1 of 28

Course: Pediatric Nursing

Topic: Nursing Care of Child with

Neoplastic Disorders (Part III)

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 28

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 28

Module Goals

Learners will be able to:

Identify causes and risk factors of neuroblastoma and retinoblastoma in children including signs and symptoms.
Identify risk factors for development of neuroblastoma and retinoblastoma in children.
Describe common laboratory and diagnostic procedure.
Explain common medical treatments/therapies.
Explain the role of the nurse in management of child above conditions.

Contact info: info@nursesinternational.org

4 of 28

Neuroblastoma

Malignant (cancer) cells form in neuroblasts (immature nerve tissue) in the adrenal glands, neck, chest, or spinal cord.
The most common extracranial solid tumor in childhood (8%-10% of all childhood tumors).
Prevalence is 1/ 7,000 live births.
Incidence 10.54/1 million per year in children younger than 15 years.
Caused by a gene mutation passed from the parent to the child.

National Cancer Institute, 2021

Colon, & Chung, 2011

Contact info: info@nursesinternational.org

5 of 28

Sign and Symptoms

Lump in the abdomen, neck, or chest
Bone pain
Swollen stomach and trouble breathing (in infants)
Bulging eyes
Dark circles around the eyes ("black eyes")
Painless, bluish lumps under the skin (in infants)
Weakness or paralysis.

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

6 of 28

Sign and Symptoms (Continued)

Less common:

Fever
Shortness of breath
Fatigue
Easy bruising, bleeding, or petechiae
Elevated blood pressure
Severe watery diarrhea
Horner syndrome (droopy eyelid, smaller pupil, less sweating on one side of the face)
Jerky muscle movements
Uncontrolled eye movements

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

7 of 28

Critical Thinking Question

Describe the symptoms that a child with neuroblastoma might exhibit.

Contact info: info@nursesinternational.org

8 of 28

Neuroblastoma-Diagnosis

Health history and Physical Exam
Neurological Exam
Urine Catecholamine exam:

Increased level vanillylmandelic acid (VMA) and homovanillic acid (HVA)

Blood chemistry
MIBG scan: Used to find neuroendocrine tumors
CT scan, MRI, PET scan
X-ray
Biopsy

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

9 of 28

What Would the Nurse Do?

A student nurse asks a senior nurse what factor in Urine Catecholamine exam determines neuroblastoma?

What would be the nurse’s response to the student?

Contact info: info@nursesinternational.org

10 of 28

Neuroblastoma-Staging

Stage 1

The cancer is in one area and completely removed by surgery.

Stage 2

Stage 2A: The cancer is in one area and not completely removed by surgery.
Stage 2B: The cancer is in one area and may or may not be completely removed by surgery.

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

11 of 28

Neuroblastoma-Staging (Continued)

Stage 3

The cancer cannot be completely removed during surgery and spread from one side of the body to the other, may also have spread to nearby lymph nodes.

Stage 4:

Stage 4: The cancer spread to distant lymph nodes or to other parts of the body.
Stage 4S: The child is younger than 12 months, and cancer spread to the skin, liver, and/or bone marrow.

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

12 of 28

Neuroblastoma-Standard Treatment

Surgery
Radiation therapy
Iodine 131-MIBG therapy
Chemotherapy
High-dose chemotherapy and radiation therapy with stem cell rescue
Targeted therapy

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

13 of 28

Retinoblastoma

(National Eye Institute, 2022)

A rare eye cancer that forms in the retina (the light-sensitive tissue at the back of the eye).
Most common in children younger than age 5.
Affects one or both eyes.
May cause blindness and may be life-threatening.

Contact info: info@nursesinternational.org

14 of 28

Retinoblastoma

National Eye Institute, 2022

White pupil when shining a light into the eye. (most common sign)
Crossed eyes or one eye that drifts in a different direction.
Eye pain, swelling, or redness.
Watery or teary eyes.
Poor vision.

Contact info: info@nursesinternational.org

15 of 28

Retinoblastoma-Causes

A change to the gene (mutation) may occur at an early stage of uterine development.
During the early stages of a fetal development, retinal eye cells grow very quickly and then stops growing.

One or or more cells continue to grow and form a cancer called retinoblastoma.

4 /10 (40%) cases,caused by a faulty gene.

