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Cancers in Children PowerPoint Presentation

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Description : Check out this medical presentation on astrocytoma in childhood, which is titled "Cancers in Children", to know about the broad types of Cancer in children including leukemias, bone cancers (osteogenic sarcoma), brain tumors (infratentorial and supratentorial), and wilm’s tumor.

Tags : astrocytoma, childhood, Cancer, Children, types, leukemias, bone cancers, osteogenic sarcoma, brain tumors, infratentorial, supratentorial, wilm’s tumor

Published on : May 10, 2021 | Views : 1943 | Downloads : 0

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Lynn Kennell 5/11/2021 1 Cancers in Children
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5/11/2021 2 Introduction Focus on 4 Broad types of Cancer LEUKEMIAS: ALL, ANLL BONE CANCERS: OSTEOGENIC SARCOMA BRAIN TUMORS: INFRATENTORIAL SUPRATENTORIAL WILM’S TUMOR
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5/11/2021 3 Cardinal Signs & Sx of Cancer in Children OVERT SYMPTOMS: A mass Purpura, pallor Weight loss Whitish reflex in the eye Recurrent of persistent infection Vomiting in the early morning COVERT SYMPTOMS: Bone Pain Headache Persistent lymphadenopathy Change in balance or gait Change in personality Fatigue General malaise
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5/11/2021 4 Diagnosis Initially, do CBC, Chem Profile (CMP) with liver function test LP is routine for leukemia, brain tumors, and others to rule out brain/CNS metastasis. Bone marrow aspiration-confirms dx and can be used to assess for relapse CT, MRI, PET scans are all helpful in pinpointing the tumor or extent of the disease if tumors are involved. Biopsy of the tumor—conclusive and determines type
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5/11/2021 5 Leukemias-2 types Acute Lymphocytic Leukemia (ALL) Acute Nonlymphocytic Leukemia (ANLL)
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5/11/2021 6 Cell Surface Immunologic Markers- --a form of classification of cell morphology in the diagnosis of leukemia CALLA Antigens Common Acute Lymphocytic Leukemia Antigen If cells are identified as CALLA+ the child has an increased survival rate These are a GOOD THING!
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5/11/2021 7 PATHOLOGY Primary pathology: decreased # of functional WBC’s but total # of immature WBC’s (blasts) is increased. See pathology flowsheet in syllabus. Bone Marrow Depression: 1. Anemia: d/t decreased RBC’s 2. Infection: d/t decreased effectiveness of WBC’s 3. Bleeding: d/t decreased platelets 4. Physiologic fractures: d/t increased # of cells in bone marrow, thinning & weakening of bone 5. Pain: d/t increased # leukemic cells in periosteum
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5/11/2021 8 Pathology (cont’d) CNS Dysfunction: d/t leukemic cells crossing the blood/brain barrier SX: Increased intracranial pressure: Headache, vomiting, irritability Papilledema, nuchal rigidity Lethargy Also known as leukemic meningitis
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5/11/2021 9 Pathology (cont’d) EXTRA MEDULLARY INFILTRATION leads to the following ORGAN INVOLVEMENT: 1. Hepatomegaly 2. Splenomegaly 3. Lymph Node Enlargement
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5/11/2021 10 Pathology (cont’d) GENERALIZED HYPERMETABOLISM: Also known as “cellular starvation”” 1. Muscle wasting 2. Fatigue 3. Anorexia 4. Weight loss
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5/11/2021 11 Phases of Chemotherapy Remission Induction: Goal: complete absence of leukemic cells as evidenced by <5% blast cells in bone marrow.
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5/11/2021 12 Phases of Chemotherapy (cont’d) Intensification or Consolidation therapy Goal: to further decrease the # of leukemic cells Consists of pulses of chemotherapy
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5/11/2021 13 Phases of Chemotherapy (cont’d) CNS PROPHYLAXIS:| Goal: Treatment is directed at those anatomic areas that are protected to some degree from systemic chemotherapy Triple Intrathecal Administration: 1. Methotrexate– used in all 3 phases of Tx 2. Cytarabine 3. Hydrocortisone Cranial irradiation– now reserved for high risk and those with CNS involvement
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5/11/2021 14 Phases of Chemotherapy (cont’d) MAINTENANCE phase Goal is to preserve remission by preventing the reappearance of leukemic cells. Child is usually on chemotherapy for 2.5 – 3 years.
