CELLULAR ABERRATIONS
stage III and IV: designate tumors
- an alteration in the cellular structures and
functions
Neoplasm – means new growth, it usually refers to
a new abnormal growth that does not respond to
normal growth-control mechanisms
Neoplastic growth
• benign – growth is limited
• malignant – cancerous or unlimited growth
Assessing Children with Cancer
- Any suspicion of a malignancy requires a
thorough physical examination.
- Assessing weight and height of children is
an important component.
- To confirm a diagnosis, a number of
diagnostic procedures maybe used:
o Radiography
o Sonography
o MRI
o Blood analysis
o Biopsy
Warning Symptoms and Signs of Cancer
1. General Symptoms
a. Unexplained weight loss
b. Fever
c. Fatigue
d. Pain
e. Skin changes (itching, darkening,
reddening, hairiness)
2. General Signs
a. A change in bowel or bladder habit
b. A nonhealing sore
c. Unusual bleeding or discharge
d. A thickening or lump in the breast or
other body part
e. Indigestion or difficulty swallowing
f. An obvious change in a wart or a
mole
g. A nagging cough or persistent
hoarseness
Diagnosis
1. Biopsy – surgical removal of tissue or cells
for laboratory evaluation and analysis
2. Tumor staging – documents the extent and
progress of malignant tumor
a. stage I: a tumor that can be
completely removed surgically.
b. stage II: a tumor that cannot be
completely removed surgically.
c.
that have extended beyond the
original site or have spread
systematically (metastasis).
Treatment
1. Radiation – changes the DNA component
of a cell nucleus to a point at which the cell
cannot replicate DNA material and thereby
inhibits further cell division and growth.
2. Chemotherapy – a chemotherapeutic
agent is one that is capable of destroying
malignant cells; they have differing
mechanisms used to ensure maximal
tumor cell death
3. Stem cell/Bone marrow transplantation –
transplantation of bone marrow that was
previously harvested from a child with
cancer or transplantation of bone marrow
from a well person to a child with cancer;
immune cells in the transplanted marrow
may help to kill remaining cancer cells in
the child’s circulation through immune-
mediated reactions
4. Immunotherapy – treatment that stimulates
or suppresses your immune system to help
your body fight disease or infection; it
involves any modality that modulates the
immune system to boost or create an
anticancer effect through a number of
mechanisms
Cancers in children and adolescents
LEUKEMIA
1. Acute Lymphoblastic Leukemia
a. Type of cancer that affects the bone
marrow and the production of red
blood cells and lymphocytes
b. Symptoms
i. Anemia – pallor, low-grade
fever, lethargy
ii. Low platelet count –
petechiae and bleeding
from oral mucus
membranes, easy bruising
on extremities
iii. Abdominal pain, vomiting,
anorexia
iv. Bone and joint pain
v. Prolonged fevers
vi. Headache, uneasy gait
vii. Painless, generalized
swelling of lymph nodes
viii. Elevated leukocyte count
c. Diagnosis:
 i. Blood tests – may reveal too spinal cord –
many or too few white blood additional treatment
cells, not enough red blood to kill leukemia cells
cells, and not enough located in the central
platelets; may also show the nervous system
presence of blast cells ii. Chemotherapy
ii. Bone marrow test – a e. Nursing diagnosis
needle is used to remove a i. Bleeding risk due to
sample of bone marrow diminished platelet
from the hipbone or production
breastbone; sample is sent ii. Pain related to invasion of
to a lab for testing to look for leukocytes and replacement
leukemia cells and of marrow with leukemic
determine whether the cells
leukemia cells began from B iii. Impaired health
lymphocytes or T maintenance related to
lymphocytes long-term therapy for
iii. Imaging tests – such as an leukemia
X-ray, a computerized f. Nursing management
tomography (CT) scan or an i. Frequently monitor the
ultrasound scan may help client for pneumonia,
determine whether cancer pharyngitis, esophagitis,
has spread to the brain and perianal cellulitis, urinary
spinal cord or other parts of tract infection, and cellulitis,
the body which are common in
iv. Spinal fluid test – may be leukemia and which carry
used to collect a sample of significant morbidity and
spinal fluid (the fluid that mortality.
surrounds the brain and ii. Monitor for fever, flushed
spinal cord); sample is appearance, chills,
tested to see whether tachycardia; appearance of
cancer cells have spread to white patches in the mouth;
the spinal fluid redness, swelling, heat or
d. Medical management: pain in the eyes, ears,
i. Phases throat, skin, joints,
1. Induction therapy – abdomen, rectal and
to kill most of the perineal areas; cough,
leukemia cells in the changes in sputum; skin
blood and bone rash.
marrow and to iii. Avoid invasive procedures
restore normal blood and trauma to skin or
cell production mucous membrane to
2. Consolidation prevent entry of
therapy – aimed at microorganisms.
destroying any iv. Care for the patient in
remaining leukemia private room with strict
in the body handwashing practice.
