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Pediatrics
Child Hood Cancer
| Question | Answer |
|---|---|
| The most common clinical manifestations of brain tumors in children are which of the following? A. Headaches and vomiting B. Blurred vision and ataxia C. Hydrocephalus and clumsy gait D. Fever and poor fine motor control | Headaches especially on awakening, and vomiting that is not related to feeing are the most common clinical manifestations of brain tumors in children. |
| Which of the following is a common clinical manifestation of Hodgkin disease? A. Petechiae B. Bone and joint pain C. Painful, enlarged lymph nodes D. Nontender enlargement of lymph nodes | Nontender enlargement of lymph nodes |
| What is the most common presentation of Hodgkins diseaes? | Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. |
| Which of the following tests confirms the diagnosis of leukemia in chhildren? A. Complete blood count (CBC) B. Lumbar puncture C. Bone Marrow biopsy D. Computed tomography (CT) scan | The confirmng test for leukemia is microscopic exmination of bone marrow obtained by bone marrow aspiration and biopsy. A CBC may show blast cells that would raise suspicion of leukemia but it is not a confirming diagnostic study. |
| You are preparing a child for poss alopecia from chemotherapy. What should be included? A. Wearing hats/scarves is preferable to wig B. Expose head to sunlight to stimulate hair regrowth C. Hair may have a slightly different color/texture when it regrows | Children should choose the head covering that they prefer. Hair usually grows back within 3-6 months & it will be of a different color or texture when it regrows. |
| T/F A wig makes hair loss less noticeable & should be selected similar to the child's own hairstyle & color before alopecia occurs. | true |
| Which of the following immunizations should not be given to a child receiving chemotherapy for cancer? A. Tetanus vaccine B. Inactivated poliovirus vaccine C. Diphtheria, pertussis, tetanus (DPT) D. Measles, mumps, rubella (MMR) | The vaccine used for measles, mumps, and rubella is a live virus and can cause serious disease in immunocompromised chhildren. |
| A child with leukemia is receiving intrathecal chemotherapy. The purpose of this is to prevent? A. Infection B. Brain tumor C. CNS disease D. Drug side effects. | Children with leukemia are at risk for invasion of the CNS with leukemic cells. CNS propylactic therapy is indicated to prevent CNS disease. Intrathecal chemotherapy will not prevent infection or drug side effects. |
| Which nursing intervention would not be included in the post-op plan of care for a child undergoing surgery for a brain tumor? A. Position with head lower than body B. Neurologic assessments C. Assess dressings for drainage D. Monitor temperature | The child is never placed in the Trendelenburg position because it increases intracranial pressure and the risk of bleeding. |
| Which of the following is the best choice when a child with mucositis asks for something to drink? A. Hot chocolate B. Lemonade C. Popsicle D. Orange juice | C. Popsicle rationale: Cool liquids are soothing and ice pops are usually well tolerated. A hot beverage can be irritating to mouth ulcers and citrus products can be very painful to an ulcerated mouth as well. |
| What is the most appropriate nursing action when you note a reddened area on the forearm of a child w/ leukemia? A. Massage the area B. Turn the child more frequently C. Document the finding & continue to observe the area D. Notify the DR immediately. | Any signs of infection in a child who is immunosuppressed must be reported dr immediately because it is considered a medical emergency. The observation should be documented. Never massage the area. Forearms not typical pressure points |
| When a child is neutropenic, pus may not be produced and the only sign of infection may be ____. | When a child is neutropenic, pus may not be produced and the only sign of infection may be redness. |
| A child with acute myeloblastic leukemia is scheduled to have a bone marrow trasplant (BMT). The donor is the child's brother. What type of BMT would this be? A. Autologous B. Allogenic C. Syngeneic D. Stem cell | In an allogenic BMT, the donor's tissue is a match for the child. 35% of the population have a non-twin sibling who matches their tissue type. |
