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Alterations in Cellular Growth. Neoplasm Benign Malignant.

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Presentation on theme: "Alterations in Cellular Growth. Neoplasm Benign Malignant."— Presentation transcript:

1 Alterations in Cellular Growth

2 Neoplasm Benign Malignant

3 Variable Etiology Alterations in cellular growth Single or Combination of factors External stimuli Innate immune system & gene abnormalities Chromosomal abnormalities

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5 Incidence of Childhood Cancer 2012 Statistics Estimated 12, 060 new cases in children under the age of 14 Estimated 1, 340 cancer deaths to occur in children under age 14 (1/3 of those deaths from leukemia) Cancer Facts & Figures 2012 American Cancer Society

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7 Prevention Smoking Prevention Limit exposure to sun Testicular self exams Breast self exams Pap smears

8 Cardinal Symptoms of Cancer in Children Unusual mass or swelling Unexplained paleness & loss of energy Sudden tendency to bruise Persistent, localized pain or limping Prolonged, unexplained fever/illness Frequent headaches, often with vomiting Sudden eye or vision changes Excessive, rapid weight loss

9 Laboratory Tests Complete blood count (CBC) Serum chemistries Liver function tests Coagulation studies Urinalysis

10 Diagnostic Tests Lumbar puncture Bone marrow aspiration Bone marrow biopsy Radiographic examinations CT MRI Ultrasound Biopsy of tumor

11 Treatment Modalities Surgery Chemotherapy Radiotherapy Biotherapy Hematopoietic stem cell transplant Palliative Care

12 Common Forms of Childhood Cancer Leukemia Lymphoma Brain & CNS tumors Bone Solid tumors Soft tissue tumors

13 Leukemia Most common form of childhood cancer Peak age is 4 with more boys than girls affected Classified by type of WBC that becomes neoplastic & immaturity of neoplastic cell

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15 Leukemia Unrestricted proliferation of immature white blood cells Infiltration & replacement of body tissues with nonfunctioning leukemic cells-most effected are bone marrow, spleen, liver CNS at risk-can have leukemic infiltration of the meninges

16 Acute Lymphoctyic Leukemia Most common form of cancer Better Prognosis-current survival rates about 80 %

17 Acute Myelogenous Leukemia Poorer prognosis Current cure rates approximately 40-50%

18 Diagnostic Evaluation CBC Bone Marrow Aspiration or Biopsy (definitive test) Lumbar puncture

19 Treatment Chemotherapy-IV & Intrathecal Radiation –Cranial Bone marrow transplant

20 Phases of Chemotherapy Induction: achieves complete remission or disappearance of leukemic cells Intensification: further decreases number of leukemic cells Maintenance: preserve remission & reduce number of leukemic cells Reinduction after relapse

21 Nursing Care Priorities Manage symptoms Prevent/ treat side effects chemo Neutropenic precautions Protect from injury/trauma due to anemia & low platelet count Nutrition Communication

22 Lymphomas Hodgkin disease Originates in lymphoid system-primarily involves lymph nodes Can metastasize to spleen, liver, bone marrow, lungs, mediastinum Excellent prognosis for localized disease Mostly adolescents affected

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24 Signs & Symptoms Painless enlargement of lymph nodes (most commonly in supraclavicular or cervical area) Mediastinal lymph nodes-persistent dry cough Systematic symptoms-fevers, night sweats, anorexia, nausea, weight loss, pruritus

25 Diagnostic Evaluation Blood work-CBC, Uric acid levels, Liver function tests, C-reactive protein, alkaline phosphatase, UA CXR CT of neck, chest, abdomen, pelvis Gallium scan Bone scan (looking for metastasis) Lymph node biopsy

26 Treatment Chemotherapy Radiation

27 Lymphoma Non-Hodgkin Diffuse disease Dissemination occurs earlier & more rapidly Mediastinal & invasion of meninges are typical

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29 Diagnostic Evaluation Surgical biopsy Bone Marrow Aspiration CXR CT- lungs, abdomen Lumbar puncture Blood work

30 Treatment Treatment tailored to staging Chemotherapy Radiation CNS prophylaxis with intrathecal chemo

31 Brain Tumors

32 Signs & Symptoms Increased signs ICP Personality changes Seizures Ataxia Visual disturbances Delayed or precocious puberty & growth failures

33 Diagnostic Evaluation MRI CT Biopsy done during surgery

34 Treatment Surgery Radiation Chemotherapy

35 Nursing Care Priorities Nutrition Frequent assessment of mental status I & O/ Fluid regulation Head positioning post op Monitor surgical site Prepare family Promote return to optimum functioning

36 Neuroblastoma Tumors originate in cells that normally give rise to the adrenal medulla and sympathetic nervous system Primary site is within abdomen but also could include head/neck, chest, and pelvis

37 Signs & Symptoms Depend on stage/location Abdominal tumors-firm mass in abdomen-crosses midline Urinary frequency/retention Widespread metastasis- pallor, weakness, irritability, anorexia, weight loss

38 Diagnostic Evaluation CT of abdomen, pelvis, chest Bone scan /MIBG scan Bone marrow aspirate & biopsy Urinalysis to evaluate for excretion of catecholamines

39 Treatments Surgery Chemotherapy Radiation HSCT

40 Bone Tumors Osteosarcoma Most common bone cancer in children affects metaphysis Ewing Sarcoma Tumor originates in shaft of bones (pelvis, femur, tibia, fibia, humerus, ulna, vertebra, scapula, ribs, skull)

41 Wilms Tumor (Nephroblastoma) Most common kidney tumor of childhood 80% diagnosed under age 5

42 Signs & Symptoms Painless swelling/mass in abdomen-confined to one side Hematuria Anemia Hypertension

43 Diagnostic Evaluation Abdominal ultrasound CT/MRI abdomen CT chest to look mets to lung Blood work-CBC, Chemistries UA NO ABDOMINAL PALPATIONS

44 Treatment Treatment based on staging Surgery Chemotherapy Radiation

45 Rhabdomyosacroma Most common soft tissue sarcoma in children Skeletal muscle is most everywhere so tumors can occur throughout body Most common site head/neck especially the orbit

46 Signs & Symptoms Initial signs/symptoms related to site of tumor and compression of organs Many signs & symptoms vague frequently passes off as common childhood illness- Primary tumor site rarely identified

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48 Diagnostic Evaluation Careful history and physical CT/MRI Bone scan Bone marrow aspirate & biopsy Lumbar puncture Biopsy or surgical resection of tumor

49 Treatment Complete removal of tumor if possible Chemotherapy Radiation

50 Retinoblastoma Arises from retina Hereditary & Nonhereditary Signs/Symptoms White pupil-Leukocoria Treatment Radiation, Chemotherapy, Removal of eye in advanced disease

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52 Cancer Survival Long-term effects of chemotherapy, radiation, and surgery Neurocognitive impairment Endocrinopathy Second malignancy Organ dysfunction-kidney/liver failure


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