Chapter 32: Pediatric Oncological Problems

Leukemia, the most prevalent childhood cancer, arises from malignant proliferation of immature white blood cells that suppress bone marrow function, resulting in anemia, neutropenia, and thrombocytopenia; treatment involves multiphase chemotherapy including induction, intensification, central nervous system prophylaxis, and maintenance therapy, requiring nurses to implement strict infection control protocols and bleeding precautions while avoiding live virus vaccines in immunocompromised patients. Hodgkin lymphoma, characterized by the presence of Reed-Sternberg cells on biopsy, typically presents as painless lymph node enlargement and systemic symptoms like fever and night sweats, managed through radiation and multidrug chemotherapy regimens. Nephroblastoma (Wilms tumor), the most common intra-abdominal tumor in young children, manifests as a unilateral flank mass and necessitates a critical nursing precaution: abdominal palpation must be strictly avoided to prevent tumor rupture and metastasis. Neuroblastoma, arising from neural crest cells in the adrenal gland or sympathetic chain, typically presents as an irregular abdominal mass crossing the midline with poor prognosis due to late diagnosis; supraorbital ecchymosis or raccoon eyes appearance may indicate metastatic disease. Osteosarcoma, the most common bone malignancy occurring in adolescents at the metaphysis of long bones particularly the femur, is frequently misattributed to growing pains and requires limb salvage surgery or amputation combined with chemotherapy, with nursing care addressing phantom limb pain and body image concerns. Brain tumors, classified as infratentorial or supratentorial, present with increased intracranial pressure symptoms including morning headaches, projectile vomiting, ataxia, and behavioral changes; postoperative craniotomy care requires vigilant monitoring for intracranial pressure elevation, cerebrospinal fluid leaks, and strict positioning protocols specific to tumor location. Across all pediatric oncological conditions, comprehensive nursing care addresses chemotherapy side effects including bone marrow suppression nadir, chemotherapy-induced nausea and vomiting, oral mucositis, alopecia, and nutritional deficiencies through antiemetic therapy, small frequent meals, and psychosocial support for children and families coping with cancer diagnosis and treatment.