| ____ is when the bone marrow comes from an identical twin. | Syngeneic is when the bone marrow comes from an identical twin. |
| A ___transplantation uses a unique immature cell present in the peripheral circulation | A stem cell transplantation uses a unique immature cell present in the peripheral circulation |
| ___transplant is when the child's own marrow is used. | Autologous transplant is when the child's own marrow is used. |
| What are the 4 Environmental cancer risk factors? | 1. Ionizing radiation 2. Electromagnetic fields 3. Parental exposure to Benzene, petroleum agents 4. Alcohol and smoking during pregnancy |
| Radioisotope, Immunosuppressive agents and disease, and Previous successful cancer treatment are all ___ that are cancer risk factors in children? | drugs |
| T/F Epstein-Barr Virus (EBV) is a childhood cancer risk factor? | True |
| What are the 2 genetic predisposition of cancer with chromosome abnormalities? | Down syndrome and fanconi syndrome |
| What are some genetic predispositions of cancer with diseases with specific genetic links? | Retinoblastoma, wilms tumor, and neuroblastoma |
| Cancer is the ___ leading cause of death in children 5-14 years old? | |
| Cancer is the second leading cause of death in children 5-14 years | |
| There are 129 per million children that have ____? | 129 per million children that have cancer |
| How many new cancer cases are there estimated to be every year in children? | 12,400 new cases a year estimated |
| T/F there has been no improvement of prognosis in the last 3 decades? | false-- Improved prognosis over last 3 decades |
| What is the most common form of Childhood cancer? | Leukemias |
| Leukemia there are ____ cases per 100,000 white children younger than 15 years old? | 3-4 cases per 100,000 white children younger than 15 years old |
| Leukemia is more frequent in ___ older than 1 year; has a peak onset between __& __ years; and affects the bone ___ and ___ system? | Leukemia is more frequent in males older than 1 year; Peak onset between 2 and 6 years; and Affect the bone marrow and lymphatic system |
| Leukemia is classified by the type of ___ affected by the disease? | Leukemia is classified by the type of WBC affected by the disease |
| What does ALL stand for? | ALL: Acute lymphocytic leukemia |
| Lymphatic, lymphoid, lymphoblastic, and lymphoblastoid (synonyms) all are ___ types of leukemias? | ALL acute lymphocytic leukemia |
| What does AML stand for? | AML: Acute myelogenous leukemia– Myelocytic, myelogenous, monoblastic, nonlymphoid leukemia (ANLL) |
| What does ANLL stand for? | acute nonlymphoid leukemia |
| What is the most common form of leukemia (80% of all leukemia’s)? | ALL |
| T/F ALL rarely occurs in adults over 40? | Rarely occurs in adults over 40 |
| In ALL there are FAB subtypes (L1,L2, L3) , which one has the best prognosis? | L1 most common and has best prognosis |
| There are two cell surface immunological markers that have the best positive prognosis what are they? | Early pre B cell and CALLA markers |
| If your leukocyte count at diagnosis is less than ___ you have a favorable prognosis for ALL? | Leukocyte count at diagnosis less than 50,000 |
| If you are greater than ___ years and less than ___ years of age then you have a favorable prognosis for ALL? | Greater than 2 years and less than 10 years of age |
| Greater than 50 chromosomes, Female, FAB morphology L1 and CALA IS A GOOD ONE TO HAVE are all favorable prognosis for which type of leukemia? | ALL |
| Acute Mylogenous Leukemia accounts for only __ % of acute leukemias in children and is the most common form in Adults? | AML Accounts for only 20% of acute leukemias in children and Most common form in adults |
| What is the most common form of adult leukemia? | AML |
| T/F The Chronic form (CML) of AML accounts for only 2% of childhood leukemias? | true |
| What makes AML more difficult to treat than ALL? | Cell- surface markers are not well defined with AML; AML is more difficult to treat!!!! |
| In Leukemia there is ___ proliferation of immature WBCs in the blood forming tissues of the body? | Unrestricted proliferation of immature WBCs in the blood forming tissues of the body |