3. Maintenance v. Encourage and assist
therapy – prevents patient with personal
leukemia cells from hygiene, bathing, and oral
regrowing; lower care.
doses over a long vi. Obtain cultures and
period of time, often administer antimicrobials
years promptly as directed.
4. Preventive vii. Watch for signs of minor
treatment to the bleeding, such as bleeding
 gums, bleeding at puncture i. Assess for the response in
sites, vaginal spotting, activities of daily living.
heavy menses. Easy fatigability is the first
viii. Be alert for signs of serious symptom to appear among
bleeding, such as headache cases.
with change in ii. Watch out for fever as well
responsiveness, blurred as changes in the vital signs
vision, hemoptysis, such as tachycardia.
hematemesis, melena, iii. Ask the patient for visual
hypotension, tachycardia, changes.
dizziness. iv. Check for the appetite, as
ix. Monitor platelet counts well as the dental health.
daily. There are cases that
x. Administer blood patients suffer in poor
components as directed. dentition as well as gum
xi. Keep patient on bed rest hypertrophy.
during bleeding episodes. v. Changes in skin as well as
xii. Teach signs and symptoms nodules.
of infection and advise vi. Conduct a physical
whom to notify. assessment in order to find
xiii. Encourage adequate evidence for splenomegaly,
nutrition. hepatomegaly and
xiv. Teach avoidance of lymphadenopathy.
constipation with increased vii. Assist the patient for
fluid and fiber, and good screening examinations
perineal care. such as MRI for complaints
in back pain, lower
2. Acute myeloid leukemia extremity weakness or
a. Over proliferation of granulocytes paresthesias.
(neutrophils, basophils,
eosinophils) LYMPHOMA
b. Granulocytes grow so rapidly that 1. Hodgkin disease
they are forced out into the a. Lymphocytes proliferate in the
bloodstream while still in blast lymph glands and Reed-Sternberg
stage; they are not able to carry out cells develop
normal immune functions and put b. They lack B- and T-lymphocyte
the child at risk for infection surface markers and cannot
c. Symptoms: produce immunoglobulins
i. Same with ALL c. Symptoms:
d. Diagnosis: i. Enlargement of only one
i. Bone marrow aspiration and painless, enlarged, rubbery
biopsy – procedures to lymph node
collect and examine bone ii. Anorexia
marrow; can show whether iii. Malaise
your bone marrow is healthy iv. Night sweats
and making normal v. Unintentional weight loss
amounts of blood cells vi. Fever
e. Medical management vii. Elevated ESR
i. Chemotherapy d. Diagnosis:
1. Cytarabine i. Biopsy of lymph nodes –
2. Etoposide detects characteristic Reed-
3. Daunorubicin sternberg giant cell, helping
ii. Bone marrow to confirm diagnosis
transplantation ii. Chest and abdominal CT
f. Nursing management scan – will reveal enlarged
 mediastinal nodes and
lymph nodes of abdomen
iii. Bone marrow analysis
iv. Lymphangiography – viii. Assess for ulcers, plaques,
detects size and location of
deep nodes involved,
including abdominal nodes,
which may not be readily
seen by CT scan
v. Gallium-67 detects areas of
active disease; determines
aggressiveness of disease.
e. Medical management
i. Combination chemotherapy
ii. Radiation therapy
iii. Immunotherapy
iv. Bone marrow
transplantation
f. Nursing diagnosis
i. Risk for powerlessness
related to fear of disease
recurrence
g. Nursing management
i. To protect the skin receiving
radiation, avoid rubbing,
powders, deodorants,
lotions, or ointments (unless
prescribed) or application of
heat or cold.
ii. Encourage patient to keep
clean and dry, and to bathe
the area affected by
radiation gently with tepid
water and mild soap.
iii. Encourage wearing loose-
fitting clothes and to protect
skin from exposure to sun,
chlorine, and temperature
extremes.
iv. To protect oral and gastro-
intestinal tract mucous
membranes, encourage
frequent, small meals, using
bland and soft diet at mild
temperatures.
v. Teach the patients to avoid
irritants such as alcohol,
tobacco, spices, and
extremely hot or cold foods.
vi. Administer or teach self-
administration of pain
medication or antiemetic
before eating or drinking, if
needed.
vii. Encourage mouth care at
least twice per day and after
meals using a soft
toothbrush or toothete and
mild mouth rinse.
or discharge that may be
indicative of superimposed
infection.
ix. For diarrhea, switch to low-
residue diet and administer
anti-diarrheals as ordered.
x. Teach patient about risk of
infection. Advice patient to
monitor temperature and
report any fever or other
sign of infection promptly.
