Pediatric Cancer NURB 340
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This 7 page Class Notes was uploaded by Kelsey Forbeck on Saturday October 1, 2016. The Class Notes belongs to NURB 340 at University of Indianapolis taught by Moore in Fall 2016. Since its upload, it has received 5 views. For similar materials see Pathophysiology in NURSING at University of Indianapolis.
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Date Created: 10/01/16
NURB 340: Pathophysiology Exam 2 Pediatric Cancer Adult vs. Children o Childhood cancer is usually the result of DNA changes. o These changes include: Aneuploidy Translocations Deletions Fragile spots that can break of o Children respond better to chemo and their bodies tolerate cancer better o Childhood cancer are not linked to environmental risk factors o The chemo has long term side efects and need careful attention for the rest of their life because they may have relapse or mutate into a diferent type of cancer o Cancer of children is rare but is the LEADING cause of death from disease o Survival rates increase because of how far we have come with medical technology o The most common types of cancer in children: #1 Leukemia #2 Brain Tumors #3 Sarcomas o There is new data that says that when mom smokes or lives close to a chemical plant, the children develop new kinds of cancer o 2/3 of those who do survive face at least 1 chronic health condition o 1/4 face late efect treatments (heart damage, lung damage, infertility, cognitive impairment, hearing loss, and stunted growth.) o CHILDHOOD CANCER IS A CHRONIC CONDITION o Most cancer originates from the mesodermal germ layer In cardiac muscles, skeletal muscle cells, tubule cells of the kidney, RBCs, smooth muscle cells (in gut). Because it arises from this layer, you do not see much skin cancer o Diagnosed in peak times of growth typically before age 5 o Tumor growth in fast growing and without early signs o Difference between sarcoma and carcinoma is where the cancer is located Sarcoma is more from connective tissue Carcinoma comes from the epithelia tissue o Rare in children because these are from environmental factors o But you will see these kinds of cancers pop up in 15- 19 because they are starting the peer pressure of smoking, anabolic steroid use, and experiencing with drugs. Embryotic tumors Originate in the embryo (intrauterine life) Tumors are immature tissue cells that are unable to mature or diferentiate into fully developed cells o EX: neuroblastoma and Wills tumor o Diagnosed before 5 years and rare to find in adults because you would have caught it earlier Leukemia Children with Down Syndrome have a greater risk of developing leukemia Inside leukemia there is AML and ALL o ALL is acute lymphatic leukemia Bone marrow makes too many lymphocytes These lymphocytes do not mature correctly and they crowd out other cells in the area such as RBCs and platelets Because they are not mature they cannot fight of disease like they are supposed to, they are just taking up space o AML is acute mylogeneious leukemia Too many granulocytes The granulocytes (a WBC) is not properly forms so it doesn’t fight infection like it is supposed to and crowds out good cells. Sarcoma Bone Tumors o Osteosarcoma (bone cancer) o Ewing sarcoma (bone or soft tissue around it) o Others Neuroblastoma is tumor of sympathetic nervous system Wilms Tumor is of the kidneys Rhabdomyosarcoma is soft tissue Retinoblastoma is in the eye The multiple causation concept refers to the idea that there can be multiple causes of cancer. o EX: not every downs child will have leukemia. May be caused by diet, where they live, ect. o This is why it is difficult because we don’t know what we need ot get rid of in order to stop the cancer causing agents Etiology o Since most childhood cancer do not demonstrate predisposing environmental factors, these cancers may be caused by: o Genetic Factors: Chromosomal abnormalities o Deletion o Aneuploidy o Fragile x Certain congenital syndromes and cancers occur together o Wilms tumor and urogenital abnormalities o Down syndrome and leukemia Oncogenes and tumor-suppressor genes o If tumor suppressor gene is inactivated, then it can lead ot cancer o Onc means cancer o Fanconi anemia and Bloom syndrome are autosomal recessive diseases that lead to ALL o Environmental factors: Prenatal exposure to drugs increase chance of baby developing cancer o EX: DES Some things moms are exposed to can cross placenta Childhood exposure o Drugs, secondhand smoke, ionizing radiation, viruses, steroids, extensive imaging studies can cause cancer. Congenital Factors Tied to Cancer o Down syndrome= leukemia and at greater risk at getting Beckwith- Wiedemann (they have large tongues and kidney