| Leukemia results in the replacement of ___ ___ cells with ___ leukemic cells? | results in the replacement of normal functioning cells with nonfunctional leukemic cells |
| Consequences of Leukemia: Decreased functioning erythrocytes leads to ____? | Anemia |
| Consequences of Leukemia: Decreased Platelets production leads to ___? | Bleeding |
| Consequences of Leukemia: Decreased functioning WBCs (Neutropenia)leads to ___? | Infection |
| Leukemia leads to Infiltration, enlargement, and fibrosis of ___, ___, &___ glands? | spleen, liver, and lymph glands |
| What are the Clinical Manifestations of leukemia? | Insidious onset with a cold or minor symptoms; Fever, pallor, fatigue. anorexia, petechiae, bone and joint pain, spleen, and liver enlargement; Excessive bruising, lymphadenopathy, malaise, profound anemia, abnormal WBC, thrombocytopenia |
| Diagnostic Evaluation of ___ is: Based on Hx, physical s/s; Peripheral blood smear– Immature leukocytes– Frequently low blood counts; Bone marrow aspiration)– Lg #s of blast cells; Lumbar puncture for CNS involvement | |
| What is t he most definitive diagnositic evaluation of leukemia? | Bone marrow aspiration (definitive)– Large numbers of blast cells |
| What is the goal of Treatment of Acute Leukemia? | Goal of treatment is to achieve a complete remission and restoration of normal bone marrow function |
| Combination chemotherapy is used with drugs according to the established protocol of the institution. When is radiation used? | Radiation used sparingly only in high risk situations |
| When is bone marrow treatment considered in ALL and AML? | BMT considered– ALL second remission– AML first remission |
| What are the 4 courses of chemotherapy goes through? | 1. Induction 2. Intesification or consolidation therapy 3. CNS prophylactic therapy 4. Maintenance therapy |
| When is induction begun? | Begun immediately for 4-6 weeks |
| What is the goal of induction? | Goal is to achieve a complete remission determined by absence of clinical signs of disease and presence of 5% blast cells in bone marrow |
| In Intensification or Consolidation Therapy ____ of several medications given periodically during the first ____ months of treatment? | Pulses of several medications given periodically during the first 6 months of treatment |
| What is the goal of intensification or consolidation therapy? | Goal is to eradicate residual leukemic cells and prevent resistant leukemic clones |
| ______ therapy continued throughout all phases with intrathecal methotrexate sometimes in combination with other drugs to prevent CNS disease? | CNS prophylactic therapy continued throughout all phases with intrathecal methotrexate sometimes in combination with other drugs to prevent CNS disease |
| Why is maintenance therapy done? | to preserve remission |
| In maintenance therapy : Daily 6-mercaptopurine, weekly methotrexate and pulses of steroids and vincristine. Continue ___ or ___ blood counts to assess for effects of ____? | Continue weekly or monthly blood counts to assess for effects of myelosuppression |
| How long is maintenance therapy continued for? | Continue therapy for a total of 2.5 to 3 years; Relapses can occur in this period. |
| In ALL & AML The majority of children who receive ___ chemo will survive? | multiagent chemo will survive |
| ___% achieve long term survival without serious health problems from the disease or treatment of ALL? | 80% achieve long term survival without serious health problems from the disease or treatment (ALL) |
| In ALL & AML the Prognosis with BMT varies but long term survival ranges between ___%? | 25-50% |
| Overall prognosis with ___ is less favorable than with ALL? | Overall prognosis with AML is less favorable than with ALL |
| ___ is a neoplastic disease originating in the lymphoid system? | Lymphomas: Hodgkin Disease |
| Hodgkin Disease is rare under ___ years and more common between __ & ___ years? | Occurrence in children– Rare under 5 years– More common between 15 and 19 years |
| Hodgkin Disease etiology is unknown possible ___ association and has predictable metastasis to where? | Etiology unk possible EBV association & has Predictable metastasis to spleen, liver, bone marrow, lungs, & other tissues |