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5/11/2021 15 Phases of Chemotherapy (cont’d) REINDUCTION FOLLOWING RELAPSE Goal: get child back in remission. Each relapse gives a poorer prognosis Testes are a common site of relapse d/t resistance to chemotherapy
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5/11/2021 16 Bone Marrow Transplantation(BMT) For ALL, BMT is usually only indicated if chemotherapy is UNSUCCESSFUL For ANLL, BMT may be considered with first remission because of poorer prognosis See handout in syllabus on process of preparation and receiving BMT
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5/11/2021 17 Nursing Care see careplan pp. 1388-1390 (10th ed.) Prepare family for procedures– painful diagnostic tests & chemo Provide emotional support--use childlife specialists Recognize side effects of drugs
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5/11/2021 18 Nursing Care (cont’d) Monitor for infections, bleeding, mucosal ulcerations, pain * especially note need for careful oral care in all patients receiving chemotherapy * Infection is the biggest concern for any child receiving chemotherapy. Prepare child in an age-appropriate fashion for all procedures.
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5/11/2021 19 Osteogenic Sarcoma Etiology-- OS is the most frequently encountered bone cancer in children. peak incidence between 10-25 years Primary tumor sites: metaphysis(wider part of the shaft of long bones by the epiphyseal growth plate) of long bones, especially of the lower extremities; > 1/2 occur in the femur
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5/11/2021 20 . Medical Management- - still controversial **Surgery-- Traditionally, radical surgical resection or amputation has been recommended. Amputation ~ 3” above the proximal tumor margin or above the joint proximal to the involved bone. For some pts., limb salvage procedures may be indicated. This involves tumor resection and prosthetic replacement of the involved bone. Chemotherapy-- such drugs as high dose Methotrexate, adriamycin, bleomycin, actinomycinD, ifosfamide, cyclophosphamide, and cisplatin may be used alone or in combination before and after surgery.
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5/11/2021 21 Nursing Considerations: Support the family during the dx and the decision about tx. BE HONEST with the child about the dx and tx. Nurses do not usually inform families of dx, but should be available for clarification, reinforcement and emotional support. Offer only as much information as the child can absorb at a given time. Allow for questions, and follow-up.
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5/11/2021 22 Nursing Considerations (continued) Care for a child with a prosthesis is similar to any person, except that compliance and understanding may take a little longer. Phantom limb pain-- common after amputation may be manifested as itching, pain, tingling, burning, and/or cramping in the area of the amputated leg. Acknowledge the sensations as real. Amitriptyline (Elavil) may be used to  pain. Support through referral to national organization as Candlelighters For Children with Cancer would be helpful to families
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5/11/2021 23 Ewing Sarcoma is another bone tumor but it arises from the bone marrow rather than the osseous tissue (as in osteogenic sarcoma). Treatment is more commonly intensive irradiation of the bone and combined chemotherapy. Amputation is NOT routinely recommended.
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5/11/2021 24 Brain Tumors Infratentorial—Posterior 1/3 of the brain, primarily in the cerebellum or brainstem. Supratentorial—less frequent, located in the anterior 2/3 of the brain, mainly the cerebrum.
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5/11/2021 25
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5/11/2021 26 Etiology--cause is often unknown the most common solid tumors that occur in children and are 2nd only to leukemias as a form of cancer. May be benign or malignant. Infratentorial-- 30% of tumors occur in the posterior third of the brain, primarily in the cerebellum or brainstem. Sx are from  ICP. Supratentorial-- < frequent; located in the anterior 2/3 of the brain, mainly the cerebrum.
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5/11/2021 27 Types-- The type of cell from which the tumor originates helps to classify it histologically. Common names: medulloblastoma, cerebellar astrocytoma, brainstem glioma, ependyomas. Astrocytoma, is the most common Glial brain tumor in children
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5/11/2021 28 Symptoms-- often R/T increased intracranial pressure (ICP) Headache-- especially worse on arising Vomiting-- unrelated to feeding Neuromuscular changes-- incoordination or clumsiness, + Babinski sign after age two Behavioral changes-- irritability,  appetite, fatigue, failure to thrive, lethargy Cranial nerve involvement-- most common: head tilt, visual defects Vital sign changes:  pulse and respirations,  BP, widened pulse pressure, hypo or hyperthermia Other: seizures, cranial enlargement or bulging fontanel at rest (only in young children whose skull sutures have not yet fused),
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5/11/2021 29 Diagnosis-- Thorough hx and attention to details is essential. MRI is most common diagnostic procedure to determine the location and extent of the tumor. CT scan-- may also be used. Lumbar puncture is NOT recommended due to risk of brainstem herniation in light of  ICP.
