Chapter 48: The Child With Cancer

Pediatric cancer, though uncommon, represents a significant cause of childhood mortality, and differs markedly from adult malignancies in presentation and biology. Children typically present with nonspecific symptoms that may resemble benign illnesses, requiring nurses to maintain heightened clinical awareness for early detection. Diagnostic evaluation employs multiple modalities including bone marrow aspiration, cerebrospinal fluid analysis via lumbar puncture, and sophisticated imaging techniques such as positron emission tomography and single-photon emission computed tomography scanning to establish staging and guide therapeutic planning. Treatment typically involves multimodal therapy combining intensive chemotherapy regimens, surgical intervention for tumor removal or cytoreduction, and targeted radiation therapy. The chapter addresses critical nursing management of treatment-related complications, including severe bone marrow suppression manifesting as anemia, neutropenia, and thrombocytopenia, along with prevention and management of tumor lysis syndrome and monitoring for delayed effects on growth and developmental outcomes. Specific malignancies receive detailed attention, including acute lymphocytic leukemia characterized by proliferation of immature lymphoid cells that impairs normal hematopoiesis, central nervous system tumors representing the most prevalent solid malignancies in the pediatric population, Wilms tumor with its essential nursing consideration to avoid abdominal palpation, neuroblastoma, and skeletal malignancies including osteosarcoma and Ewing sarcoma. Nursing care emphasizes family-centered approaches incorporating psychosocial support, management of treatment toxicities such as oral mucositis and chemotherapy-induced nausea and vomiting, and support for successful reintegration into school and normal activities. The chapter also explores hematopoietic stem cell transplantation as a treatment modality and discusses biologic response modifiers and targeted molecular therapies that represent advances toward precision oncology aimed at improving survival while reducing long-term treatment sequelae.