2. Non-Hodgkin lymphoma
a. Malignant disorders of lymphocytes
(B or T cells)
b. Spread from original site is through
the bloodstream, making the
course of the disease unpredictable
c. Symptoms:
i. Chest tightness and
shortness of breath
ii. Abdominal pain
iii. Diarrhea or constipation
iv. Mass may be palpable on
examination
d. Diagnosis:
i. Biopsy of affected lymph
nodes and bone marrow
e. Medical management:
i. Systemic chemotherapy
1. Cyclophosphamide
2. Doxorubicin
3. Vincristine
4. Prednisone
ii. Intrathecal chemotherapy
iii. Allopurinol – to prevent uric
acid accumulation and
blocking of kidney tubules
f. Nursing management
i. Administer the prescribed
antiemetics to help prevent
nausea and vomiting
related to chemotherapy
ii. Ensure your client is well
hydrated and that their urine
output amounts to about 3
L/day
iii. Monitor for fluid overload
and pulmonary edema
iv. Administer the prescribed
allopurinol to help prevent
hyperuricemia
 v. Monitor closely the patient's support to the child and family
response to treatment, regarding diagnostic testing,
particularly the laboratory treatment plan, ongoing therapy,
test results and prognosis.
o Monitor for findings of infection
NEUROBLASTOMA o Administer antibiotics as prescribed
- Tumors that arise from neuroectodermal for infection
cells of the sympathetic nervous system o Keep the child’s skin clean and dry
- It most commonly arises in and around the o Provide oral hygiene
adrenal glands, which have similar origins o Provide age-appropriate
to nerve cells and sit atop the kidneys diversional activities
- Symptoms o Provide support to the child and
o Weight loss family
o Constipation o Avoid false reassurance
o Anorexia o Listen to the child’s concerns
o Excessive sweating o Allow time for the child and family to
o Flushed face discuss feelings regarding grief and
o Hypertension loss
o Abdominal pain
o Constipation
o Loss of motor function in lower CHROMOSOMAL ABERRATIONS
extremities - chromosomal disorders that result from
o Dyspnea mistakes during mitosis and meiosis cell
o Difficulty swallowing division processes
o Neck and facial edema
o Jaundice 1. Trisomy 13 Syndrome
o Blue or purplish nodules on arms a. Also called as Patau syndrome
and legs b. Child has an extra chromosome 13
- Diagnosis and is severely cognitively
o MIBG (metaiodobenzylguanidine) challenged
scans – identify tissues with c. Symptoms:
norepinephrine transporters in high i. Cleft lip and palate
concentrations ii. Heart disorders (ventricular
o MRI septal defects)
o Bone marrow aspiration and biopsy iii. Abnormal genitalia (small
o Urine sample – for presence of penis or enlarged clitoris)
VMA and HVA iv. Microcephaly with disorders
- Treatment of the forebrain and
o Surgical removal of primary tumor forehead
o Chemotherapy combinations v. Microphthalmos (eyes
▪ Doxorubicin smaller than usual or
▪ Cyclophosphamide absent)
▪ Etoposide vi. Low-set ears
▪ Carboplatin vii. Polydactyly (extra fingers or
o Immunotherapy toes)
o Stem cell transplants viii. Low birth weight, problems
- Nursing management with feeding, and low
o Use extreme caution when muscle tone
handling or bathing the client to ix. Microcephaly (small head)
prevent trauma to the tumor site and face/head issues
o Assess the child’s and family’s x. Apnea
coping and support xi. Deafness
o Assess for developmental delays d. Causes:
related to illness i. In most cases, trisomy 13
o Assess physical growth (height and happens spontaneously
weight). Provide education and
 soon after the sperm and
egg meet.
ii. The extra chromosome
happens at random.
