Pediatric cancer - Overview: Nursing pathophysiology

Childhood cancer is a collection of conditions occurring in Children and adolescents that are characterized by abnormal cells that divide and grow uncontrollably.

Now, the cause of childhood cancer is multifactorial, meaning a child's unique genetic factors and environmental factors interact to promote the development of cancer even so, these factors are often not known at the time of diagnosis.

So, in many cases, the exact cause of cancer in Children is unknown. Genetic factors involved in cancer can be mutations that are either inherited or acquired.

These include mutations that typically occur in genes that regulate cell division including proto oncogenes which promote cell division or tumor suppressor genes that inhibit uncontrolled cell division.

For example, mutations to the mycin proto-oncogene can predispose Children to neuroblastoma and glioblastoma. Both cancers of the nervous system.

On the other hand, mutations to the R B1 tumor suppressor gene are associated with retinoblastoma. A type of cancer in the light sensing layer of cells in the back of the eye called the retina.

This mutation can be spontaneous or it can be familial cancer resulting from germline mutation, meaning the mutation occurred in a reproductive cell, either the sperm or egg.

So it becomes part of the DNA of each of the body's cells. Other genetic changes such as chromosomal translocations where pieces of two chromosomes split off and swap places like with the Philadelphia chromosome are also associated with an increased risk of leukemia.

A cancer of blood forming tissues that disrupts the normal function of bone marrow. Leukemia can also occur in Children born with certain congenital conditions like Down syndrome or Trisomy 21 a condition where there's an extra copy of chromosome.

21. Environmental risk factors can include exposure to carcinogens or substances that can promote the development of cancer like tobacco smoke and certain chemicals and medications.

For example, taking anabolic androgenic steroids increases the risk of hepatocellular carcinoma and brain tumors. Also while in utero exposure to agents such as ionizing radiation like from x rays and certain medications like diethylstilbestrol or D ES can increase cancer risk.

And even before conception, parental exposure to carcinogens can increase the risk of cancer in their offspring by initiating epigenetic changes.

Lastly, some viruses can heighten cancer risk. For example, strains of the Epstein Barr virus are associated with Burkitt lymphoma and Hodgkin lymphoma, which are cancers affecting the lymphatic and immune systems.

Ok. So most childhood cancers arise from the mesodermal germ layer of cells formed during embryonic development which eventually grow into tissues, including the musculoskeletal circulatory and urogenital systems.

This can include hematologic or bloodborne cancers like leukemia as well as solid tumors such as rhabdomyosarcoma, a cancer that usually starts in the muscle tissues and osteosarcoma, a tumor that forms in the bones, embryonal tumors which are tumors that develop from cells left over from fetal development can also occur.

Examples include neuroblastoma and retinoblastoma where the root word blast indicates that the cancer comes from an immature cell because these cancers are initiated so early in development.

They present early in childhood and are rare in older Children and adolescents. Childhood cancers are frequently identified during periods of rapid physical growth and are believed to be influenced by the cellular regulatory processes involved in development and maturation.

So as a result, the distribution of cancer types evolves throughout childhood. For example, leukemias peak earlier in childhood, whereas central nervous system tumors peak later in adolescence.

Additionally, childhood cancers tend to be diagnosed later in their progression since they tend to be fast growing and have a short latency period, which is the time between exposure to carcinogens and development of symptoms.

Childhood cancers often have favorable outcomes when treatment plans are in place that involve combining therapies such as chemotherapy radiation and other therapies like biologic or immune therapy.

However, survivors of childhood cancers are more likely to develop another type of cancer later in life. For example, chemotherapy and radiation therapies used to treat a primary cancer can also promote the development of a secondary cancer.

Also genetic factors and the type of primary cancer can increase the risk of a secondary cancer later in life. For example, survivors of familial retinoblastoma could also develop osteosarcoma later in life.

All right. As a quick recap, childhood cancer refers to a group of cancers that occur in Children and adolescents.

The cause of these cancers is multifactorial and involves both genetic and environmental factors. Despite a high rate of favorable outcomes in treating childhood cancers, Children that survive cancer often face a higher risk of secondary cancers later in life.