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• 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.
• When cells grow old, they die and new cells take their place. Sometimes, this process does not work right. In cancer, new cells form when the body does not need them, and old cells do not die when they should.
• Leukemia (Greek leukos "white"; aima "blood") is a cancer of the blood or bone marrow characterized by an abnormal increase of blood cells, usually leukocytes (white blood cells).
• 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• Smoking• Hereditary factors such as the twins one egg
Unknown aetiology Somatic mutation in geneDeactivate tumour suppressor gene
Malignant transformation of lymphoblast in the bone marrowUncontrolled proliferation of lymphoblast in bone marrowLymphoblasts replace the normal marrow element Leukemia
• Fever and night sweats.• Headaches• Bruising or bleeding easily.• Bone or joint pain
• A swollen or painful belly from an enlarged spleen• Swollen lymph nodes in the armpit, neck, or groin.• Getting a lot of infections.• Feeling very tired or weak.• Losing weight and not feeling hungry.
• Leukemia can be divided in to 4 types. Leukemia is either chronic (which usually gets worse slowly) or acute (which usually gets worse quickly): In chronic leukemia, the leukemia cells come from mature, abnormal cells. The cells thrive for too long and accumulate.The cells grow slowly.
Acute leukemia,on the other hand,develop from early cells, called"blasts". Blasts are young cells, thatdivide frequently. In acute leukemiacells, they dont stop dividing like theirnormal counterparts do. The remain two types refer to the typeof cells in which the leukemia startedfrom.
• Myelogenous leukemia develops from myeloid cells. The disease can either be chronic or acute, referred as chronic myelogenous leukemia(CML), or acute myelogenous leukemia(ALL).
• Lymphocytic leukemia develops from cells called lymphoblasts or lymphocytes in the blood marrow. The disease can be acute or chronic, referred as chronic lymphocytic leukemia (CLL), or acute lymphocytic leukemia (ALL).
Checks for swollenlymph nodes, spleen, or liver. The complete blood countto check the number of white bloodcells, red blood cells, and platelets.Leukemia causes a very high level ofwhite blood cells. It may also cause lowlevels of platelets and hemoglobin,which is found inside red blood cells.
Chemotherapy isthe major form of treatment forleukemia. This drug treatment useschemicals to kill leukemia cells.Depending on the type of leukemiaclient may receive a single drug or acombination of drugs. These drugsmay come in a pill form, or they maybe injected directly into a vein.
Biological therapy works byhelping immune systemrecognize and attack leukemiacells.
Targeted therapy uses drugs thatattack specific vulnerabilitieswithin cancer cells. For example,the drug imatinib (Gleevec) stopsthe action of a protein within theleukemia cells of people withchronic myelogenous leukemia.This can help control the disease.
• Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. client may receive radiation in one specific area of body where there is a collection of leukemia cells, or client may receive radiation over whole body. Radiation therapy may be used to prepare for a stem cell transplant.
• A stem cell transplant is a procedure to replace diseased bone marrow with healthy bone marrow. Before a stem cell transplant, client receive high doses of chemotherapy or radiation therapy to destroy diseased bone marrow. Then client receive an infusion of blood-forming stem cells that help to rebuild bone marrow.
• Risk for Infection related to neutropenia or leukocytosis secondary to leukemia or treatment• Risk for Haemorrhage related to thrombocytopenia secondary to either leukaemia or treatment• Fatigue related to side effects of treatments, low haemoglobin levels, pain, lack of sleep, or other causes
• Imbalance Nutrition: Less Tan Body Requirements related to diseased condition evidenced by anorexia, pain or fatigue.• Risk for Ineffective Family Therapeutic Regimen Management related to increased fear of death, recurrent hospitalisations etc.
• Lymphoma is a type of cancer that develops in the lymph system, part of the bodys immune system.