1. Issue may arise as
the reproductive
material of either
parent divides, or it
may happen as cells
divide after
fertilization itself.
e. Risk factors
i. Paternal age
f. Diagnosis/Laboratory Procedures
i. Cell free DNA screening – a
noninvasive blood test that
can be done as early as 10
weeks into pregnancy
ii. Ultrasound – may reveal
certain features that match
up with Patau syndrome
iii. Amniocentesis – doctor will
obtain a sample of amniotic
fluid to look for additional
chromosomes
iv. Chorionic villus sampling –
doctor will obtain a sample
of placental tissue to look for
additional chromosomes
g. Medical Management
i. There is currently no cure
ii. Treatment is focused on
symptoms and making the
child comfortable
h. Surgical Management
i. Cardiac
ii. Gastrointestinal and
genitourinary
iii. Ears, nose, throat
iv. Respiratory and
neurological
v. Muscoskeletal and
dermatological
vi. Ophthalmological
2. Trisomy 18 Syndrome
a. Also called as Edwards syndrome
b. Child has 3 copies of chromosome
18
c. Symptoms:
i. Severely cognitively
challenged
ii. Small for gestational age
iii. Low-set ears
iv. Small jaw
v. Congenital heart defects
vi. Misshapen fingers and toes
(index finger deviates or
crosses over other fingers)
vii. Rocker-bottom feet (soles
of feet are rounded instead
of flat)
d. Diagnosis
i. Ultrasound – healthcare
provider will look for signs of
Edwards syndrome
including fetal activity, the
amniotic fluid surrounding
your fetus and the size of
your placenta
ii. Amniocentesis – between
15 and 20 weeks of
pregnancy, the healthcare
provider will take a small
sample of amniotic fluid to
identify potential health
conditions in your baby
iii. Chorionic villus sampling
(CVS) – between 10 and 13
weeks of pregnancy, the
healthcare provider will take
a small sample of cells from
your placenta to look for
genetic conditions
iv. Screenings – after 10
weeks of pregnancy, the
healthcare provider will
examine a sample of your
blood to assess whether or
not your child has common
extra chromosome
conditions, including
trisomy 18
e. Medical management
i. Cardiac treatment
ii. Assisted feeding – child can
have problems eating
normally due to delayed
physical growth; a feeding
tube might be necessary to
address early feeding
problems
iii. Orthopaedic treatment –
child may have spinal
problems like scoliosis,
which could impact how
child moves; could involve
bracing or surgery
iv. Psychosocial support
f. Surgical management
 i. Surgery for heart defects, develop at puberty (except
kidney issues, head or face pubic hair)
irregularities iv. Hairline at the nape of neck
is low-set
3. Cri-Du-Chat Syndrome v. Neck may appear webbed
a. Also called as cat’s cry and short
b. Result of a missing portion of vi. Appreciable edema of
chromosome 5 hands and feet
c. Symptoms: vii. Congenital anomalies
i. Abnormal cry (sounds like a (coarctation of aorta, kidney
cat) disorders)
ii. Small head d. Diagnosis:
iii. Wide-set eyes (ocular or i. Sonogram – during
orbital hypertelorism) pregnancy; extra skin at the
iv. Downward slant to the sides of the neck
palpebral fissure of the eye ii. Prenatal screening tests
v. Recessed mandible that evaluate the baby's
vi. Severely cognitively DNA in the mother's blood
challenged may also indicate an
vii. An inguinal hernia (a increased risk of Turner
protrusion of organs syndrome
through a weak area or tear iii. Chorionic villus sampling
in the abdominal wall) iv. Amniocentesis
d. Diagnosis v. Standard karyotyping –
i. X-ray – on child’s head to examination of
detect abnormalities in the chromosomes
base of the skull e. Medical management
ii. Chromosome test that uses i. Growth hormone therapy –
a special technique called a recommended to increase
FISH analysis helps detect height as much as possible
small deletions at appropriate times during
iii. Chromosome analysis or early childhood until the
genetic testing while child is early teen years
still in the womb (if there is ii. Estrogen therapy – most
history) girls with Turner syndrome
iv. Chorionic villus sampling need to start estrogen and
v. Amniocentesis related hormone therapy in
e. Medical management order to begin puberty to
i. Manage symptoms with promote breast
physical therapy, language development and improve
and motor skill therapy, and the size (volume) of the
educational intervention uterus
f. Surgical management
5. Klinefelter Syndrome
4. Turner Syndrome a. Child has two X chromosomes and
a. Also called as gonadal dysgenesis a Y chromosome
or congenital ovarian hypoplasia b. Symptoms:
syndrome i. At puberty, secondary sex
b. Child only has one functional X characteristics do not
