NEUROBLASTOMA

-is the most common extracranial solid tumor of infancy. Neuroblastoma is a disease in which malignant (cancer) cells form in nerve tissue of the adrenal gland, neck, chest, or spinal cord.
PATHOPHYSIOLOGY CAUSES
not well understood genetics mutation in the anaplastic lymphoma kinase (ALK) gene occupation (i.e. exposure to chemicals in specific industries), smoking, alcohol consumption, use of medicinal drugs during pregnancy and birth factors) atopy and exposure to infection early in life, use of hormones and fertility drugs, and maternal use of hair dye.

MEDICAL MANAGEMENT
Low Risk-surgery with 6 to12 weeks of chemo Intermediate Risk -surgery and 12 to 24 weeks of the same chemotherapy High Risk- aggressive multiagent chemo, resection of the primary tumor, myeloablative chemotherapy. Radiation-Radiation therapy is reserved for patients with symptomatic life- or organ-threatening tumor that does not respond rapidly enough to chemotherapy Monoclonal antibody therapy

SIGNS AND SYMPTOMS

Lump in the abdomen, neck, or chest. Bulging eyes. Dark circles around the eyes ("black eyes"). Bone pain. Swollen stomach and trouble breathing in infants. Painless, bluish lumps under the skin in infants. Weakness or paralysis (loss of ability to move a body part).

NURSING MANAGEMENT

DIAGNOSTIC EXAMS

Twenty-four-hour urine test- higher than normal amount of the substances homovanillic acid (HMA) and vanillyl mandelic acid (VMA) may be a sign of neuroblastoma Blood chemistry studies-high dopamine and norepinephrine Cytogenetic analysis microscopy,-the tumor cells are typically described as small, round and blue, and rosette patterns (HomerWright pseudo-rosettes) may be seen

OSTEOSARCOMA
Osteosarcoma is a cancerous tumor that occurs in the bone. Most osteosarcomas appear in the long bones of the body, such as the femur (the thigh bone) the tibia (the shinbone) or the humerus (the bone that runs from the shoulder to the elbow), although they can appear in any bones.
PATHOPHYSIOLOGY CAUSES MEDICAL MANAGEMENT

1. Etiology is unknown. Predisposing factors is mutation of tha DNA 2. activation of oncogene 3. deactivation of the suppressor gene 4. formation of malignant osteoblast 5. proliferation of abnormal osteoblasts 6. formation of osteiod tissue 7. uncontrolled growth of the tumor 8. suppression of red bone marrow 9. metastasizes

exposure to therapeutic radiation genetic influences hormonal fluctuations and spurts of growth adults who are affected by Pagets disease, hyperparathyroidism, and chronic osteomyelitis Having hereditary retinoblastoma.

chemotherapy given before and after surgery surgery-Limb sparing, Rotation Plasty and amputation antibiotics to prevent and treat infections radiation

SIGNS AND SYMPTOMS

NURSING MANAGEMENT

Persistent pain, swelling or a firm lump on a bone, especially on an arm or leg. A limp (if the tumor affects the leg). Pain or difficulty breathing (if the tumor affects the ribs). A bone fracture that occurs spontaneously or after a minor bum

DIAGNOSTIC EXAMS

Provide quiet environment and calm activities to prevent or lessen pain. Provide comfort measure such as back rub, change position and use of heat or cold application. Encourage diversional activities Administer analgesics as indicated to maximal dose as needed. Encourage the patient to increase fluid intake. Encourage rest periods to prevent fatigue. Assess muscle strength, gross and fine motor coordination. Provide pillows for cushion and support. Keep side rails up all the time.

