Top 5 Pediatric Cancers Brandee Aquilino 2012 1

Top 5 Pediatric Cancers Brandee Aquilino, 2012 1. Acute Lymphoblastic Leukemia 2. Brain Tumors 3. Neuroblastoma 4. Wilms Tumor 5. Lymphoma ผศ. กาญจนา ศรเจรญวงศ

��� 4 ������������ Biopsy : ������ Wilms’ tumor chemotherapy : - Actinomycin-D 4 mg+NSS up to 20 ml drip in 15 min x 18 wks - Vincristine 0. 7 mg IV push x 18 wks - Doxorubicin 17 mg + NSS 20 ml v drip in 30 min x 18 wks 1. ����������� � 2. ����������� ผศ. กาญจนา ศรเจรญวงศ

Concept of Pediatric Cancers Nursing Bio Body-G&D Life-threatening Activity S/S chemotherapy radiation surgery Rx Psycho Pain transplant Social Family-Peers e edg l w o Kn Spiritual ผศ. กาญจนา ศรเจรญวงศ Kanj’ s conceptual model of pediatric cancers nursing, 2019

�������� (leukemia) 1. Acute leukemia : > 95% - ANLL (acute non-lymphocytic leukemia), AML(acute myeloid leukemia) 25 -30% - ALL (acute lymphoid/lymphoblastic leukemia 70 -75% 2. Chronic leukemia : < 5% - CML (chronic myeloid leukemia) - JMMol (juvenile myelomonocytic leukemia) ผศ. กาญจนา ศรเจรญวงศ

1. Acute Lymphoblastic Leukemia (ALL) ����������� Pathophysiology Bone marrow ����� Wbc ������� : Immature WBC �� : �� mature WBC, RBC, PLT ผศ. กาญจนา ศรเจรญวงศ blasts

Acute Lymphoblastic Leukemia Symptoms: • Fever • Pale • Echymosis/Bleeding • Hepatosplenomegaly * LN enlargement * Bone pain • Weight loss, poor appetite. etc. ผศ. กาญจนา ศรเจรญวงศ

Dx: Bone Marrow Aspiration/Biopsy Blasts cells ผศ. กาญจนา ศรเจรญวงศ

Lumbar Puncture : metastasis to CSF Blasts cells ผศ. กาญจนา ศรเจรญวงศ

���� ALL The National protocals for ALL (������������ ) ������� 1. Chemotherapy -Induction of remission (4 -6 wks) -Consolidation (6 -8 wks) -CNS. Prophylaxis (4 -6 wks) -Maintenance (2 -3 yrs) 2. Transplantation : Stem cell ���� 50% ผศ. กาญจนา ศรเจรญวงศ

���� ALL ������������ Induction of remission ������������ Prenisolone, Vincristine, L-asparaginase +/�� Dixorubicin ������������ Consolidation / intensification ������������ Methotrexate (MTX), ����������� 6 -mercaptopurine (6 MP) Cyclophosphamide (Cy), Cytarabine (Ara-C) L-asparaginase CNS prophylaxis MTX high dose/ ������������ � cranial radiation 1, 800 c. Gy ������� MTX (intrathecal) Maintenance 6 MP q day ������������ �� MTX q wk ����������� Vincristine q 4 wk ผศ. กาญจนา ศรเจรญวงศ ���� Prednisolone 7 day q 4 wk

Lymphoma Hodgkin’s lymphoma Non-Hodgkin’s lymphoma • Epstein-Barr virus (EBV) • Reed-Sternberg Cells • cells localized in one / more group lymph node • or surrounding chain in cervical / mediastinal LN. • develop in peripheral lymph nodes • and spread throughout the body. ����� ผศ. กาญจนา ศรเจรญวงศ �����

Pel-Ebstein fever Reed-Sternberg cell ผศ. กาญจนา ศรเจรญวงศ

Hodgkin’s Lymphoma) HL) Symptoms • Painless swelling in 1 or more LN: 60 -80% cervical , 60% mediastinum • Weight loss • Fever • Sweats • Weakness ผศ. กาญจนา ศรเจรญวงศ

