Chapter 53: Pediatric Malignancies & Nursing Care

Despite being less frequent than accidents or infections, cancer is the leading medical cause of death for individuals under 25 years old. Malignant tissue is defined by chaotic, uncontrolled cell growth, contrasting sharply with the balanced proliferation of healthy cells. The origins of these abnormal growths are typically complex, involving genetic triggers, predisposing conditions, and potential links to oncogenic viruses like EBV, rather than common environmental exposures often implicated in adult cancers. Nursing assessment is crucial because early cancer symptoms—such as fever, persistent pain, or headache—can be subtle and easily confused with benign childhood illnesses; notably, unintentional weight loss is never considered normal in a healthy child and warrants investigation. Diagnosis is confirmed through procedures like biopsy and sophisticated imaging (MRI, CT, PET), followed by tumor staging, such as the TNM system, to guide treatment and determine prognosis. Treatment protocols often combine surgery, chemotherapy, radiation, stem cell transplantation, and modern immunotherapy. Radiation therapy, delivered externally (teletherapy) or internally (brachytherapy), destroys cells by damaging DNA, but requires monitoring for immediate side effects like radiation sickness, and long-term concerns such as cognitive impairment, asymmetric bone growth, or endocrine deficiencies. Chemotherapy is administered in precise protocols, requiring safe handling practices by healthcare professionals and parents. Nurses manage critical toxicities, including severe immunosuppression that elevates infection risk, and gastrointestinal side effects like mucositis, nausea, and vomiting, often necessitating aggressive prophylactic antiemetic administration. Immunotherapies, such as chimeric antigen receptor T cells (CAR-T), leverage the immune system to destroy cancer but demand vigilance for immune-mediated complications like Cytokine Release Syndrome (CRS). Key pediatric malignancies discussed include Leukemia, the most common childhood cancer, treated across induction, consolidation, and maintenance phases, with intrathecal chemotherapy vital for central nervous system (CNS) prophylaxis; Brain Tumors, which frequently manifest as symptoms of increased intracranial pressure, such as morning headaches and vomiting unrelated to nausea; and Nephroblastoma (Wilms tumor), an abdominal mass requiring prompt surgical management. Nursing care continually focuses on upholding the patient’s quality of life and supporting the entire family unit, including managing grief, addressing altered body image perception (e.g., hair loss), promoting developmental normalcy, and providing extensive education for seamless care transitions across healthcare settings.