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CANCER IN CHILDREN

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Title: CANCER IN CHILDREN


1
CANCER IN CHILDREN
  • KAREN E. MILES
  • FLORIDA GULF COAST UNIVERSITY
  • DEPARTMENT OF NURSING

2
CHILDHOOD CANCERS BY AGE
  • SITE 0-5 YR 5-10 YR 10-15 YR
  • Leukemia 39.6 35.7 22.1
  • Lymphoma 03.7 13.3 16.4
  • CNS 15.0 27.1 18.9
  • Wilms Tumor 09.2 06.1 02.0
  • Neuroblastoma 13.0 02.2 00.5
  • Retinoblastoma 06.4 01.3 00.0
  • Bone 00.6 05.0 10.5
  • Other 08.8 05.8 23.6
  • Peak Incidence

3
INCIDENCE
  • 14 cases per 100,000 children/yr
  • 10-25 more common in white than black children

4
ETIOLOGY
  • Largely unknown
  • Most likely - complex interactions of both
    genetic and environmental factors - Ecogentics

5
HOST FACTORS
  • Ataxiatelangectasia - autosomal recessive
    transmission
  • Xeroderma Pigmentosum
  • Immunodeficiency States - 100-fold increased
    risk, either congenital or acquired
  • Specific Congenital Anomalies - Down Syndrome
    (10-18 times greater risk of developing Leukemia)

6
HOST FACTORS CONT.
  • Single Gene Defects - 150 associated with
    development of Cancer (Fanconi Anemia Bloom
    Syndrome)
  • Familial Tendencies - Sibling with Leukemia (4
    times greater chance), Monozygous Twins (almost
    100 chance)

7
ENVIRONMENTAL FACTORS
  • Chemical and Physical Agents - 1) DES 2)
    Choramphenical, 3) Benzene, 4) Asbestos
  • Radiation Exposure
  • Anabolic Androgenic Steriods
  • Cytotoxic Agents
  • Immunosuppressive Agents
  • Viruses - Epstein Barr

8
PROGNOSIS
  • 70 will be cured
  • Children are more responsive to tx and better
    able to tolerate immediate side effects of surgery

9
LEUKEMIA
  • Definition - White Blood, Involves blood
    forming tissues of the bone marrow, spleen, and
    lymph nodes
  • Outstanding Characteristic - Abnormal
    uncontrolled proliferation of one type of wbc
  • 80-85 of childhood Leukemias are Acute
    Lymphocytic Leukemia (ALL)

10
INCIDENCE
  • 4 per 100,000 children per year
  • Peak Incidence - Between 2-6 years
  • Twice as common in white children as non-white
  • More common in males

11
CLASSIFICATION
  • Acute or Chronic
  • Cell Line - Lymphoid or Myeloid Cells
  • FAB Cooperative Group Classification - Based on
    histologic appearance of abnormal lymphoblast -
    85 - L1, 15 - L2, less than 1 - L3

12
CLASSIFICATION CONT.
  • Immunologic Classification - based on
  • certain surface cell antigens
  • T- Cell - common in older boys
  • B- Cell - Poor Prognosis
  • Pre B- Cell
  • Early Pre B- Cell (Null Cell)
  • Common Acute Lymphoblastic Leukemia Antigen
    (CALLA)

13
BEST PROGNOSIS
  • ALL 1
  • Early Pre B- Cell
  • CALLA Positive

14
CLINICAL MANIFESTATIONS
  • Onset - Abrupt or Insidious
  • Common Symptoms Reflect Bone Marrow Failure -
    Decreased rbcs, decreased platelets, and changes
    in wbcs
  • Pallor, fatigue, petechiae, purpura, bleeding and
    fever
  • WBC Count of less than 10,000/mm3

15
CLINICAL MANIF. CONT.
  • Renal Failure because of high uric acid levels -
    Give Allopurinal
  • Extramedullary invasion of Leukemic cells
  • CNS most common site
  • MOST have at diagnosis

16
CLINICAL MANIF. CONT.
  • Infiltration into bones and joints
  • Infiltration of other organ sites kidneys,
    heart, eyes, skill and GI tract

17
EVALUATION
  • Peripheral smear
  • Blast Cell hallmark of acute leukemia
  • Normal - less than 5 blast cells in bone marrow
    and none in peripheral blood
  • With ALL the bone marrow may be replaced by
    80-100 blast cells

18
TREATMENT
  • FOUR PHASE TREATMENT PROGRAM
  • Induction Phase - Goal is no clinical evidence of
    disease and normal bone marrow. 95 in 4-6 weeks
  • Intensification (Sanctuary) Therapy
  • Prophylactic Therapy for the CNS
  • Maintenance Therapy - Usually 3 years

19
PROGNOSIS
  • ALL IS CURABLE
  • Overall - 60-70
  • ALL1, Pre- B Cell, CALLA Positive - 90

20
LYMPHOMAS
  • Non - Hodgkin Lymphoma
  • Two Types - Nodular (Adults) and Diffuse (Child)
  • Affects 7 to 8 children per 1 million
  • Rapidly progressive with enlarging lymphoid
    tissue and painless lymphadenopathy