problems) o Genitourinary anomalies= Wilms Tumor o A child who has a twin with leukemia has a 2-4 greater chance of getting it as well Medications Tied to Childhood Cancer o Anabolic steroids, inducing puberty, and stimulating bone growth leads to hepatic cellular carcinoma (notice it is a carcinoma instead of sarcoma because of exposure) o Cytotoxic (chemotherapy) exposure put them at greater risk of getting leukemia o Immunosuppressant agents (transplant patients so their body doesn’t reject organ) also leads to lymphoma Prognosis o 80% of children are cured o Survival rates are higher in those under 15 because more likely to be enrolled in clinical trials o Again, it is a chronic disease not a fatal illness o Those who survive way have more cancer in the future Sign and Symptoms o They are very vague o Cancer can be difficult to detect because they may have no symptoms or may have symptoms that go along with other illnesses o Extreme weight loss o Headaches o Early morning vomiting o Pain in joints o Persistent infections o Rash o Bruises o Constant tiredness o Consistent fevers Treatment o Clinical trial – test new approaches to treating cancer o Surgery- take out the tumor o Chemotherapy o Radiation therapy o Immunotherapy- boost body’s own immune system to fight infection o Stem cell transplant- bone marrow is replaced with specialized cells All the money is going to prevention of cancer and not fixing it Wilms Tumor o RARE o Cancer of the kidneys (nephroblastoma) o Incidence is 7.1 million children o S/S abdominal swelling, palpable mass, abdominal pain, fever or blood in the urine o Due to an error in the DNA and uncontrollable replication in kidney cells o Most common after year 5 o Associated with genetic malfunction o Usually just one kidney that get efected o No known connection between parents and children Lymphoma o Tumor of the body’s lymphatic tissue o Includes: lymph nodes, tonsils, thymus, spleen, adenoids, and bone marrow o Third most common cancer in children o S/S: chills, fever, NIGHT SWEATS, weight loss, lack of energy, and swelling lymph nodes o 90% non-Hodgkin’s and 10% Hodgkin’s o Autoimmune disease can lead to lymphoma o Because lymphoma occurs in bone marrow it can cause anemia and bleeding disorders Hodgkin’s o Reed Sternberg cells causes Hodgkin o Develops in lymph system o Most common first sign is PAINLESS ENLARGMENT OF THE LYMPHNODES o Found in ages 15-19 o If cancer is in center of chest then may have shortness of breath o Most kids are cured and go on to live normal lives o Prognosis depends on when you catch it and how far its gone to and if it is a reoccurring case Non-Hodgkin’s o Does not have reed Sternberg o More common than Hodgkin’s o Malignant growth in lymphocytes (WBC) o May occur in any age but rare before age 3 o Minimal bone marrow involvement o Can be difficult to distinguish between leukemia and non Hodgkin lymphoma o Burkett Lymphoma (B cell lymphoma) B lymphocytes protect body against germs, make antibodies, and they mark they for destruction Usually develops in abdomen and spreads to other organs including the brain Very rapid growing Average age of diagnosis is 5-10 Strong association with exposure to Ebsten Barr virus More common in children Leukemia o Can occur in white or any other types of cells o Any cell in bone marrow can turn into leukemia cell o As cells mature and multiply, they crowd out normal cells in bone marrow o Fast growing o Can accumulate in spleen or liver (so may have swollen abdomens) o Hard to kill o Slower growing in adults o S/S: tired, pale, infections, fever (WBC not fighting of infection), bruise and bleed easily, joint or bone pain. Osteosarcoma/ Ewing’s Sarcoma o Cancer in the bone or tissue around the bone o Osteosarcoma is the third most common cancer in teens, after lymphoma and brain tumors o Usually on the long bones o S/S: pain, swelling, decreased joint motion, and bone fractures o Most common type of BONE cancer in children o Survival rate depends on location o Ewing’s: involves bones AND tissue around bones Rhabdomyosarcoma o Cancer involving SOFT TISSUE, CONNECTIVE TISSUE, OR BONE o Can happen anywhere o Common sites include: Head and neck (could have frequent nose bleeds) Arms and legs Trunk or reproductive organs Urinary o S/S: Lump that does not go away Headache Difficulty with bowel and bladder Blood in urine Excessive bleeding Retinoblastoma o Occurs in retina (layer of nerve tissue in back of eye) o Many parents find this by taking picture of their kids and seeing a white spot o 60% have no family history o Average diagnosis is 12-18 months o Only in one eye o S/S: Cat’s eye reflex wondering eye diferent size pupil difficulty seeing
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