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PEDIATRIC ONCOLOGY. Leslie Meador, RN, BSN, CPON Children’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.

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  1. PEDIATRIC ONCOLOGY Leslie Meador, RN, BSN, CPON Children’s Mercy Hospital

  2. 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.

  3. Cell development

  4. Benign v. Malignant • Benign: overgrowth of cells that are NOT cancerous • Malignant: overgrowth of cells that ARE cancerous

  5. What is cancer? Cell development Healthy growth Unhealthy growth Normal cells Tumor cells Benign Malignant

  6. Pediatric Oncology Facts • In the U.S., cancer remains responsible for more deaths in ages 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.

  7. 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.

  8. Pediatric Oncology Facts • Most common childhood cancers: -leukemia (blood) -brain and nervous system -the lymphatic system (lymphoma) -kidneys (Wilm’s tumor) -bones (osteosarcoma & Ewing’ssarcoma) -muscles (rhabdomyosarcoma)

  9. Pediatric v. Adult

  10. Pediatric v. Adult

  11. 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

  12. Methods for treatment • Depends of type and stage of malignancy • Includes the following: -Chemotherapy -Radiation -Surgical resection -Stem cell transplantation

  13. 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).

  14. Chemotherapy • Works by interfering with the ability of cancer cells to divide and reproduce themselves. • Attacks all rapidly dividing cells.

  15. Rapidly dividing cells: • Hair • Skin • Nails • Blood cells -Red blood cells -White blood cells -Platelets

  16. Three blood lines • Red blood cells: -carry oxygen to surrounding tissues • White blood cells: -fight off infection • Platelets: -help to prevent excessive bleeding; assists in clot formation

  17. Complications of chemotherapy • Low Red Blood Cells  Anemia • Low Platelets  Thrombocytopenia • Low White Blood Cells  Neutropenia • INFECTION • Hair loss • Mouth sores (mucositis) • Nausea, vomiting & diarrhea • Organ toxicities

  18. 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.

  19. 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

  20. 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.

  21. Complications of Surgery • Infection • Rupture of tumor – increases risk of later metastasis • Delay in other treatments due to time required to heal from surgery.

  22. 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.

  23. Complications of Stem Cell Transplant • Organ toxicity • Organ failure • INFECTION • Engraftment Failure • Graft v. Host Disease • Death


  25. Normal WBC on smear G A E D B H F C • Banded Neutrophil B. Lymphocyte • Monocyte D. Segmented Neutrophil • Eosinophil F. Basophil G. Platelet H: Red blood cell

  26. Acute Lymphocytic Leukemia on smear

  27. Osteosarcoma Humerus Distal Femur

  28. Osteosarcoma

  29. Brain tumor

  30. Brain tumor

  31. Photo video • http://www.onetruemedia.com/otm_site/view_shared?p=70c54d2a5c5870016c90d7&skin_id=701&large

  32. 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!!!

  33. What is my day like? • 12 hour shifts; 7 – 7 • 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.

  34. 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

  35. 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!

  36. References Hooke, M., Kline, N., O’Neill, J., Norville, R., Wilson, K. (2004). (Essentials of Pediatric Oncology: A Core Curriculum( 2nded.)(pp2-12,57). Glenview, IL: Association of Pediatric Oncology Nurses http://www.cancer.org http://www.childsdoc.org/fall2000/braintumors.asp http://www.curesearch.org/ ghr.nlm.nih.gov/.../ basics/MitosisMeiosis.jpg http://www.med.harvard.edu/JPNM/TF96_97/Nov4/WriteUp.html http://www-medlib.med.utah.edu/WebPath/HEMEHTML/HEMEIDX.html http://www-medlib.med.utah.edu/WebPath/BONEHTML/BONE001.html http://faculty.mercer.edu/summervill_j/iv.htm Sciencephotolibrary

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