Serum alkaline phosphatase levels are frequently elevated Hypercalcemia X-rays and computed tomography (CT) -Visualization of lesions; malignant lesions often have poor margination, irregular new bone growth

BREAST CANCER
Breast cancer is a malignant tumor (a collection of cancer cells) arising from the cells of the breast. Although breast cancer predominantly occurs in women it can also affect men. This article deals with breast cancer in women
PATHOPHYSIOLOGY CAUSES MEDICAL MANAGEMENT

oral contraceptives overweight or obese exposure to previous chest radiation or use of diethylstilbestrol Women who started their menstrual cycle at a younger age Family history Age
SIGNS AND SYMPTOMS

SURGERY Chemotherapy - many different therapies Hormonal therapy - tamoxifen, aromatase inhibitors RADIATION THERAPY

NURSING MANAGEMENT

Lump Skin dimpling Change in color or texture of the breast Change on how the nipple looks like Abnormal discharges from the nipple

DIAGNOSTIC EXAMS

Mammography (most accurate method of detecting non-palpable lesions) shows lesions and cancerous changes, such as microcalcification. Ultrasonography- used to distinguish cysts from solid masses. Biopsy or aspiration confirms diagnosis, determines the type of breast cancer. Estrogen or progesterone receptor assays, proliferation or S phase study (tumor aggressive), and other test of tumor cells determine appropriate treatment and prognosis. Chest x-rays, bone scans, or possible brain and chest CT scans detect metastasis.

Monitor for adverse effects of radiation therapy such as fatigue, sore throat, dry cough, nausea, anorexia. Monitor for adverse effects of chemotherapy; Provide psychological support to the patient throughout the diagnostic and treatment process. Administer antiemetics prophylactically, as directed, for patients receiving chemotherapy. Administer I.V. fluids and hyperalimentation as indicated. Describe surgical procedures to alleviate fear. Suggest to the patient the psychological interventions may be necessary for anxiety, depression, or sexual problems. Teach all women the recommended cancer-screening procedures.

GASTRIC/ STOMACH CANCER

Stomach cancer (also known as gastric cancer) is a disease in which the cells forming the inner lining of the stomach become abnormal and start to divide uncontrollably, forming a mass called a tumor.
PATHOPHYSIOLOGY CAUSES MEDICAL MANAGEMENT

Helicobacter pylori Advanced age (an average age of 70 for men and 74 for women). Male gender A diet low in fruits and vegetables. A diet high in salted, smoked, or preserved foods. Chronic gastritis Pernicious anemia Some gastric polyps Family history of gastric cancer Smoking.
SIGNS AND SYMPTOMS

surgey- gastric resection. Surgical options include proximal or distal subtotal gastric resection; total gastrectomy (includes adjacent organs such as tail of pancreas, portion of liver, duodenum); or palliative surgery such as subtotal gastrectomy with gastroenterostomy to maintain continuity of the GI tract. Surgery may be combined with chemotherapy to provide palliation and prolong life.

NURSING MANAGEMENT

Indigestion or a burning sensation (heartburn) Loss of appetite Weakness and fatigue Bloating of the stomach, usually after meals Abdominal pain in the upper abdomen Nausea and occasional vomiting Diarrhea or constipation Weight loss Bleeding This can lead to anemia. Dysphagia
DIAGNOSTIC EXAMS

Upper GI X-ray with contrast media may initially show suspicious ulceration that requires further evaluation. Endoscopy with biopsy and cytology confirms malignant disease. Imaging studies (bone scan, liver scan, CT scan) helps determining metastasis. Complete blood count (CBC) may indicate anemia from blood loss.

Monitor nutritional intake and weigh patient regularly. Monitor CBC and serum vitamin B12 levels ,albumin and prealbumin levels Provide comfort measures and administer analgesics as ordered. Frequently turn the patient and encourage deep breathing to prevent pulmonary complications, to protect skin, and to promote comfort. Maintain nasogastric suction to remove fluids and gas in the stomach and prevent painful distention. Provide oral care to prevent dryness and ulceration. Keep the patient nothing by mouth as directed to promote gastric wound healing. Administer parenteral nutrition, if ordered. Avoid giving the patient high-carbohydrate foods and fluids with meals, Administer protein and vitamin supplements to foster wound repair and tissue building. Eat small, frequent meals rather than three large meals. Reduce fluids with meals, but take them between meals. Stress the importance of long term vitamin B12 injections after gastrectomy

