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

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Presentation on theme: "CANCER IN CHILDREN KAREN E. MILES FLORIDA GULF COAST UNIVERSITY DEPARTMENT OF NURSING."— Presentation transcript:

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

2 CHILDHOOD CANCERS BY AGE SITE0-5 YR5-10 YR10-15 YR Leukemia39.6* Lymphoma * CNS *18.9 Wilms Tumor09.2* Neuroblastoma13.0* Retinoblastoma06.4* Bone * Other * 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 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 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 % 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 % 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 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 “cat’s 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 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 CHILD WITH 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 ) 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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