Chapter 25: Childhood Cancer: Treatment & Nursing Care

Childhood Cancer: Treatment & Nursing Care begins by identifying cancer as the leading cause of death from disease in children past infancy, with leukemia, central nervous system tumors, and lymphomas being the most common diagnoses. The text explores the etiology of childhood malignancies, noting that unlike adult cancers, lifestyle factors play a minimal role, while genetic predisposition, congenital anomalies, and chromosome abnormalities like Down syndrome are significant risk factors. A thorough diagnostic evaluation is described, involving complete blood counts, lumbar punctures, bone marrow aspirations, and advanced imaging techniques such as MRI and PET scans to determine disease extent and staging. The chapter outlines therapeutic modalities including surgery for tumor resection, radiation therapy (including proton beam therapy), and chemotherapy, which requires strict safety precautions due to the vesicant nature of many antineoplastic agents. Biologic therapies, such as immunotherapy and targeted therapies, and hematopoietic stem cell transplantation (HSCT)—both allogeneic and autologous—are presented as critical interventions for high-risk or relapsed disease. Significant attention is given to the nursing management of treatment side effects, particularly myelosuppression (anemia, thrombocytopenia, neutropenia), which places patients at high risk for life-threatening infections and hemorrhage. The text details the management of gastrointestinal toxicities like severe nausea, vomiting, and mucosal ulceration, as well as neurologic, hemorrhagic, and dermatologic complications such as alopecia. Oncologic emergencies are highlighted, specifically tumor lysis syndrome, hyperleukocytosis, superior vena cava syndrome, and spinal cord compression, requiring immediate intervention to prevent organ failure or death. The chapter systematically categorizes specific malignancies, starting with leukemias (Acute Lymphoblastic Leukemia and Acute Myeloid Leukemia), describing the proliferation of immature white blood cells and the multiphase chemotherapy regimens consisting of induction, consolidation, and maintenance. It differentiates between Hodgkin lymphoma, characterized by Reed-Sternberg cells and lymph node enlargement, and Non-Hodgkin lymphoma, which includes subtypes like Burkitt lymphoma. Nervous system tumors are classified by location (infratentorial vs. supratentorial), with nursing care focusing on intracranial pressure monitoring and postoperative positioning. Neuroblastoma is described as a "silent" embryonic tumor often arising in the adrenal gland with an abdominal mass that crosses the midline. Bone tumors are contrasted, distinguishing Osteosarcoma (often requiring limb salvage or amputation) from Ewing Sarcoma (sensitive to radiation). The chapter also covers Wilms tumor (nephroblastoma), emphasizing the contraindication of abdominal palpation to prevent tumor rupture, Rhabdomyosarcoma of the soft tissues, and Retinoblastoma, which presents with the classic leukocoria or "cat's eye reflex". Finally, the text addresses the critical importance of survivorship care to monitor for late effects of treatment, including secondary malignancies and organ dysfunction.