Non-Hodgkin’s lymphoma Symptom LN enlargement : Anterior mediastinum -Abdominal ascites +/-Pleural effusion -CNS / LN / lungs / testis muscle / GI / Bone / Skin -Intussusception - ผศ. กาญจนา ศรเจรญวงศ

���� Lymphoma 1. Chemotherapy : 6 m -1 yr - induction remission - consolidation or intensification - CNS prophylaxis: LP+IT, /Cranial irradiation 3. Stem cell transplantation ผศ. กาญจนา ศรเจรญวงศ

Wilms’ Tumor ���� Nephroblastoma Pathophysiology ������ � ������������ http: //www. mayoclinic. org/diseases- conditions/wilms tumor/basics/prevention/con 20043492 retrive April 13, 2015 ผศ. กาญจนา ศรเจรญวงศ

Wilms’ Tumor ���� Nephroblastoma Symptoms • Abdominal swelling • An abdominal mass • Abdominal pain • Fever Hypertension • Blood in the urine • Nausea-Poor appetite ผศ. กาญจนา ศรเจรญวงศ

������� Wilms’ tumor https: //www. slideshare. net/santam/management-of-wilms-tumors. September 3, 2017. ผศ. กาญจนา ศรเจรญวงศ

Staging II. The tumor has grown beyond the kidney, either into nearby fatty tissue or into blood vessels in or near the kidney, but it was removed completely by surgery without any apparent cancer left behind. Nearby lymph nodes (bean-sized collections of immune cells) do not contain cancer. The tumor was not biopsied before surgery. �� 20% ���������������������� ผศ. กาญจนา ศรเจรญวงศ

Stage III. This stage refers to Wilms tumors that may not have been removed completely. The cancer remaining after surgery is limited to the abdomen. �� 20 - 25% ���������� ��������������������� ผศ. กาญจนา ศรเจรญวงศ

Stage IV. The cancer has spread through the blood to organs away from the kidneys such as the lungs, liver, brain, or bones, or to lymph nodes far away from the kidneys. As with stage III tumors, surgery to remove the tumor might be the first treatment, but it might need to be delayed until other treatments can shrink the tumor. �� 10% ������������ ������� ��� ผศ. กาญจนา ศรเจรญวงศ

Stage V. Tumors are found in both kidneys at diagnosis. Treatment for children with tumors in both kidneys is unique for each child, although it typically includes surgery, chemo, and radiation therapy at some point. 5% ������������ 2 �������� ผศ. กาญจนา ศรเจรญวงศ

Neuroblastoma (��������� /����� ( Pathophysiology ����������� sympathetic nervous system ������ ��� (adrenal medulla) http: //www. uptodate. com/contents/epidemiologypathogenesis-and-pathology-of-neuroblastoma Retrived April 13, 2015 ผศ. กาญจนา ศรเจรญวงศ

Symptoms: • Impaired ability to walk • Changes in eyes (bulging, dark circles, droopy eyelids) • Pain in various locations of the body • Diarrhea • High blood pressure ผศ. กาญจนา ศรเจรญวงศ

Neuroblastoma �������� Catecholamines -Vanillyl Mandelic Acid (VMA) ผศ. กาญจนา ศรเจรญวงศ

: https: //www. google. co. th/search? q=neuroblastoma&dcr สบคน 14/10/2560

������� 1. 2. 3. 4. Headache, IICP, Hydrocephalus nausea & vomiting seizures, lethargy motor abnormality , ������� unsteady gait(������ ), behavior change 5. weakness 6. irritability, hyper reflexes 7. failure to thrive (FTT), G&D ผศ. กาญจนา ศรเจรญวงศ

Grading of thrombocytopenia Mild 50, 000 – 150, 000 Moderate 20, 000 – 50, 000 Severe < 20, 000 cell/cu. mm ผศ. กาญจนา ศรเจรญวงศ

Extravasation ���������� ��� 15 ����� 4 ������ Vincristine, Vinblastine, Etoposide ( �����

