Childhood Cancer Presentation Spr 2024 PDF

Childhood Cancer P R E S E N T E D B Y: K A T H E R I N E R O Q U E , B S N , R N , C P H O N , B M T C N A Quick Overview A Quick Overview Worth knowing about, even if you’re not interested in beco...

Childhood Cancer P R E S E N T E D B Y: K A T H E R I N E R O Q U E , B S N , R N , C P H O N , B M T C N A Quick Overview A Quick Overview Worth knowing about, even if you’re not interested in becoming a Peds. H/O RN! A Quick Overview It is highly common that these patients will be admitted to adult facilities in the future d/t long-term side effects!  Pediatric Cancer Definition A group of acute and chronic diseases characterized by uncontrolled growth and spread of abnormal cells which, if not adequately treated, results in the death of the patient. How Does Cancer Begin? Normal cells follow the rules, cancer cells don’t:  Starts with DNA damage (DNA being the instruction manual for the cell) 1. Oncogene- genes that normally promote growth (proto-oncogene) are mutated to be hyperactive/overexpressed 2. Tumor Suppressor- genes that normally inhibit growth are mutated to be inactive  Carcinogenesis  AKA “oncogenesis” or “tumorigenesis”- term to describe the formation of cancer, whereby normal cells are transformed into cancer cells. 1. Initiation- occurs when a cell undergoes any change that is passed on to its daughter cells 2. Promotion- characterized by an increase in cell growth that goes unchecked under normal conditions. 3. Progression- the cells has an inherent ability to exert influence over its environment. The cells become self-sustaining & a tumor occurs.  Carcinogenesis  AKA “oncogenesis” or “tumorigenesis”- term to describe the formation of cancer, whereby normal cells are transformed into cancer cells. What Initiation- occurs when a cell 1. undergoes any change that is causes passed on to its daughter cells 2. Promotion- characterized by an initiation increase in cell growth that goes unchecked under normal ? conditions. 3. Progression- the cells has an inherent ability to exert influence over its environment. The cells become cell-sustaining & a tumor occurs. https://www.youtube.com/watch?v=hI3wrKpxySA#action=share  C H L EE I S A R N CE C A  Common Types of Childhood Cancer Hematological (“liquid”)  leukemia (blood/marrow)  lymphoma (lymphatic system) Solid Tumors  CNS tumors (brain/spine)  Neuroblastoma (SNS)  Rhabdomyosarcoma (muscle)  Wilms tumor & rhabdoid (kidney)  Ewing’s sarcoma, Osteosarcoma (bone)  Retinoblastoma (eye)  Characteristics of Childhood Cancer Usually affects deep tissues Often disseminated at diagnosis Sometimes related to peak growth periods No screening or early detection available Usually very responsive to therapy 75% - 80% overall cure rate Cancer Stat Facts: Childhood Leukemia (Ages 0–19) Cancer Stat Facts: Childhood Brain and Other Nervous System Cancer (Ages 0– 19) Incidence of Childhood Cancer  The Impact of a Cancer Diagnosis in Childhood Loss of control Living with uncertainty Potential loss of My Sister's Keeper Trailer future of child of future generations Developmental issues Familial distress Being a pediatric oncology nurse is more then caring for the patient, it’s caring for the whole family. Moral distress  Treatment Modalities  Chemotherapy  Radiation  Surgery  Hematopoietic stem cell transplant  Auto= own cells  Allo= donated cells  Biotherapy  Steroids*  Multidisciplinary Supportive Care  Oncology  Social Work  Radiation  Psychology  Surgery  Dietary  Nursing  Clergy  Rehabilitation  Educators  Pharmacy  Child Life  Laboratory  Volunteers  Radiology  Interpreters  Parent Therapy Dogs Liaisons Let’s Dive Right In!  What is Leukemia? “leuk” = white “emia” = blood Malignancy of Photo courtesy of Dr. C-H. Pui blood-forming tissue Incidence of Childhood Leukemia LEUKEMIA AGE % % CHILDHOOD TYPE PEAK CHILDHOOD CANCER LEUKEMIA ALL 2–4 75% 25% years AML Neonate 15 – 20% 5% Teen CML None 100,000 Age at diagnosis- for ALL >2 y.o and 90%)  Most likely derived from B cells; express CD30  Reed-Sternberg cell: - Multinucleated giant cell - “Owl’s eye” appearance  Hodgkin’s Disease: Clinical Presentation Painless lymphadenopathy (60-90% in the cervical chain) Nodes often firm, rubbery Extension to contiguous areas Mediastinal mass (66%) Hepatosplenomegaly (10- 30%)  Hodgkin’s Disease: Clinical Presentation Systemic “B” Symptoms (30%) - unexplained fever >38° for 3 consecutive days - drenching night sweats - weight loss >10% in 6mos  Hodgkin’s Disease: Epidemiology Etiology unknown Rare before age 5, with peak in young adulthood 15-25% of AYA’s have EBV+ HL Occasionally occurs in siblings and multiple family members More commonly seen in males (3:1 when under 10 y.o., then evens out by  Hodgkin’s Work-Up Physical Examination- emphasis on lymph-node dense areas Labs: ESR, CRP, CBC with differential, liver/kidney function, serum copper/ferritin Gold Standard to confirm dx: Surgical lymph node biopsy Radiographic scans: CXR, CT of N/A/P, PET scan, bone scan, Pathology: bilateral bone marrow aspirate/biopsy, lymph node biopsy Patient’s with >25% blasts  Ann Arbor Classification- Staging for Hodgkin’s Disease  Hodgkin’s Treatment Multimodal: - Chemotherapy - Many types of chemotherapy agents used! Alternating cycles often used. - Length of tx: 3 years of age Chemotherapy High dose chemotherapy followed by auto stem cell rescue  IMPLICATIONS OF A BRAIN TUMOR DIAGNOSIS  Devastating disease  high morbidity  high mortality  Permanent residual deficits  Interferes with  work/school  development/maintenance of family/social relationships  Financial burden  Loss of previous lifestyle/independence  Neuroblastoma - Tumor malignancy that arises from neural crest cells that make up the Sympathetic Nervous System - Most common extracranial solid tumor in children; 8% of all childhood cancers (800 cases/year) - 15% of childhood CA deaths - Most commonly diagnosed in Toddler - Majority (65%) are located above the kidney, from the adrenal medulla - Other common sites: chest, neck or pelvis - Often spreads from "primary" location to the bone marrow, bones or lymph nodes. - Signs/Symptoms depending upon tumor/metastases location(s); can be asymptomatic or have paralysis - More unique identifiers: - Blueberry muffin spots - Swelling/bruising around eyes - Changes in urination - Dx made by histology of biopsy of tumor Neuroblastoma Treatment - Severity of disease varies durastically - MYCN gene amplification (>10 copies) associated with aggressive tumors, advanced stage at dx, and poor outcomes - Hyperdiploid/