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5/11/2021 30 Treatment--all 3 of the following may or may not be used depending on tumor type and size. Surgery-- total removal of tumor without neurological damage is the goal. Radiation-- used to tx most tumors and to shrink the size of the tumor before attempting surgical removal. Chemotherapy-- being used more frequently
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5/11/2021 31 Nursing Considerations- Assess for signs and sx-- establish a baseline of data for pre and post operative evaluation. Vital signs are assessed routinely along with a neurological assessment, and head circumference in infants and young children. Detail all sx as HA, N/V, etc. Prepare child and family for Diagnostic Procedures Teach in an age-appropriate manner about x-rays & MRI’s etc. Clarify child’s understanding of what is a brain tumor and why tx is necessary. Avoid giving false reassurance to parents re: outcomes following surgery. There are no guarantees. Be honest yet hopeful. Teach about surgery-- shaving area of the head, dressing post-op, need for frequent assessments, etc.
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5/11/2021 32 Prevent post operative complications Assessment-- VS, neuro ‘s, watch for  temp secondary to hypothalamus or brainstem involvement during surgery. Positioning– For INFRATENTORIAL surgery, keep flat or on left or right side. Pillows are placed beside child’s back not head to maintain position. For SUPRATENTORIAL surgery, may have HOB  to promote CSF drainage. Fluid regulation-- monitor carefully I & O. For Infratentorial surgeries, keep NPO at least 24 hrs or longer if child’s gag reflex is depressed or he is comatose. For supratentorial surgeries, feedings may be resumed as soon as the child is alert. If vomiting occurs, make NPO to decrease risk of  ICP.
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5/11/2021 33 Comfort measures-- Headache may be severe secondary to  ICP. Maintain quiet environment; avoid any jarring of the bed, and prevent anything which might  ICP. Ice bag to the head may be soothing. Opioids may be used if monitored closely. Prevent constipation with stool softeners/laxatives.
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5/11/2021 34 Support child and family Be present at time of discussion of prognosis so that clarification can be done later of any misconceptions of what was said initially. Encourage verbalization of feelings re: guilt they may feel, fears, etc. Collaborate together in telling the child. Honesty preop will help in discussion post-op. Prognosis
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5/11/2021 35 Promote return to optimal functioning-- goal is to return to “normal Life”. Need multidisciplinary approach with parents, doctors/case managers, school nurse, teachers to make transition smooth for the child. Need also to be open to discuss feelings about death and dying if prognosis is poor. Integrate hospice care if indicated.
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5/11/2021 36 Wilm’s Tumor—Nephroblastoma, a tumor that arises in the kidney INCIDENCE & ETIOLOGY: Most common malignancy of the kidney in children and accounts for 5-6% of all childhood cancer. Usually presents between 2-3 years of age. > prevalent in females than males. Etiology is often unknown.
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5/11/2021 37 Pathophysiology A fast-growing tumor of the kidney that is usually encapsulated by a thin membrane that can easily be torn or broken. 2 Categories describe the histology: Favorable responsive to therapy with good prognosis Unfavorable  less responsive to therapy with poorer prognosis Metastasis can occur to lungs, liver, brain, bones, or to the unaffected kidney.
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5/11/2021 38 Diagnosis Any abdominal mass needs a timely & thorough work-up. Rapidly growing tumors often migrate to the point of least resistance and may be found in the renal veins or inferior vena cava. Abdominal CT Scan or MRI will give a clearer preoperative view of the abdomen. Diagnosis is confirmed at surgery when a biopsy is performed. Wilm’s Tumor
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5/11/2021 39 Nursing Alert A precaution is to limit manipulation of the abdomen or liver in children with Wilm’s Tumor that might cause spread of malignant cells should the encapsulated mass rupture. A sign placed on the child’s crib or bed that warns all health care providers to avoid palpation of the abdomen, and instructions to caregivers to use caution when handling and bathing their child can prevent trauma to the tumor.
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5/11/2021 40 Treatment Surgical Resection—nephrectomy Chemotherapy Dactinomycin (Actinomycin D) Vincristine Doxorubicin Radiation Today, only done with metastatic dz, residual tumor after resection, and recurrent tumors
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5/11/2021 41 Nursing Care Support the family when the initial diagnosis is made because surgical treatment is usually quick followed by chemotherapy. Pain management post-op is essential to care Careful assessment of I and O to ensure that there is adequate intake with chemotherapy
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5/11/2021 42 Nursing Care cont’d Careful management of nausea, vomiting, & constipation 2ndary to chemotherapy is critical as well. Wound care and activity restrictions should be reviewed. Review side effects of radiation if part of treatment: altered growth, scoliosis, & possible secondary malignancies
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5/11/2021 43 Prognosis Continues to improve. Largely dependent on histology and staging Overall 5 year survival rate is 90% (online reference) Early diagnosis and treatment is essential to better outcome.
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5/11/2021 44 Be sure to review the Module on Perceptions of Death and Dying in Children and take the quiz on line in Reggienet.