PEDIATRIC PEDIATRIC ONCOLOGYONCOLOGYPEDIATRIC PEDIATRIC ONCOLOGYONCOLOGY

Leslie Meador, RN, BSN, CPONLeslie Meador, RN, BSN, CPONChildren’s Mercy HospitalChildren’s Mercy Hospital

What is cancer?• Normal cells grow and divide, then

eventually die. • Cancer occurs when the body is

unable to regulate cell growth, leading to an overgrowth of abnormal cells.

Cell development

Benign v. Malignant• Benign: overgrowth of cells that

are NOT cancerous• Malignant: overgrowth of cells that

ARE cancerous

What is cancer?Cell development

Healthy growth Unhealthy growth

Normal cells Tumor cells

Benign Malignant

Pediatric Oncology Facts

• In the U.S., cancer remains responsible for more deaths from one year through adolescence than any other disease; more deaths than asthma, diabetes, cystic fibrosis and AIDS combined.

• Each year in the U.S., approximately 12,500 children and adolescents are diagnosed with cancer. That’s the equivalent of two average size classrooms diagnosed each school day.

Pediatric Oncology Facts

• In the early 1950s, less than 10 percent of childhood cancer patients could be cured.

• Today, nearly 80% of children diagnosed with cancer become long-term survivors and the majority of them are considered cured.

Pediatric Oncology Facts

• Most common childhood cancers:-leukemia (blood) -brain and nervous system-the lymphatic system (lymphoma)

-kidneys (Wilm’s tumor) -bones (osteosarcoma & Ewing’s

sarcoma)-muscles (rhabdomyosarcoma)

Pediatric v. AdultCharacteristic Pediatric Adult

Frequency Rare: <1% of all cancers

Common: >99% of all cancers

Primary sites Involves TISSUE

Involves ORGANS

Pathogenesis Genetic alterations

Environment & lifestyle

Pediatric v. AdultCharacteristic Pediatric Adult

Screening/Early detection

Small percentage; screening tests are generally not applicable

Many can be detected by adhering to screening guidelines

Manifestations at diagnosis

Metastatic disease ~80%

Local or regional disease

Treatment Follows protocols as standard

Doesn’t always follow a protocol

Prognosis

70-90% cure (depending on tumor & stage)

<60% cure (depending on tumor & stage)

Means of diagnosis• Well child check-ups (physical

assessment & review of symptoms)• Blood tests• Radiology exams (x-rays, CT, MRI)• Pathology (biopsy of mass)• Diagnostic procedures

-Bone marrow aspirate-Bone marrow biopsy-Lumbar puncture

Methods for treatment• Depends of type and stage of

malignancy• Includes the following:

-Chemotherapy -Radiation

-Surgical resection-Stem cell transplantation

Chemotherapy• Chemotherapy can be delivered by the

bloodstream to reach cancer cells all over the body, or it can be administered directly to specific cancer sites.

• Chemotherapy can be given through various methods:

-intravenously (IV) -intrathecally (IT) -intramuscularly (IM) -subcutaneously (SQ) -orally (PO).

Chemotherapy• Works by interfering with the

ability of cancer cells to divide and reproduce themselves.

• Attacks all rapidly dividing cells.

Rapidly dividing cells:• Hair• Skin• Nails• Blood cells

-Red blood cells-White blood cells-Platelets

Three blood lines• Red blood cells:

-carry oxygen to surrounding tissues

• White blood cells:White blood cells:-fight off infection-fight off infection

• Platelets:Platelets:-help to prevent excessive -help to prevent excessive

bleeding; assists in clot formationbleeding; assists in clot formation

Complications of chemotherapy

• Anemia (low RBC)• Thrombocytopenia (low platelet)• Neutropenia (low WBC)• INFECTION• Hair loss• Mouth sores (mucositis)• Nausea, vomiting & diarrhea• Organ toxicities

Radiation• Managed by a radiation oncologist• The radiation oncology team will

precisely measure and mark the radiation “field." This field is established to deliver the maximum radiation to the tumor with the least impact possible on the surrounding tissues.