| T/F Hodgkin Disease is painful enlargement of lymph nodes? | False painless enlargement of lymph nodes…Firm, nontender, moveable nodes in the clavicular or cervical region |
| Describe the lymph nodes of a Hodgkin disease pt? | Firm, nontender, moveable nodes in the clavicular or cervical region |
| In children the “___ node” located near the left clavicle is often involve first in Hodgkin disease? | sentinel node |
| What are the manifestations of Hodgkin disease? | nonpainful enlargement of lymph nodes. May also have night sweats, wt loss, anorexia, pruritis, mediastinal mass, hepatosplenomegaly, nonproductive cough. |
| CT scan of neck, chest, abdomen, and pelvis, Chest x-ray, bone marrow, complete blood work and urinalysis may all be used to Diagnose ____? | Hodgkin disease |
| In Hodgkin disease lymph node biopsy –the presence of ___ cell is diagnostic of it? | Lymph node biopsy– Presence of Reed-Sternberg cell is diagnostic |
| In selected cases may do a laparotomy with multiple biopsies of organs and lymph nodes and a splenectomy to diagnose ___? | Hodgkin disease |
| Hodgkin Disease Treatment is Chemotherapy and irradiation based on the clinical staging of the disease (Box 36-3). How does it respond to this treatment? | Responds well to aggressive therapy but increases chances of complications and serious late effects (puts them at a greater risk of developing CA later in life) |
| T/F In Hodgkins disease follow up care essential to monitor for relapses? | True |
| What does splenectomy require? | Splenectomy requires prophylactic antibiotics for an undetermined period |
| What is the overall 10 year survival rate of Hodgkin Disease and what is the prognosis with localized stage 1&2? | Overall 10 year survival rate is 90%. Prognosis excellent with localized disease (stage 1&2) |
| In Hodgkins Disease late reoccurrences do occur both with the ___ disease process and second malignancies? | late reoccurrences do occur with both the original disease process and second malignancies |
| In Hodgkin disease risk for late reoccurrence is ___ in females than in males? | Risk for late reoccurrences is higher in females than males |
| What does NHL stand for? | Non-Hodgkin Lymphoma (NHL) |
| ___ % of pediatric lymphomas are classified as NHL & occurs most often under __ yrs of age in children (Peak___)? | 60% of pediatric lymphomas are classified as NHL; Occurs most often under 15 years of age in children (peak 7-11) |
| NHL is seen most often in patients with …? | Seen most often in patients with immunodeficiency syndromes or immunosuppressed due to transplants |
| NHL: Classification: Malignancy of the B &T lymphocytes. Clones of malignant cells infiltrate what? | lymph nodes, bone marrow, blood, and other organs. |
| NHL includes numerous subtypes classified according to what? | NHL includes numerous subtypes classified according to cellular size, structure. Appearance, grade (how fast or slow they grow) etc. |
| What are the three NHL that affects children very aggressively and are fast growing? | The three NHL that affects children are very aggressive, fast growing types – Lymphoblastic, Burkitt or non-Burkitt, and Large Cell lymphoma |
| T/F NHL clinical manifestations depends on the anatomic areas involved and extent of involvement? | true |
| What are the NHL (non hodgens lymphoma) clinical manifestations? | Abdominal cramping, constipation, pain, anorexia, wt loss, ascites, vomiting; Painless & enlarged lymph glands in cervical & auxiliary region, fever; Compression of tumor to organs in abs, mediastinum, head, & neck cause symptoms of obstruction |
| ____: Diagnosis: Surgical Biopsy of lymph nodes; Bone marrow aspiration; X-rays and CT of the chest, abdomen and pelvis; Lumbar Puncture; Staging (Box 36-4)? | NHL |
| How does NHL: BURKITT’S LYMPHOMA present? | Presentation: Rapidly growing tumor; Abdomen, jaw, or eye orbit; Rarely see enlarged lymph nodes or hepatosplenomegaly; Tumor lysis syndrome |
| NHL treatment: Present treatment protocols include an aggressive approach primarily with ___? | Present treatment protocols include an aggressive approach primarily with chemo. |
| T/F NHL treatment Protocols may be similar to therapy given to leukemia patients? | true |
| How long is NHL treatment administered for? | Administered for 6-24 months |
