are aspirated from the donor and given to the recipient.
• Limited by the presence of a suitable marrow donor.

Managing Side Effects of Treatment

• Infection control measures include managing the environment, hand hygiene, visitor restriction, nutrition, and planning for home care.
• Increased susceptibility to hemorrhage and anemia requires prevention and treatment, potentially including platelet transfusion

Managing Problems of Drug Toxicity

• Includes addressing nausea and vomiting, anorexia, mucosal ulceration, neuropathy, hemorrhagic cystitis, alopecia, moon face, and mood changes.

Leukemia

• Broad term given to a group of malignant diseases of the bone marrow, blood, and lymphatic system.
• It is the most common form of childhood cancer.

Classification of Leukemia

• Two main forms are acute lymphoblastic leukemia (ALL) and acute nonlymphoid (myelogenous) leukemia (AML).

Consequences of Leukemia

• Depressed bone marrow function leads to anemia from decreased RBCs, infection from neutropenia, and bleeding tendencies from decreased platelet production.
• Spleen, liver, and lymph glands show marked infiltration, enlargement, and fibrosis.
• There may be CNS involvement and increased intracranial pressure (ICP).

Diagnostic Evaluation of Leukemia

• Based on history and physical manifestations, peripheral blood smear (looking for immature leukocytes and low blood counts).
• Lumbar puncture evaluates central nervous system (CNS) involvement, along with bone marrow aspiration or biopsy.

Therapeutic Management of Leukemia

• Includes chemotherapeutic agents, cranial irradiation (in some cases), and bone marrow transplantation (BMT).

Phases of Therapy for Leukemia

• Induction therapy lasts 4 to 5 weeks.
• Intensification (consolidation) therapy eradicates residual leukemic cells and prevent resistant leukemic clones.
• Maintenance therapy preserves remission.

Nursing Considerations for Leukemia

• Preparing the child and family for procedures, pain management, preventing myelosuppression complications, and providing continued emotional support.

Lymphomas

• Neoplastic diseases originate in the lymphoid system and can metastasize to non-nodal sites.
• Hodgkin is more prevalent in patients aged 15 to 19.
• Non-Hodgkin lymphoma (NHL) is more prevalent in children younger than 14 years.

Hodgkin Disease

• It is a neoplastic disease that originates in the lymphoid system.
• Often metastasizes to the spleen, liver, bone marrow, lungs, and other tissues
• Classified by histologic type.

Staging of Hodgkin Disease-Ann Arbor

• Stages include I, II, III, and IV.

Diagnosis of Hodgkin Disease

• Clinical manifestations include enlarged, firm, nontender, movable nodes in the supraclavicular or cervical area, cough, abdominal pain, and anorexia.
• Diagnostic tests; CBC, T-cell tests, radiographic tests, and lymph node biopsy for diagnosis and staging (presence of Reed-Sternberg cells).
• Bone marrow aspiration and biopsy is performed in patients with advanced disease.

Management of Hodgkin Disease

• Includes irradiation and chemotherapy (alone or with irradiation).
• Nursing considerations include preparation for diagnostic procedures, prevention and treatment of side effects, and child and family support.

Non-Hodgkin Lymphoma (NHL)

• Approximately 60% of pediatric lymphomas are NHLs.
• Clinical appearance: disease is usually diffuse rather than nodular, cell type is undifferentiated or poorly differentiated, dissemination occurs early, often, and rapidly, and mediastinal involvement and invasion of meninges.

NHL Management

• Diagnostic evaluation staging is similar to Hodgkin disease but of little value.
• Therapeutic management is similar to leukemic therapy.
• Prognosis is excellent with 85-95% cured.

Wilms Tumor

• Also known as nephroblastoma.
• Malignant renal and intraabdominal tumor of childhood; more common in African-American children.
• Peak age of diagnosis is 3 years; more frequent in males.

Wilms Tumor Symptoms and Management

• Symptoms: swelling or mass, weight loss, signs of anemia.
• Palpation of the abdomen is contraindicated.
• Tests: X-rays, ultrasound (U/S), or CAT scan.
• Therapeutic management: surgical removal and chemotherapy with or without radiation.
• Use protective equipment before engaging in contact sports; prompt detection and treatment of urinary signs or symptoms.