COLONIC CARCINOMA/COLONCARCINOMA/COLON CANCER

It is a disease in which malignant (cancer) cells form in the tissues of the colon.
PATHOPHYSIOLOGY CAUSES MEDICAL MANAGEMENT

physical inactivity alcohol intake diet colonic polyps ulcerative colitis gender: males
SIGNS AND SYMPTOMS

surgey o partial colectomy o Cryosurgery o resection Radiation Therapy Chemotherapy

NURSING MANAGEMENT

A change in bowel habits. Blood (either bright red or very dark) in the stool. Diarrhea, constipation, or feeling that the bowel does not empty completely. Stools that is narrower than usual. Frequent gas pains, bloating, fullness, or cramps. Weight loss for no known reason. Feeling very tired. Vomiting.
DIAGNOSTIC EXAMS

biopsy virtualcolonoscopy/CT scanning colonoscopy/sigmoidoscopy barium enema digital rectal exam Fecal occult blood test

Monitor intake and output Provide Safe environment Encourage increase protein, vitamins, and vitamin C Monitor Vital signs Monitor WBC Provide comfort measures and administer analgesics as ordered. Avoid giving the patient high-carbohydrate foods and fluids with meals, Administer protein and vitamin supplements to foster wound repair and tissue building. Eat small, frequent meals rather than three large meals. Reduce fluids with meals, but take them between meals. Stress the importance of long term vitamin B12 injections

LEUKEMIA
-literally White blood is a neoplastic proliferation of one particular cell type( granulocytes,monocytes, lymphocytes or megakaryotes)
PATHOPHYSIOLOGY CAUSES MEDICAL MANAGEMENT

is not fully known genetic influence and viral pathogenesis maybe involved bone marrow damage from radiation exposure or from chemicals such as benzene and alkylating agents Having Down syndrome or Fanconi's syndrome increases the risk
SIGNS AND SYMPTOMS

Complete blood count- show a decrease in both RBC and platelets Bone marrow analysis- shows an excess of immature blast cells Physical examination Spinal tap (lumbar puncture) Chest x-rays

NURSING MANAGEMENT

Fever of unknown origin Unexplained weight loss Frequent bacterial or viral infections Headaches Skin rash Bone pain with no known cause Easy bruising Bleeding from gums and nose Blood in urine or stools Enlarged lymph nodes and/or spleen Fullness in the stomach
DIAGNOSTIC EXAMS

Monitor vital signs monitor blood counts provide mouth care before and after feedings provide small frequent meals advise patient to avoid putting fresh flowers or avoid eating fresh vegetables Patients should be encouraged to preserve mobility and function as well as self-esteem. Soft-bristled toothbrush should be used until neutropil and platelet counts become very low;at that time,sponge-tipped applicators should be substituted.

Complete blood count- show a decrease in both RBC and platelets Bone marrow analysis- shows an excess of immature blast cells Physical examination Spinal tap (lumbar puncture) Chest x-rays

RHABDOMYOSARCOMA
An aggressive soft tissue tumor that can arise virtually anywhere in the body and is composed of striated muscles. The most common sites are the structures of the head and neck, the urogenital tract, and the arms or legs
PATHOPHYSIOLOGY CAUSES MEDICAL MANAGEMENT

unknown children with certain birth defects families have a gene mutation

In general, surgery and radiation therapy are used to treat the primary site of the tumor, while chemotherapy is used to treat disease at all sites in the body. Chemotherapy is an essential part of treatment to prevent further spread of the cancer

SIGNS AND SYMPTOMS

NURSING MANAGEMENT

Symptoms vary depending on location of the tumor

Tumors in the nose or throat may cause bleeding, congestion, swallowing problem Tumors in the vagina may be visibly protruding from the opening of the vagina. Bladder and vaginal tumors may cause urinary or bowel obstruction. Tumors in the muscles may appear as a painful lump and are often thought to be an injury

DIAGNOSTIC EXAMS

Biopsy of the tumor CT scan of the chest to look for spread of the tumor CT scan of the tumor site Bone marrow biopsy (may show the cancer has spread) Bone scan to look for spread of the tumor MRI scan of the tumor site Possible spinal tap, to check for spread into the brain, depending on the site of the tumor