| T/F in NHL the aggressive tumors are not responsive to treatment? | Aggressive tumors are very responsive to treatment |
| What are the most common solid tumors in children? | Brain Tumors |
| Brain tumors are ___ % of all childhood CA and ___% are infratentorail or below the tentorium cerebri (cerebellum & brain stem)? | 20% of all childhood cancers; 60% are infratentorial or below the tentorium cerebri (cerebellum and brain stem) |
| Other brain tumors are ___, within the anterior 2/3 of the of the brain (cerebrum)? | Other tumors are supratentorial, within the anterior 2/3 of the of the brain (cerebrum) |
| Brain tumors originates from abnormal ___ and uncontrolled ___ of cells; ___ etiologic factor? | Originates from abnormal DNA and uncontrolled division of cells; no clear etiologic factor |
| In brain tumors death to surrounding tissue occurs by __ & ___? | Death to surrounding tissue occurs by infiltration and compression |
| In brain tumors __leads to increased ICP causing focal neuro deficits, obstruction of CSF flow, pituitary dysfunction, and eventual herniation of brain stem? | Cerebral edema leads to increased ICP causing focal neuro deficits, obstruction of CSF flow, pituitary dysfunction, and eventual herniation of brain stem. |
| In brain tumors where do neoplasms arise from? | Neoplasms arise from any cell within the cranium. Tumors are named according to the tissue of origin. |
| ___ is classified as: Benign / malignant; Invasive / noninvasive; Encapsulated / non-encapsulated; Slow growing / rapid growing; High level / low level? | Brain tumors |
| What is the most common pediatric brain tumor? | astrocytoma |
| ____ brain tumors are 20-25% of pediatric brain tumors and Highly malignant? | Medulloblastoma |
| Childhood brain tumors: Cerebellar Astrocytoma ___ % of all brain tumors and Brainstem Glioma ___% of tumors, difficult to ___? | Cerebellar Astrocytoma– 15% of all brain tumors and Brainstem Glioma – 15% of tumors, Difficult to remove |
| What kind of childhood brain tumorinvades ventricles? | Ependymoma– 4% of tumors, Invades ventricles |
| Brain tumors s/s are related to what? | Signs and symptoms are related to anatomic location, size, and child’s age |
| What are the clinical manifestations of brain tumors? | HA, Vomiting (early manifestation), neuromuscular changes & behavioral changes; cranial nerve neuropathy; VS disturbances; seizures, nuchal rigidity, papilledema, cranial enlargement, bulging fontanel |
| Why do children with brain tumors vomit & have headaches on arising? | HA especially on awakening due to pressure changes of position changes usually goes away during the day…Vomiting on arising due to position changes |
| What are the neuromuscular changes that children with brain tumors exhibit? | Neuromuscular changes– Uncoordinated, clumsiness, loss of balance, loss of developmental milestones |
| What are the behavioral changes that children with brain tumors manifest/ have? | Behavioral Changes– Irritability, lethargy, bizarre behaviors |
| T/F A child who has loss a developmental mile stone doesn’t need to be checked out? | false they do possible brain tumor |
| In brain tumors what are the clinical manifestations a person with cranial nerve neuropathy exhibit? | Cranial Nerve Neuropathy– Head tilt, facial weakness, visual defects |
| In brain tumors what are the vital sign disturbances they can have? | Vital Sign Disturbances– Decreased pulse and respiration, increased blood pressure--Hypothermia or hyperthermia |
| Seizures, nuchal rigidity, papilledema, Cranial enlargement, bulging fontanel are all s/s of ____? | brain tumors? |
| Careful & thorough Hx; Physical & Neurological exam to establish deficits; MRI, CT, skull films, EEG, & LP are all diagnosis used to diagnosis? | Brain Tumors |
| What is the definitive diagnosis of brain tumors? | Definitive diagnosis is usually based on tissue specimens obtained during surgery |
| Surgery, Radiotherapy, and Chemotherapy are used depending on the type of tumor to treat ___? | brain tumors |
| T/F brain tumor treatment: Stereotactic Surgery involves the use of CT and MRI and special computer techniques? | true |