• The specific cause of lymphoma is unknown. It is possible that a genetic predisposition and exposure to viral infections may increase the risk for developing Hodgkin lymphoma. There is a slightly increased chance for Hodgkin lymphoma to occur in siblings of patients.
• There has been much investigation into the association of the Epstein- Barr virus (EBV), which causes the infection mononucleosis. This virus has been correlated with a greater incidence of children diagnosed with Hodgkin lymphoma, although the direct link is unknown.
• Exposure to certain pesticides, herbicides, and solvents such as benzene has been associated with lymphoma.
• painless swelling of the lymph nodes in neck, underarm, groin, and/or chest• difficulty breathing (dyspnea) due to enlarged nodes in the chest
• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer
The removal of anentire lymph node or lump of tissue. The removal of partof a lump, lymph node, or sample oftissue. The removal of tissue orpart of a lymph node using a wideneedle.The removal of tissue or part of alymph node using a thin needle.
The four stages of lymphoma are:• Stage I: A single tumor which hasnt 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.
• 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.
• Chemotherapy is the most common treatment for lymphomas. Depending on the type and stage of disease, various combinations of drugs are administered in cycles to reduce or eliminate cancer cells.
• Radiation therapy is sometimes used in conjunction with chemotherapy to treat large areas, or to minimize discomfort caused by cancerous lymph nodes that are affecting nearby organs or structures.
• Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow.
• Tyrosine kinase inhibitors (TKIs) block signals that tumors need to grow. Some TKIs also keep tumors from growing by preventing the growth of new blood vessels to the tumors.
• Bone marrow transplantation and peripheral blood stem cell transplantation are sometimes performed. Radioimmunotherapy, which is treatment with a radioactive substance that is linked to an antibody that will attach to the tumor when injected into the body, is being tested in clinical trials. Surgical removal of the tumor may also be performed.
• Risk for impaired Gas Exchange• Risk for infection related to potential bone marrow depression due to chemotherapy• Fatigue related to side effects of treatments, low haemoglobin levels, pain, lack of sleep, or other causes
• Try to eliminate potential food allergens, including dairy (milk, cheese, butter), wheat (gluten), corn, soy, preservatives, and food additives.• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables.
• Avoid refined foods, such as white breads, pastas, and sugar.• Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy), or beans for protein.• Use healthy oils in cooking, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings and processed foods.• Avoid coffee and other stimulants, alcohol, and tobacco.• Drink 6 - 8 glasses of filtered water daily.
• Retinoblastoma is a malignancy of the retinal cell layer of the eye. The tumor is composed mainly of undifferentiated anaplastic cells -- blasts -- that arise from the nuclear layers of the retina. It is the most common eye tumor in children and it usually occurs before the age of five. It can occur in one eye (unilateral) or in both eyes (bilateral).
• Leukocoria / Cat’s eye reflex: Leukocoria results when the pupil reflects a white color rather than the normal black or red color that is seen on a flash photograph.• A red and irritated eye: The diseased eye of a child with retinoblastoma also may become red and painful. As the tumor grows, new blood vessels may form on the front surface of the iris.
• Strabismus: A deviation of the eyes. It means the eyes are not straight or properly aligned. This results from the failure of the eye muscles to work together• Nystagmus: Causes the eyes to look involuntarily from side to side in a rapid, swinging motion rather than staying fixed on an object or person.• Heterochromia: Refers to a difference in coloration, usually of the iris. Is a result of the relative excess or lack of melanin (a pigment).• Double vision
• Well Baby Screening• Red reflex: checking for a normal reddish- orange reflection from the eyes retina with an ophthalmoscope or retinoscope from approximately 30 cm / 1 foot, usually done in a dimly lit or dark room.• Corneal light reflex/Hirchberg test: checking for symmetrical reflection of beam of light in the same spot on each eye when a light is shined into each cornea, to help determine whether the eyes are crossed.
