Cancer is defined as abnormal cells that divide uncontrollably and can invade other tissues or spread to other parts of the body. The development of cancer is thought to be a multistage process involving genetic changes that alter normal cell growth mechanisms. Primary risk factors for cancer include exposure to carcinogens like radiation, chemicals, and certain viruses or bacteria. Common childhood cancers include leukemia, which affects blood cells; lymphoma like Hodgkin's disease affecting lymph nodes; and tumors of the kidney (Wilms'), brain, bone (osteosarcoma), and neuroblastoma originating in nerve tissue. Treatment involves chemotherapy, radiation therapy, and surgery depending on the cancer type and stage.

1. Oncological problems
Harold Leonardo Suarez Rojas
RN-MSN

2. Definitions

3. Cancer is a term used for diseases in which
abnormal cells divide and escape the body control.
These cells are able to:
1-Invade surrounding tissues
2-Send distant metastases.
3- Lost their functions
Defining Cancer

4. Defining
Cancer
􀂄 Primary Tumors
Represent de novo tumors in their
initial site
􀂄 Metastatic Tumors
Originate from the distant growth of
the primary tumors

5. Etiology of
Cancer
A cancer, is thought to develop from a cell
in which the normal mechanisms for control
of growth and proliferation are altered.
Current evidence supports the concept of
carcinogenesis as a multistage process that
is genetically regulated

6. The first step in this process is initiation, which requires
exposure of normal cells to carcinogenic substances.
Substances that may act as carcinogens or initiators
include chemical, physical, and biologic agents
Two major classes of genes are involved in
carcinogenesis: oncogenes and tumor suppressor genes

7. Pathology of cancer
Tumors may arise from any of four basic
tissue types
• Epithelial tissue
• Connective tissue (Muscle, bone, and cartilage)
• Lymphoid tissue
• Nerve tissue

8. Carcinomas are
malignant growths
arising from
epithelial cells.
Sarcomas are
malignant growths
of muscle or
connective tissue.
Adenocarcinoma
is a malignant
tumor arising from
glandular tissue.
Malignant cells are divided into those
of epithelial origin or the other tissue
types.

9. Tumor characteristics
Invade and destroy the
surrounding tissue.
The cells are
genetically unstable
Loss of normal cell
architecture results in
cells that are atypical
of their origin.
Lose the ability to
perform their usual
functions.
Metastasize, and
consequently,
recurrences are
common after removal
or destruction of the
primary tumor.

12. Leukemia
• Leukemia is the most common
type of cancer in children. All
cancers begin in cells of the
body, and leukemia is a cancer
that begins in blood cells.
Normally, cells grow and divide
to form new cells as the body
needs them.

13. Leukemia
Leukemia is a malignant increase in the
number of leukocytes, usually at an
immature stage, in the bone marrow.
In leukemia, proliferating immature
white blood cells (WBCs) depress the
bone marrow, causing anemia from
decreased erythrocytes, infection from
neutropenia, and bleeding from
decreased platelet production
(thrombocytopenia).
The cause is unknown; it seems to
involve genetic damage of cells, leading
to the transformation of cells from a
normal state to a malignant state.

14. Exposure to large
amounts of
radiation
Exposure to
certain chemicals
at work, such as
benzene.
Some types of
chemotherapy to
treat another
cancer
Have Down
syndrome or
some other
genetic problems
Hereditary
factors such as
the twins one
egg
Causes

15. Unknown aetiology
Somatic mutation in gene
Deactivate tumour suppressor gene

16. Malignant transformation of lymphoblast in
the bone marrow
Uncontrolled proliferation of lymphoblast in
bone marrow
Lymphoblasts replace the normal marrow
element
Leukemia

17. Assessment
1. Infiltration of the bone marrow by malignant cells causes fever, pallor,
fatigue, anorexia, hemorrhage (usually petechiae), and bone and joint pain;
pathological fractures can occur as a result of bone marrow invasion with
leukemic cells.
2. Signs of infection occur as a result of neutropenia.
3. The child experiences hepatosplenomegaly and lymphadenopathy.
4. The child has a normal, elevated, or low WBC count, depending on the
presence of infection or of immature versus mature WBCs.
5. The child has decreased hemoglobin and hematocrit levels.