TLS: ���������������������� : �������� - hyperuricemia (uric acid > 5. 5 mg/dl) - hyperkalemia (K+ >6 m. Eq/ml) - hyperphosphatemia (PO 4 > 6. 5 -10 mg/dl) - hypocalcemia (Ca++ < 7 - 8 mg/dl) Rx & Ns ���� lab, force fluid, drugs: Al(OH)3 >>> ������ PO 4 VS & HR. ผศ. กาญจนา ศรเจรญวงศ

Complications of Leukostasis brain - headache, blurred vision, visual loss, CVA gait instability, cranial n. def, retinal he hemorrhage/intracranial bleeding lungs - dyspnea. - pulmonary leukostasis renal failure metabolic - alterations sudden death ผศ. กาญจนา ศรเจรญวงศ

Rx & Ns Leukostasis 1. chemotherapy 2. hydroxyurea; 3. leukapheresis (������� ( ผศ. กาญจนา ศรเจรญวงศ

. 3�������� )bone marrow transplantation

Graft Versus Host Disease (GVHD( https: //www. google. com/search? ei=awv. OWtao. EMev 0 AS 0 i. Yf. ACA&q=graft+versu s+host+disease+picture&oq=graft+versus+host+disease+picture

���� (��� ): - Actinomycin-D 4 mg+NSS up to 20 ml drip in 15 min x 18 wks - Vincristine 0. 7 mg IV push x 18 wks - Doxorubicin 17 mg + NSS 20 ml v drip in 30 min x 18 wks 1. ����������� ผศ. กาญจนา ศรเจรญวงศ

Nursing Concept of Pediatric Cancers Activity S/S chemotherapy radiation surgery Rx Psycho Pain transplant Social Family-Peers e Kn edg l w o Spiritual ผศ. กาญจนา ศรเจรญวงศ Kanj Sirich’s : Nursing concept of pediatric cancers , 2018 Bio Body-G&D

Kanj Sirich‘s : Nursing concept of pediatric with chemotherapy, 2018 assessment GI N/V, poor appetite stomatitis Low immunity Body image NC Hemato fatique, fever, bleeding Fear, Anxiety, Hope Skin sensitivity, alopecia Neuro pain, paresthesia Social& spiritual Uro hematuria Activity in Dialy life Knowledge ผศ. กาญจนา ศรเจรญวงศ

�������� ������������� ������. (2555). ������������ 3 ����� : �����������������. (2561). ������������������ �������� 25 -29 ���� 2561. Behrman, R. E. (2004). Nelson textbook of pediatrics. Pennsylvania: Elsevier Saunders. Betz, CL. & Sowden, LA. (2004). MOSBY’S PEDIATRIC NURSING REFERECE. (5 th ed. ) St. Louis: Mosby. Bowden, V. R. (2010). Children and Their Families: The Continuum of Care. (2 nded. ) Philadelphia: Lippincott. Hockenberry, M. J. and Wilson, D. (2011). Wong’s nursing care of infants and children. (9 thed. ). Missouri: Elsevier Mosby. Kyle, T. & Carman, S. (2017). Pediatric Nursing: CLINICAL GUIDE. Wolters Kluwer: Philadelphia. ผศ. กาญจนา ศรเจรญวงศ

������� https: //www. sickkids. ca/clinical-practice-guidelines/clinical-practice- guidelines/ export/CLINS 125/Main%20 Document. pdf. http: //www. ohsu. edu/xd/health/services/doernbecher/healthcareprofessionals/maternal and-pediatric-nursing-network/nursing-resources/upload/APON_16 -Oncologic. Emergencies. pdf https: //www. cancer. org/cancer/wilms-tumor/detection-diagnosisstaging/staging. html Retrived August 30, 2017 http: //en. wikipedia. org/wiki/Pel-Ebstein_fever. Retrived April 13, 2015 http: //www. uptodate. com/contents/epidemiology-pathogenesis-and-pathologyof-neuroblastoma Retrived April 13, 2015 https: //www. slideshare. net/santam/management-of-wilms-tumors. Retrived September 3, 2017. http: //www. ohsu. edu/xd/health/services/doernbecher/healthcareprofessionals/maternal-and-pediatric-nursing-network/nursingresources/upload/APON_16 -Oncologic-Emergencies. pdf. Retrived April 3, 2018 ผศ. กาญจนา ศรเจรญวงศ