Chapter 25: Cancer
Neoplastic Disorders:
Types
Leukemias (most common)
o Acute lymphocytic leukemia (ALL)
o Acute Myelogenous Leukemia (AML)
Lymphomas
o Hodgkin’s and non-Hodgkin
Solid tumors
Childhood Cancer:
Epidemiology:
Rare
Etiology:
Genetic events (5%)
o Problems with DNA itself
o Syndromes can risk
Two-hit hypothesis
o Healthy gene will override unhealthy gene
o Two toxic genes will present in cancer
Risk Factors:
Little information on environmental role
Radiation, carcinogens, infections, syndromes
Prevention:
sun exposure, radiation exposure and smoke
Early identification is key
Cardinal Symptoms:
Unusual mass or swelling
Paleness, loss of energy
o Lots of napping
Bruising
o Leukemia
Persistent localized pain or limping
o Limping, bone pain
Prolonged, unexplained fever or illness
o Continual colds, challenge to recover
Frequent headache with vomiting
o Worse in the morning d/t ICP
, Sudden eye or vision changes
o Linked with tumor in brain
Excessive rapid weight loss
o Most cancers
Treatment:
GOALS: cure of patient & SE of medicaitons
Surgery
o Removal of tumors
o Biopsys
Chemotherapy
o Most cancers
o Handling Chemo:
Chemo gloves
Disposal: double flushing and covering lid
Specific BINS for chemo
Use PPE (chemo gown, gloves, goggles, masks)
Specific linen bag
Crush meds in closed container
Sweat, urine and other bodily fluids can expose you to chemo**
educate the parents!
o Managing Chemo:
Vesicants: cause tissue death
** interventions for extraversion**
Stop med, notify Dr. & pharmacy (don’t flush)
Do not pull IV until PO
Risk for anaphylaxis
Hives, itchy, redness, VS changes, back pain, resp
EPI
Biological Therapies
Radiotherapy:
o Causes cell death via radiation
o S/E:
Skin burns peeling and cracking skin
Bone Marrow Transplantation:
Side Effects of Treatment:
Infection:
o Chemo suppresses immune system
o Nursing considerations: school and NO large groups, wearing masks
, Hemorrhage:
o Epistaxis’s and gingival bleeding are the most common (nose and gum,
heavy periods )
o Activity restricitons but still want the kid to be active in a safe manner
Anemia:
o O2 & work of breathing & heart
o Can be fatigued
o Regular CBC
Nausea and Vomiting
o Tx 30-45mins before (Zofran) and for 24-48 hours after
TOXIC SIDE EFFECTS:
N/V
o Extreme care for nutrition d/t GROWTH
o Don’t give child favorite foods
o Small frequent meals
o Water
Anorexia
o Stimulants (cannibas)
Mucosal ulcerations (can be whole GI tract) (d/t chemo targeting rapid
replicating cells)
o N/V can make it much worse
o Magic mouthwash
o Pain management prior to meals
Neuropathy
o Foot drop
o Fall risk
o Boots
o Causal Rx: VINCHRISTINE
Hemorrhagic cystitis : bleeding in the bladder**
o Causal RX: Ifosphamide & Cyclophosphamide
Give Rx in AM
Given with MESNA (bladder protective)
Frequent UA to assess for bladder
EXTRA FLUIDS to help flush
o Mucous membrane in bladder
o Impossible to reverse, permanent damage to bladder
Alopecia
o Considerations: Reassure pt it will grow back & discuss before
Neoplastic Disorders:
Types
Leukemias (most common)
o Acute lymphocytic leukemia (ALL)
o Acute Myelogenous Leukemia (AML)
Lymphomas
o Hodgkin’s and non-Hodgkin
Solid tumors
Childhood Cancer:
Epidemiology:
Rare
Etiology:
Genetic events (5%)
o Problems with DNA itself
o Syndromes can risk
Two-hit hypothesis
o Healthy gene will override unhealthy gene
o Two toxic genes will present in cancer
Risk Factors:
Little information on environmental role
Radiation, carcinogens, infections, syndromes
Prevention:
sun exposure, radiation exposure and smoke
Early identification is key
Cardinal Symptoms:
Unusual mass or swelling
Paleness, loss of energy
o Lots of napping
Bruising
o Leukemia
Persistent localized pain or limping
o Limping, bone pain
Prolonged, unexplained fever or illness
o Continual colds, challenge to recover
Frequent headache with vomiting
o Worse in the morning d/t ICP
, Sudden eye or vision changes
o Linked with tumor in brain
Excessive rapid weight loss
o Most cancers
Treatment:
GOALS: cure of patient & SE of medicaitons
Surgery
o Removal of tumors
o Biopsys
Chemotherapy
o Most cancers
o Handling Chemo:
Chemo gloves
Disposal: double flushing and covering lid
Specific BINS for chemo
Use PPE (chemo gown, gloves, goggles, masks)
Specific linen bag
Crush meds in closed container
Sweat, urine and other bodily fluids can expose you to chemo**
educate the parents!
o Managing Chemo:
Vesicants: cause tissue death
** interventions for extraversion**
Stop med, notify Dr. & pharmacy (don’t flush)
Do not pull IV until PO
Risk for anaphylaxis
Hives, itchy, redness, VS changes, back pain, resp
EPI
Biological Therapies
Radiotherapy:
o Causes cell death via radiation
o S/E:
Skin burns peeling and cracking skin
Bone Marrow Transplantation:
Side Effects of Treatment:
Infection:
o Chemo suppresses immune system
o Nursing considerations: school and NO large groups, wearing masks
, Hemorrhage:
o Epistaxis’s and gingival bleeding are the most common (nose and gum,
heavy periods )
o Activity restricitons but still want the kid to be active in a safe manner
Anemia:
o O2 & work of breathing & heart
o Can be fatigued
o Regular CBC
Nausea and Vomiting
o Tx 30-45mins before (Zofran) and for 24-48 hours after
TOXIC SIDE EFFECTS:
N/V
o Extreme care for nutrition d/t GROWTH
o Don’t give child favorite foods
o Small frequent meals
o Water
Anorexia
o Stimulants (cannibas)
Mucosal ulcerations (can be whole GI tract) (d/t chemo targeting rapid
replicating cells)
o N/V can make it much worse
o Magic mouthwash
o Pain management prior to meals
Neuropathy
o Foot drop
o Fall risk
o Boots
o Causal Rx: VINCHRISTINE
Hemorrhagic cystitis : bleeding in the bladder**
o Causal RX: Ifosphamide & Cyclophosphamide
Give Rx in AM
Given with MESNA (bladder protective)
Frequent UA to assess for bladder
EXTRA FLUIDS to help flush
o Mucous membrane in bladder
o Impossible to reverse, permanent damage to bladder
Alopecia
o Considerations: Reassure pt it will grow back & discuss before