18. To prevent
Protecting the Child
from Infection
Protecting the
Child from
Bleeding
Manifestations of
Increased
Intracranial
Pressure in
Infants and
Children

19. Chemotherapy Monitor for severe bone
marrow suppression;
during the period of
greatest bone marrow
suppression (the nadir),
blood cell counts are
extremely low.
Monitor for infection
and bleeding.
Protect the child from
life-threatening
infections.
Monitor for nausea,
vomiting, and alteration
in bowel function.
Administer stool
softeners as prescribed
and if needed to prevent
straining if constipation
occurs.

20. Hodgkin’s Disease
Hodgkin’s disease (a type
of lymphoma) is a
malignancy of the lymph
nodes that originates in a
single lymph node or a
single chain of nodes.
The disease predictably
metastasizes to non-nodal
or extralymphatic sites,
especially the spleen, liver,
bone marrow, lungs, and
mediastinum.
Hodgkin’s disease is
characterized by the
presence of Reed-
Sternberg cells noted in a
lymph node biopsy
specimen.
Peak incidence is in mid-
adolescence.

22. Assesment
Painless
enlargement of
lymph nodes
Enlarged, firm,
nontender, movable
nodes in the
supraclavicular area;
in children, the
“sentinel” node
located near the left
clavicle may be the
first enlarged node.
Nonproductive
cough as a result of
mediastinal
lymphadenopathy
Abdominal pain as a
result of enlarged
retroperitoneal
nodes
Advanced lymph
node and
extralymphatic
involvement that
may cause systemic
symptoms, such as a
low-grade or
intermittent fever,
anorexia, nausea,
weight loss, night
sweats, and pruritus

23. The four stages of lymphoma are:
Stage I: A single tumor which hasn't
spread.
Stage II: More than one tumor, but the
tumors are all found in lymph nodes
on the same side of the diaphragm
(all above or all below). Stage II can
also mean that a tumor has spread to
another organ, but that it is close to
the original lymph node tumor.

24. Stage III: More than one tumor
with the tumors found on different
sides (above and below) of the
diaphragm. There may be tumors
in the spleen or more than one
tumor in nearby organs.
Stage IV: Many tumors spread
throughout an organ such as the
liver or stomach, as well as in the
lymph nodes.

25. Interventions
For early stages without mediastinal node involvement, the
treatment of choice is extensive external radiation of the
involved lymph node regions.
With more extensive disease, radiation and multidrug
chemotherapy are used.
Monitor for medication-induced pancytopenia and an
abnormal depression of all cellular components of the blood,
which increases the risk for infection, bleeding, and anemia.
Monitor for signs of infection and bleeding.
Protect the child from infection.

26. Nephroblastoma
(Wilms’ Tumor)
Wilms’ tumor is the most common intraabdominal and
kidney tumor of childhood; it may manifest unilaterally and
localized or bilaterally, sometimes with metastasis to other
organs.
The peak incidence is 3 years of age.
Occurrence is associated with a genetic inheritance and with
several congenital anomalies.
Therapeutic management includes a combined treatment of
surgery (partial to total nephrectomy) and chemotherapy
with or without radiation, depending on the clinical stage
and the histological pattern of the tumor.

27. Neuroblastoma
Neuroblastoma is a tumor that originates from the
embryonic neural crest cells that normally give rise
to the adrenal medulla and the sympathetic ganglia.
Most tumors develop in the adrenal gland or the
retroperitoneal sympathetic chain; other sites may
be within the head, neck, chest, or pelvis.
Most children present with neuroblastoma before
10 years of age.
Most presenting signs are caused by the tumor
compressing adjacent normal tissue and organs.

28. Osteosarcoma
(Osteogenic
Sarcoma)
The most common bone cancer in children; it is also known as
osteogenic sarcoma.
Cancer usually is found in the metaphysis of long bones, especially in
the lower extremities, with most tumors occurring in the femur. 3.
The peak age of incidence is between 10 and 25 years.
Symptoms in the earliest stage are almost always attributed to
extremity injury or normal growing pains.
Treatment may include surgical resection (limb salvage procedure) to
save a limb or remove affected tissue, or amputation.
Chemotherapy is used to treat the cancer and may be used before
and after surgery.

29. Brain
Tumors