21
LYMPHOMAS CONT.
  • Most frequent site - Abdomen
  • Treatment - Biopsy, combination chemotherapy and
    radiation
  • 60-80 can be cured

22
HODGKIN DISEASE
  • Affects about 5 in 1 million children
  • Mostly Adolescents
  • Characterized by painless enlargement of lymph
    nodes
  • Presence of Sternberg-Reed cell
  • Treatment Modalities - Irradiation and
    chemotherapy
  • 90 10 year survival rate with localized disease

23
BRAIN TUMORS
  • Incidence - 2.4 per 100,000
  • Cause Unknown
  • CLASSIFICATION - Most arise from glial tissue,
    the supportive tissue of the brain
  • 60 are INFRATENTORIAL - Occur in the posterior
    third of the brain

24
TYPES
  • Cerebellar Astrocytomas
  • Most common Type
  • Benign, Cystic, Slow-growing
  • 95 cure rate with surgical excision

25
TYPES CONT.
  • Medulloblastomas
  • Fast growing
  • Highly malignant
  • Cerebellum most common site
  • 40 survival rate

26
TYPES CONT.
  • Brainstem Gliomas
  • Slow growing
  • astrocytomas or glioblastomas
  • Radiation may shrink tumor

27
TYPES CONT.
  • Ependymomas
  • Varying speed of growth
  • Freq. occur in the 4th Ventricle which leads to
    CSF Obstruction
  • Close to vital centers
  • Chemotherapy and radiation

28
NEUROBLASTOMA
  • Definition - Embryonal Tumor of neural crest
    cells that normally give rise to the sympathetic
    ganglia and adrenal medulla
  • Tumor of young children
  • Silent tumor - 70 have metastatic disease at
    diagnosis
  • Primary Site - Addomen

29
RETINOBLASTOMA
  • Definition - Rare congenital tumor that
    originates in the retina of one or both eyes
  • 200 children a year in the US
  • 2 forms - Inherited - Diagnosed during first year
    and often involves both eyes, and Aquired -
    Diagnosed 2-3 years and 60 unilateral

30
RETINOBLASTOMA CONT.
  • Primary Sign - LEUKOKORIA, a white pupillary
    reflex called cats eye reflex. Others -
    strabismus, red, painful eye, and limited vision
  • Treatment - radiation for small tumors, large or
    multiple tumors require enucleation
  • Prognosis - 90 long term survival rate

31
WILMS TUMOR
  • Definition - Embryonal tumor of the kidney,
    Nephroblastoma
  • Incidence - 7.8 cases per 1 million children.
    Approximately 400 children diagnosed each year or
    1 per 10,000 children
  • Pathogenesis - 2 forms - Sporadic - No known
    genetic predisposition and Inherited

    -Autosomal Dominant Transmission

32
WILMS TUMOR CONT.
  • Both forms linked to the deletion or inactivation
    of genes on the short arm of Chromosome 11
  • 18 of children with Wilms have other congenital
    anomalies

33
WILMS CONT.
  • Clinical Manifestations - 90 have enlarging
    asymptomatic upper abdominal mass that is firm,
    nontender, smooth, and encapsulated
  • Treatment - Nephrectomy. Radiation (except in
    Stage I II ), Chemotherapy.
  • Prognosis - 95 cure rate for Stage I to III

34
RHABDOMYOSARCOMA
  • Definition - Soft tissue sarcoma that arises from
    undifferentiated mesenchymal cells in muscle,
    tendons, bursae, and fascia, or fibrous,
    connective, lymphatic or vascular tissue
  • Two thirds diagnosed by 10 years of age
  • Many sites - head and neck most common

35
RHABDOMYOSARCOMA
  • Treatment - Combination surgery, radiation and
    chemotherapy
  • Prognosis - Long term survival rate 70-80

36
NURSING CARE OF CHILDWITH LEUKEMIA
  • Prepare Child Family for Diagnostic and
    Therapeutic Procedures
  • Bone Marrow Aspiration (W W -pg. 1252)
  • Lumbar Puncture (W W - pg. 1251)
  • Placement of Central Catheter (W W - pg.
    1308-1311)
  • Boviac
  • Hickman
  • Infus-A-Port

37
PREVENT COMPLICATIONS OF MYELOSUPPRESSION
  • Infection
  • Goal is prevention
  • Hemorrhage
  • Platelet Count less than 20,000/mm
  • Epistaxis and Gingival
  • Anemia
  • Transfusions

38
MANAGE PROBLEMS OF IREADIATION AND DRUG THERAPY
  • Nausea and Vomiting
  • Anorexia
  • Mucosal Ulceration
  • Neuropathy
  • Hemorrhagic Cystitis
  • Alopecia
  • Moon Face

39
RELIVE PAIN
  • Analgesics
  • Positioning
  • Decrease Environmental Stimuli

40
PROVIDE ADEQUATE FAMILY SUPPORT
  • Explain tests and procedures honestly
  • Schedule uninterrupted family time
  • Encourage family to discuss feelings and concerns
  • Encourage active family participation in care
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