Environmental carcinogens o drug exposure as risk for

Environmental carcinogens
o Drug exposure as risk for cancer
• Patterns of onset
o Infancy/early childhood
• Neuroblastoma
• Retinoblastoma
• Wilm’s tumor
• ALL – Acute Lymphocytic Leukemia
o Adolescence
• Lymphomas
• Osteosarcoma
• Melanomas
o **Slide 36 Pic**
• Adolescents – more likely to get different TYPES of cancer
• **Don’t need to memorize certain numbers**
• **Know which kids are more likely to get what*
o **Slide 37 Pic**
• S/S diff types of cancer
• Infections – fevers DO NOT go away with Tylenol
• Pediatric (0 – 19 yrs) Diagnoses of Cancer 1975 – 2010
o ALL
o Brian/CNS tumors
• Pediatric (0 – 19 yrs) Mortality Rate 1975 – 2010
o Decreased throughout the years for all cancers
o CNS still highest cause for mortality
• General diagnostic tests
o CBC
• Look at WBC, RBCs, Hgb, Hct, Platelets = all low (pantycopenia)
o BMP
o Absolute Neutrophil Count (ANC)
o Lumbar Puncture – make sure no CNS involvement
• Relieve ICP pressure – if big tumor = can cause hernia of brain tissue
• **MUST DO CT SCAN BEFORE LUMBAR PUNCTURE**
o CT – tumor in brain = larger ICP
o MRI
o Ultrasound
o Biopsy
o Bone Marrow Aspiration
• Bone Marrow Aspiration
o **Pic on slide 41**
o To rule out Leukemia = MUST DO BOTH SIDES
o Ilieac spine
o Pathologists reads IN room
• General treatment modalities
o Surgery – take out tumor if can
• Encapsulated tumor = better prognosis
o Chemotherapy
o Steroids
o Radiation
o Bone marrow transplantation
• Chemotherapy
o Primary form of treatment
o Interferes with cells ability to grow and reproduce
• Chemo kills rapidly growing cells
• **NOT cell specific**
o Used alone or in combination with other treatments
o Routes of chemotherapy
• IV Push – MUST BE ON THE DOT
• IVPB
• Intrathecal – into CSF
• IM – sometimes dose is too much for one muscle – 2 nurses give 2 shots at once
• PO – comfort in hospice situation or after treated aggressively
o Side Effects of Chemo
• Extravasation – necrotic tissue
• Vinchristine – need to give in a central line

• **Always check for blood return BEFORE, DURING, and AFTER
• Alopecia
• GI Problems – Biggest issues
• Nausea/ Vomiting (48 hours) – can be up to a week after
• Nutrition
• Offer small meals & give them what they want
• Give child choice – whatever they want = give it
• Constipation/diarrhea (constipation = miralax)
• Diarrhea = SKIN CARE
• Mucosal ulceration = magic mouth wash
• Chew on ice chips while getting chemo
• = causes vasoconstriction in mouth
• **Watch for ulcerations on anal area too**
• GU Problems
• Hemorrhagic cystitis
• Bleeding and clots in bladder
• Mesna = protects bladder
• **TONS of IV fluid = 200% maintenance
• Will always be peeing – look for color (blood) & weigh
o Side Effects of Chemo
• Myelosuppression
• Usually within 7-10 days after drug given
• Nadir: lowest blood count
• Anemia
• Epoetin Alfa (SQ or IV)
• Transfusion if Hgb <7
• Neutropenic Fever – if have a fever = COME IN NOW
• Emergency!