| T/F Radiotherapy is not used to treat many brain tumors? | False: Radiotherapy may be used to treat many tumors and to shrink tumors before surgery |
| T/F Chemotherapy has emerged with more effective drugs in the last decade to cross the BBB and treat tumors alone or with radiotherapy and surgery? | True |
| Other Drugs used: Corticosteroids to control cerebral edema; Anticonvulsants for seizures; Pain meds; Antibiotics; Antiemetics and histamine blockers are all used to treat ___? | Brain tumors |
| T/F The Diagnosis of a brain tumor is always a crises event. Family and child need much support? | True |
| What do you need to inform a child and family about when they are going for a brain tumor procedure? | Inform child and family the head will be shaved; Prepare them for the size of the dressing; Inform them they will be in an ICU and child may sleep for several days |
| What do you do to prevent post op complications of brain tumor pts? | Place HOB at 30 degree angle (supratentorial tumor) or flat on either side (infratentorial); Monitor VS; Monitor for increased ICP & hemorrhage; Restraint; Fluids |
| What do you want to monitor VS for in post op brain tumor pts? | potential hypothermia/hyperthermia |
| Why do you NEVER whant to place a post op pt of brain tumor surgery in trendelenberg position? | – Never place in Trendelenberg position due to herniation of the brain |
| How do you monitor for increased ICP and Hemmorage in post op brain tumor pts? | Neuro signs and dressings |
| ___ is a tumor that originates from the embryonic neural crest cells that normally give rise to the adrenal medulla and sympathetic system? | Neuroblastoma |
| Where do most neuroblastoma tumors arise from? | Most tumors arise from the adrenal glands or the retroperitoneal sympathetic chain |
| Where is the primary site of neuroblastomas? Other sites are? | Primary site is in the abdomen. Others are head, neck, chest or pelvis |
| Neuroblastoma: Incidence 1 in 10,000 births with increase in ____? | males |
| ½ cases of neuroblastomas occur under __ years? | 2 years |
| T/F there is no evidence that there is a familial form of neuroblastoma? | false: Evidence of a familial form of the disease |
| ___ is One of few tumors that sometimes demonstrate spontaneous regression? | Neuroblastoma |
| In ___% of cases neuroblastoma tumor is diagnosed after metastasis has occurred (Silent Tumor)? | 70% Overall Poor Prognosis |
| In Neuroblastoma there is a firm non-tender mass located in the ___ that ___ the midline? | A firm non-tender mass located in the abdomen that CROSSES the midline |
| The neuroblastoma abdomal mass causes compression of adjacent structures creating symptoms. What does the compression of ureter, kidney, & bladder cause? | urinary problems |
| The neuroblastoma abdomal mass causes compression of adjacent structures creating symptoms. What does the compression of spinal cord cause? | bowel & bladder problems and paralysis |
| Neuroblastoma of the chest causes what manifestations? | Cough, respiratory difficulties |
| T/F sometimes a lymphadenopathy occurs in neuroblastoma? | true |
| In neuroblastoma what does an intracranial lesion cause? | Intracranial lesion-neurological impairment |
| In Neuroblastoma Metastasis from original tumor may cause ____ ecchymosis and ___ edema to the eye? | metastasis from original tumor may cause supraorbital ecchymosis and periorbital edema to the eye (black eye) |
| T/F in Dx of neuroblastoma it is important to locate the primary site and sites of metasis? | true |
| Radiological studies, CT scan and bone marrow aspirate and biopsies are all Dx of ____? | neuroblastoma |
| A 24 urine analysis for the breakdown products of catecholamine done to Dx neuroblastoma? | 24 hour Urine for analysis of breakdown products of catecholamine (excreted by kidneys, which normally don’t secrete this until they are older)– VMA and HVA, dopamine, and norepinephrine |
| What does the identification of the genetic make up of a tumor help with? | Identification of genetic make up of tumor helps to determine the prognosis and most effective treatment plan |
| In neuroblastoma accurate clinical staging is important to establish ___? | Accurate clinical staging is important to establish treatment plan (Box 36-6) |
