Pediatric Nursing Demystified

the lungs, occurs early because bones are highly vascular. Other sites of metas-

tasis are the brain and other bone tissue.

Ewing sarcomais a malignant tumor in the bone marrow of the midshaft

of the long and trunk bone, most commonly the femur, pelvic bone, tibia,

fibula, scapula, ribs and skull. It occurs most commonly between the ages of

4 and 25 years. Metastasis to the lungs and bones is often present at time of

diagnosis, with eventual spread to the CNS and lymph nodes.

Signs and Symptoms

Common assessment findings:

• History of trauma to leg (client related pain to trauma and delayed
  trip to doctor)


• Taller than average height due to rapid bone growth


• Pain, warmth, and swelling at the tumor site


• Pathologic fracture of the bone as tumor invades and weakens bone

Test Results

• Diagnosis by biopsy of suspicious area


• Elevated serum alkaline phosphatase due to rapidly growing bone
  cells


• Blood count, urinalysis


• Radiograph (will reveal an unusual “onion skin” reaction—fine lines
  on the film)


• Chest CT scan and bone scans to detect metastasis to lung


• Intravenous pyelogram or kidney MRI to detect metastasis to kidney.


• Bone marrow aspiration for Ewing sarcoma

Treatments

Surgical removal of involved bone part replaced with an internally

placed bone or metal prosthesis.

Amputation of bone above the joint (commonly total hip amputation);

not routine for Ewing sarcoma unless tumor is respectable or radiother-

apy results in useless or deformed leg

Thoracotomy for removal of cancer in the lungs

Osteogenic sarcoma:

• Chemotherapy to shrink tumor before surgery:
  Methotrexate
  Cisplatin
  Doxorubicin
  Ifosfamide


• 60% or more adolescents cured with vigorous treatment
  Ewing sarcoma:


• Radiotherapy to destroy tumor


• Chemotherapy to assist in tumor destruction:

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CHAPTER 8/ Oncology Conditions^161