• Frequency & duration depends on diagnosis & stage.

Complications of radiation

• Nausea and vomiting • Low blood counts • Infection• Mouth sores • Skin changes (may look and feel like a sunburn)• After radiation to the head and spine, other side

effects may occur months to years later, including:

– Problems with growth – Hormone production – Learning problems

Surgery• Can be done initially if tumor is

isolated (most common in benign tumors or in brain & kidney tumors).

• Usually done following a few rounds of chemo. This allows the tumor to shrink, which should allow the surgery to be less invasive.

Complications of Surgery

• Infection• Rupture of tumor – increases risk

of later metastasis• Delay in other treatments due to

time required to heal from surgery.

Stem Cell Transplant• Purpose:

1. Remove any remaining diseased cells

2. Clear bone marrow space through ablative therapy (consisting of chemotherapy or chemotherapy+radiation).3. Replace bone marrow space with healthy stem cells.

Complications of Stem Cell Transplant

• Organ toxicity• Organ failure• INFECTION• Engraftment Failure• Graft v. Host Disease• Death

WHAT DOES CANCER LOOK

LIKE?

Normal WBC on smear

A

B

C

D

E

F

G

H

A. Banded Neutrophil B. Lymphocyte

C. Monocyte D. Segmented Neutrophil

E. Eosinophil F. Basophil

G. Platelet H: Red blood cell

Acute Lymphocytic Leukemia on smear

Osteosarcoma

Distal Femur Humerus

Osteosarcoma

Brain tumor

Brain tumor

Ginny’s story

WHY this profession?• LOVE KIDS!!!!!!• Hem/Onc - Increased acuity than med/surg

units mentally challenging each day; pathophysiology is complex in this population

• Opportunity to INVEST in PEOPLE• Develop long-term relations with patients• See effects of my efforts over time• End of life care• Working 3 days/week = Full time!!!

What is my day like?• 12 hour shifts; 7am – 7pm• Nurse: patient ratio = 1:3 max• Manage care for each assigned patient, which may

include, but not limited to: medication administration, IVF, chemo (monitoring/managing side effects), blood products, procedures (including sedation) for BMA & LP, bone marrow transplant infusions, monoclonal antibodies, ng placement/feeds, IV access, obtaining & monitoring labs, coordinating with other disciplines (PT/OT, speech therapy, radiology, OR) … being PROACTIVE in patient care, focusing on management while preventing further issues/complications.

And the numbers are …• Starting salary: $21.49/hr (CMH in top

5% salary for RN’s in KC area)• Shift differentials: 10% evening (3-

11:30pm), 15% nights (7p-7a), 10% weekend

• Specialty differentials: 10% critical care, 5% OR, SDS, PACU, $1.00/hr for approved specialty certifications

• Up to $3000/year educational assistance

Why Childrens Mercy Hospitals and Clinics?

• Only pediatric hospital between St. Louis & Denver• Competitive salary & benefits• MAGNET Designation – reflects nursing satisfaction• >50 medical/surgical sections to practice in • CMH is expanding throughout KC area to include Urgent

Care South & in the Northland, along with clinics in Eastern and Western KC

• Other professions: APN, PT/OT, Speech Therapy, Musical Therapy, Child Life Specialist, RT, physicians, PA, EMT and more!

References• Hooke, M., Kline, N., O’Neill, J., Norville,

R., Wilson, K. (2004). (Essentials of Pediatric Oncology: A Core Curriculum ( 2nd ed.) (pp 2-12,57). Glenview, IL: Association of Pediatric Oncology Nurses

• http://www.cancer.org• http://www.childsdoc.org/fall2000/

braintumors.asp• http://www.curesearch.org/

References cont.• ghr.nlm.nih.gov/.../ basics/MitosisMeiosis.jpg• http://www.med.harvard.edu/JPNM/TF96_97/N

ov4/WriteUp.html• http://www-medlib.med.utah.edu/WebPath/HE

MEHTML/HEMEIDX.html• http://www-medlib.med.utah.edu/WebPath/BO

NEHTML/BONE001.html