| In neuroblastoma Surgical removal stage 1 & 2 ideal. What is done if the tumor is large? | If large partial resection and irradiation to shrink tumor |
| What is the main therapy for extensive neuroblastoma disease? | Chemo is main therapy for extensive disease |
| What is the survival rate of recurrent neuroblastoma disease in children over 2 with high-dose chemo, BMT, or peripheral stem cell resuce? | Recurrent disease in children over 2 10- 20% survival rate with high-dose chemo, BMT, or peripheral stem cell rescue. |
| In neuroblastomas the child’s age and stage of disease are important prognositic factors. What is the survival rates of children under 1 and over 1 year? | 75% of children under 1 year & 50% for children older than 1 year– In general, younger at diagnosis equals better prognosis |
| ___ is a Nephroblastoma that is most common intraabdominal & kidney tumor of children? | Wilms Tumor: Nephroblastoma Most common intraabdominal and kidney tumor of children |
| In Wilms Tumor ___% Dx under ___ years of age with peak incidence between ___ years? | 80% diagnosed under 5 years of age with peak incidence between 3 and 4 years |
| In Wilms Tumor there is increased incidence in __ & __ which reflects evidence of genetic inheritance? | Increased incidence in siblings and identical twins reflect evidence of genetic inheritance 15-20% are inheritable |
| ___ is associated with several congenital anomalies– Aniridia, hypospadius, cryptorchidism, ambiguous genitalia? | Wilms Tumor |
| In Wilms Tumor what is the most common presenting sign? | Most common presenting sign is swelling or a mass within the abdomen |
| Wilms tumor will or will not cross the midline? | Wilms Tumor will NOT cross the mid-line of the abdomen |
| ___ is a Firm, non-tender, usually confined to one side and deep within the flank? | Wilms Tumor |
| What are the other symptoms that can occur in wilms tumor that are due to compression by the tumor, metabolic alteration, or metastasis? | Hematuria, anemia, hypertension, weight loss and fever, mets to lung (pain, dyspnea, SOB, cough, etc) |
| Abdominal ultrasound, CT, MRI, hematological studies, kidney function tests, urinalysis, bone marrow; Physical exam for congenital anomalies Inferior venacavogram to look for involvement of vena cava are all Diagnostic evaluations for ____? | Wilms Tumor |
| Why do you not want to palpate the abdomen of a wilms tumor pt? | Tumor can become quite large and usually remains encapsulated for an extended period of time-don’t palpate the abdomen can cause a rupture of the tumor |
| T/F Wilm’s Tumor treatment: Combined treatment with surgery and chemotherapy with or without radiation based on clinical stage and histologic pattern? | True |
| When surgery is done in Wilm’s Tumor the entire ___ & ___ are removed and great care is taken to avoid ___ of the encapsulated tumor? | Entire kidney and adrenal gland is removed and Great care is taken to avoid rupture of the encapsulated tumor |
| If surgery is done in Wilm’s tumor the other ___ & ___ are inspected for disease? | Other kidney and lymph nodes are inspected for disease. Any other structures involved are removed. |
| What happens if both kidneys are involved in wilm’s tumor during surgery? | If both kidneys are involved a partial nephrectomy may be done on the least affected and total on the most affected. |
| In Wilm’s Tumor radiotherapy is reserved for __, __, or ___? | Radiotherapy Reserved for large tumors, metastasis, or recurrence |
| T/F It is not necessary to receive chemotherapy following removal of wilm’s tumor? | false All Children receive chemotherapy after surgery for 6-15 months See Staging for Wilms (Box 36-7) |
| What is the survival rate for wilm’s Tumor? | Survival rates for Wilms is one of the highest among all childhood cancers; Stages 1 and 2 have a 90% chance of cure with multimodal therapy |
| Wilms tumor Nursing care: there is a shock of diagnosis why and what do you do? | There is a shock of Dx because the well child with no symptoms of disease other than mass, parental guilt, swift intervention w/ surgery w/in 24-48 hrs after Dx |
| How do you care for a wilms tumor pt preoperatively? | “Do not Palpate Abdomen” sign on bed– Careful handling– Monitor blood pressure– Support parents and child |