• Eye examination: checking for any structural abnormalities• Bone marrow examination or lumbar puncture may also be done to determine any metastases to bones or the brain.• Ultrasound (Echography)• Genetic testing
Photocoagulation (Laser Therapy) Laser therapy is performed on an outpatient basis during the EUA. Laser therapy focuses a powerful beam of light through the dilated pupil or through the wall of the eye onto the cancer and the surrounding tissue. This focused and high- powered light destroys cancerous tumors inside of the eye. The small burns produced by the laser destroy the blood supply to the tumor and cause the tumor to shrink.
Cryotherapy (Freezing Treatment)• Cryotherapy, which freezes small tumors, is performed in conjunction with an EUA. A probe (which looks like a pen) is placed on the sclera nearest to the tumor Using a very cold gas; the tumor is frozen and thawed several times. This destroys the tumor cells and leaves a flat, pigmented scar with no signs of tumor. If tumor is evident, the treatment will need to be repeated to successfully destroy all of the tumor cells.
• Transpupillary thermotherapy: Laser energy (through the use of infrared light) heats up cancer cells and surrounding blood vessels, which kills the cells.• Brachytherapy: Radioactive material (little rods or pellets) is placed within the tumor to deliver beams of radiation to specific areas. This form of treatment minimizes the damage to surrounding healthy tissue.
ChemotherapyVincristine (Vincasar, Oncovin PFS) Cycle-specific and phase-specific, which blocks mitosis in metaphase. Binds to microtubular protein, tubulin, GTP dependent. Blocks ability of tubulin to polymerize to form microtubules, which leads to rapid cytotoxic effects and cell destruction.
• Carboplatin (Paraplatin) Inhibits both DNA and RNA synthesis. Binds to protein and other compounds containing SH group. Cytotoxicity can occur at any stage of the cell cycle, but cell is most vulnerable to action of these drugs in G1 and S phase.• Etoposide (Toposar, VePesid) Blocks cells in the late S-G2 phase of the cell cycle
• Immunosuppressants The addition of cyclosporine in combination with chemotherapy regimen of carboplatin, etoposide, and vincristine reportedly have showed enhanced efficacy of chemotherapy.• Cyclosporine (Sandimmune, Neoral) Cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft-vs-host disease for a variety of organs. For children and adults, base dosing on ideal body weight.
Localized Plaque Radiotherapy• In this type of treatment, a small radioactive plaque (disc) is custom made and attached to the eye. Plaque radiotherapy has advantages over external beam radiotherapy in that it delivers radiation in a more localized fashion, thereby minimizing exposure to other eye structures. It should be stressed that only a small percentage of patients with retinoblastoma are candidates for plaque radiotherapy.
Enucleation Enucleation is the surgical removal of the eyeball, leaving eye muscles and the contents of the eye socket intact. This procedure is done when there is no other way to remove the cancer completely from the eye. Unfortunately, loss of vision for the eye removed is permanent because an eye cannot be transplanted.
PREVENTION• Screening• Genetic counseling• Monitoring for recurrence• Monitoring for other cancers
COMPLICATIONS• Cataract formation• Secondary malignancy• Optic nerve atrophy• Temporal bone hypoplasia after external beam radiation
DIET PLAN• Energy (calories) should be adequate to support growth and development and to reach or maintain desirable body weight.• Keep total fat intake between between 25 to 35 percent of calories for children and adolescents 4 to 18 years of age, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids, such as fish, nuts and vegetable oils.
• Choose a variety of foods to get enough carbohydrates, protein and other nutrients.• Eat only enough calories to maintain a healthy weight for height and build. Be physically active for at least 60 minutes a day.• Serve whole-grain/high-fiber breads and cereals rather than refined grain products.• Introduce and regularly serve fish as an entrée. Avoid commercially fried fish.• Serve fat-free and low-fat dairy foods.
• Ineffective peripheral tissue perfusion related to low haemoglobin count secondary to anemia• Risk for Infection related to operative procedure• Acute pain related to release of prostaglandin