National Eye Institute, 2022

Contact info: info@nursesinternational.org

16 of 28

Retinoblastoma- Diagnosis

Red reflex test: in a darkened room using an ophthalmoscope

If the reflection is white, it may be a sign of retinoblastoma

Ultrasound scan:

diagnostic of retinoblastoma

Eye exam with dilated pupil:

Retina and the optic nerve examined with a light
Ophthalmoscopy
Fluorescein angiography
Electroretinography

RB1 gene test

National Eye Institute, 2022

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

17 of 28

Retinoblastoma-Diagnosis (Continued)

After diagnosis, tests are done to determine if cancer cells have spread within the eye or to other parts of the body:

MRI (magnetic resonance imaging)
Bone scan
Bone marrow aspiration and biopsy
Lumbar puncture

National Eye Institute, 2022

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

18 of 28

Retinoblastoma-Staging

The International Retinoblastoma Staging System (IRSS)

Stage 0:

The tumor is in the eye only
The eye has not been removed- tumor was treated without surgery

Stage I:

The tumor is in the eye only
The eye has been removed and no cancer cells remain

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

19 of 28

Staging (Continued)

Stage II:

The tumor is in the eye only
The eye has been removed and remaining cancer cells can be seen with a microscope.

Stage III:

Stage IIIa: spread to tissues around the eye socket
Stage IIIb: spread to lymph nodes near the ear or in the neck

Stage IV:

Stage IVa: spread to one or more parts of the body (bone or liver)
Stage IVb: spread to the brain or spinal cord (may to other parts of the body)

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

20 of 28

Retinoblastoma-Treatment

Depends on the size of the tumor and stage
Treatment options include:

Cryotherapy (freeze treatment)
Laser therapy
Thermotherapy
Chemotherapy
Radiation therapy
High-dose chemotherapy with stem cell rescue
Surgery (enucleation)

National Cancer Institute, 2021

National Eye Institute, 2022

Contact info: info@nursesinternational.org

21 of 28

Nursing Management

Education of the child and family
Psychosocial support for the child and family
Preparation of the child for procedures
Management of pain
Prevention and management of infection
Management of fever and neutropenia
Management of nausea and vomiting
Management of central venous access devices (CVADs)
Health promotion (dental care, immunization)
Monitoring of long-term effects of treatment

National Cancer Institute, 2021

Contact info: info@nursesinternational.org

22 of 28

Case Study

Reflection/discussion:

Parents a ten year old child diagnosed with Retinoblastoma want to know what treatment options are available to their child.

How would the nurse respond?

Contact info: info@nursesinternational.org

23 of 28

Red Flags

Lump in the abdomen, neck, or chest, Bone pain, Swollen stomach and trouble breathing (in infants), Bulging eyes, Dark circles around the eyes ("black eyes"), Painless, bluish lumps under the skin (in infants), Weakness or paralysis.

Contact info: info@nursesinternational.org

24 of 28

Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

Contact info: info@nursesinternational.org

25 of 28

Cultural Considerations (Continued):

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family.
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

26 of 28

References:

National Eye Institute. (2022 February 2). Retinoblastoma. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/retinoblastoma

NHS. (2022 January 24). Retinoblastoma (eye cancer in children). https://www.nhs.uk/conditions/retinoblastoma/

National Cancer Institute. (2021). Retinoblastoma Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/retinoblastoma/patient/retinoblastoma-treatment-pdq#:~:text=Retinoblastoma%20is%20a%20disease%20in,in%20heritable%20and%20nonheritable%20forms

Contact info: info@nursesinternational.org

27 of 28

References:

National Cancer Institute. (2021 June 10). Neuroblastoma Treatment (PDQ®)–Patient Version. https://www.cancer.gov/types/neuroblastoma/patient/neuroblastoma-treatment-pdq

Australian Government Cancer Australia. (2022). Supportive care needs of the child with ALL. https://www.edcan.org.au/edcan-learning-resources/case-based-learning-resources/acute-lymphoblastic-leukaemia/active-treatment/supportive-care-needs

Colon, N. C., & Chung, D. H. (2011). Neuroblastoma. Advances in pediatrics, 58(1), 297–311. https://doi.org/10.1016/j.yapd.2011.03.011

Contact info: info@nursesinternational.org

28 of 28

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org