| How do you care for a wilms tumor pt POSToperatively? | Postoperative– Accurate Intake and Output– Monitor Blood Pressure– Monitor Gastrointestinal Activity |
| What are some life long considerations with one kidney of a wilms tumor pt? | Life long consideration with one kidney– Avoid UTI’s especially girls and avoid contact sports. Protect the one kidney from injury. |
| ___ is the most common soft tissue sarcoma in children? | Rhabdomyosarcoma |
| What do sarcomas derive their name from? | Sarcomas derive their name from the specific tissue of origin |
| What does Rabdo mean? | striated |
| Myo means? | muscle |
| Striated (skeletal) muscle is found almost ___where in the body? | Striated (skeletal) muscle is found almost any where in the body |
| Rhabdomyosarcoma tumors occur at many sites. What are the most common? | These tumors occur at many sites most common the head, neck, and orbit of eye |
| Rhabdomyosarcoma is most common in children younger than ___ but can be seen in children of all age groups? | Most common in children younger than 5 but can be seen in children of all age groups |
| In Rhabdomyosarcoma the symptoms depend on tumor location and compression of organs. How does the tumor feel? | Soft to hard, non-tender, immobile, mass |
| What are the manifestations of periorbital rhabdomyosarcoma? | Periorbital (eye): visual changes, ptosis, proptosis, etc. |
| What are the manifestations of nasopharynx rhabdomyosarcoma? | Nasopharynx: stuffy nose, nasal obstruction, pain, sinus discharge, swelling |
| What are the manifestions of ear rhabdomyosarcoma? | Ear: Otitis media, pain, drainage |
| What are the manifestations of extremity rhabdomyosarcoma? | Extremity: ROM affected |
| What are the retroperitoneal and pelvic areas manifestations of rhabdomyosarcoma? | Retroperitoneal and pelvic areas: function of organs affected, abdominal mass, pain, intestinal and GU obstruction. Tumors here are often widely metastasized before dx |
| T/F In rhabdomyosarcoma many of the signs are vague and suggest common childhood illnesses? | True |
| Exam of the head and neck area and signs of a visible mass; Radiographic studies and chest x-ray, CT and MRI, bone scan, and bone marrow, LP and biopsy are all Dx studies for ____? | rhabdomyosarcoma |
| T/F staging is important to establish in rhabdomyosarcoma? | true |
| T/F Rhabdomyosarcoma iss not highly malignant and aggressive multimodal therapy is recommended? | false:Tumor is highly malignant with metastasis at diagnosis. Aggressive multimodal therapy is recommended |
| T/F Rhabdomyosarcoma: Treatment; In past radical surgical removal was the treatment of choice and Now with improved chemo and radiation surgery plays a lesser role | true |
| In rhabdomyosarcoma complete removal of primary tumor is preferred followed by __ &___(1-2 years)? | Complete removal of primary tumor is preferred followed by radiation and chemotherapy (1-2 years) |
| T/F Rhabdomyosarcoma: Prognosis… With the change in treatment from radical surgery or radiotherapy to a multimodal approach the survival rates have improved considerably | true |
| What is the 5 year survival rate of rhabdomyosarcoma? | 5 year survival rates are approximately 65% |
| If the child with rhabdomyosarcoma remains disease free for ___years he is probably cured if a relapse occurs what is the prognosis? | If child remains disease free for two years he is probably cured and If a relapse occurs prognosis is poor |
| Osteosarcoma and Ewing sarcoma account for ___% of all primary malignant bone tumors in children? | 85% |
| Bone tumors occur more commonly in ___, with the highest incidence during the ____ rate of adolescence? | Occur more commonly in males, with the highest incidence during the accelerated growth rate of adolescence |
| What are the clinical manifestations of bone tumors? | Clinical manifestations are similar: Localized pain and swelling at tumor site, palpable mass, Limp or decreased ROM |
| Bone Tumors it is important to rule out __ or ___ as causes? | Rule out trauma or infection |
| What are the definitive diagnosis of Bone tumors? | Definitive diagnosis based on radiologic studies ( CT scans, bone scans) and bone biopsy |
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cgwayland
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