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
• Benign: overgrowth of cells that are
NOT cancerous
• Malignant: overgrowth of cells that
ARE cancerous
What is cancer?
Cell development
Healthy growth
Normal cells
Unhealthy growth
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 longterm 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. Adult
Characteristic
Pediatric
Adult
Frequency
Rare: <1% of
all cancers
Primary sites
Involves
TISSUE
Common:
>99% of all
cancers
Involves
ORGANS
Pathogenesis
Genetic
alterations
Environment
& lifestyle
Pediatric v. Adult
Characteristic
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 Doesn’t always
standard
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:
-fight off infection
• Platelets:
-help to prevent excessive bleeding;
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
G
A
E
D
B
H
F
C
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 (311:30pm), 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/braint
umors.asp
• http://www.curesearch.org/
References cont.
• ghr.nlm.nih.gov/.../ basics/MitosisMeiosis.jpg
• http://www.med.harvard.edu/JPNM/TF96_97/No
v4/WriteUp.html
• http://wwwmedlib.med.utah.edu/WebPath/HEMEHTML/HEM
EIDX.html
• http://wwwmedlib.med.utah.edu/WebPath/BONEHTML/BON
E001.html