chromosome develop
c. Symptoms: ii. Child’s testes remain small
i. Short in stature and produce ineffective
ii. Has only streak (small and sperm
nonfunctional) ovaries iii. Gynecomastia (increased
iii. Secondary sex breast size)
characteristics do not
 iv. Increased risk of breast vi. Prominent lower jaw
cancer vii. Large protruding ears
v. Reduced muscle mass viii. Obesity
vi. Reduced body and facial ix. Enlarged testicles
hair d. Diagnosis:
c. Diagnosis: i. Amniocentesis
i. Karyotyping ii. Chorionic villus sampling
ii. Non-invasive prenatal e. Medical management:
testing (NIPT) designed to i. Seizures or mood instability:
look for other extra 1. Lithium carbonate
chromosomes 2. Gabapentin
iii. Amniocentesis ii. ADHD:
iv. Chorionic villus sampling 1. Methylphenidate
v. Testing after a healthcare and
provider notices abnormal Dextroamphetamine
growth during childhood, 2. Venlafaxine and
puberty or throughout the Nefazodone
teen years iii. Aggression or obsessive-
vi. Testing for fertility issues compulsive disorder:
and/or low testosterone in 1. Fluoxetine
adulthood 2. Sertraline and
d. Medical management Citalopram
i. Hormone replacement – iv. Sleep issues:
replacing the testosterone 1. Trazodone
hormone can help minimize 2. Melatonin
some of the symptoms of
the condition 7. Trisomy 21
ii. Therapy – help limit the a. Also called as down syndrome
impact of certain symptoms b. Most frequently occurring
(i.e., physical therapy for chromosomal disorder
muscle mass) c. A genetic disorder caused when
e. Surgical management abnormal cell division results in an
i. Removal or reduction extra full or partial copy of
surgery of extra breast chromosome 21
tissue d. Symptoms:
f. Nursing management i. Nose is broad and flat
ii. Epicanthal fold (eyelids
6. Fragile X Syndrome have an extra fold of tissue
a. Also known as Martin-Bell at inner canthus)
syndrome iii. Palpebral tissue slants
b. An X-linked disorder in which one laterally upward
long arm of an X chromosome is iv. Iris of eye may have white
defective, which results in specks (Brushfield spots)
inadequate protein synaptic v. Tongue is apt to protrude
responses from the mouth because
c. Symptoms: oral cavity is smaller
i. Maladaptive behaviors vi. Back of head is flat
(hyperactivity, aggression, vii. Neck is short
autism) viii. Extra pad of fat at the base
ii. Reduced intellectual of the head causes the skin
functioning to be loose it can be lifted
iii. Deficits in speech and easily and so thin
arithmetic ix. Ears are low set
iv. Large head x. Muscle tone is poor (rag doll
v. Long face with a high appearance)
forehead xi. Fingers are short and thick
 xii. Little finger is curved inward nebulizer treatments, or
xiii. Wide space between first medications.
and second toes and iii. Nurses should work with the
between first and second patient and their family to
fingers develop a nutrition plan that
xiv. Cognitively challenged meets their individual
xv. Head size is smaller needs.
xvi. Congenital heart disease is iv. Nurses should be familiar
common with available early
xvii. Immune function is altered intervention services in their
xviii. Tend to develop leukemia area and provide referrals
more as appropriate.
e. Risk factors: v. Nurses should provide
i. Advancing maternal age education and counseling to
ii. Being carriers of the genetic patients with Down
translocation for Down syndrome and their families
syndrome regarding the condition and
iii. Having had one child with its associated medical and
Down syndrome developmental issues. This
f. Diagnosis: may include discussing
i. Sonography treatment options, providing
ii. Prenatal screening test – information about available
tests assess your risk of resources, and addressing
having a child with Down any concerns or questions.
syndrome rather than giving vi. Nurses should provide
you a confirmation of a psychosocial support, such
diagnosis as counseling or referrals to
iii. Ultrasound – provider will mental health professionals,
look for signs of Down to help patients and families
syndrome, like extra fluid cope with these challenges.
behind your baby’s neck
iv. Amniocentesis
v. Chorionic villus sampling
(CVS)
vi. Percutaneous umbilical
blood sampling (PUBS)
vii. Karyotyping
g. Medical management
h. Nursing management
i. Assess the developmental
progress of patients with
Down syndrome, including
physical, cognitive, and
social-emotional
development. (These
assessments can help
identify areas of delay or
weakness and inform
individualized care
planning.)
ii. Monitor for signs and
symptoms of these
conditions and provide
appropriate interventions,
such as oxygen therapy,