WILMS TUMOR

NEPHROBLASTOMA
is a rare kidney cancer that mainly affects children. Also known as
nephroblastoma, it's the most common cancer of the kidneys in
children. It is mostly occurs in just one kidney. But it can sometimes be
in both kidneys at the same time.

Patophysiology
WHEN AN UNBORN BABY IS DEVELOPING, THE KIDNEYS
ARE FORMED FROM PRIMITIVE CELLS

THE CELLS MATURE & ORGANIZE INTO THE NORMAL

KIDNEY STRUCTURE

Etiology SOMETIMES, CLUMPS OF THESE CELLS REMAIN IN

is caused by a gene change THEIR ORIGINAL, PRIMITIVE O FORM
(mutation). The gene change
IF THESE CELLS BEGIN TO MUITIPLY AFTER BIRTH
causes the kidney cells to develop
into a tumor. Doctors don’t know THEY MAY UITIMATELY FORM A LARGE MASS OF
why these gene changes happen. ABNORMAL CELLS
It usually happens in kids who are
THIS IS KNOWN AS A WILMS TUMOR.
otherwise healthy.

Clinical Manifestation
Abdominal mass.
most common is asymptomatic
abdominal mass; occurs in 80% of
children at presentation.
Abdominal pain
Hematuria- occurs in 25%.
Tumor hemorrhage. A few patients with
hemorrhage into their tumor may present
with hypotension, anemia, and fever.
Swelling in the stomach area
A swollen spot or hard lump in the child’s Diagnostic Examination
abdomen (stomach area). The lump or A physical exam that includes pressing
swelling can be painful, but it’s usually not down carefully on your child's abdomen.
High blood pressure (hypertension)- This in Abdominal ultrasound
turn may cause child to have nosebleeds, X-ray or CT scan to find out if cancer has
spread (metastasized) to their lungs.
headaches and blood in their eye.
Imaging tests can show if your child has a
tumor. Your provider can also use the tests
to tell the difference between Wilms tumor
and other types of kidney cancer.
Urinalysis
Blood/urine test, including liver function
and blood clotting tests.
Intravenous Pyelography- administration of
IV contrast and X-ray imaging to evaluate
kidney and urinary tract.

Risk Factors
·Children under the age of 15 years old
·More common in Africa
·Being Black
·Aniridia
·Genitourinary Anomalies
·Mentally Retarded
·WAGR Syndrome
·Genetic Changes
·Beckwith-Wiedemann Syndrome
·Denys-Drash Syndrome
·Family History
Medication
Vincristine: Administered intravenously, it has a short
half-life (about 24 hours), primarily metabolized by the
liver, and eliminated mainly through feces.
Actinomycin-D: Also given intravenously, it has a
relatively long half-life (approximately 20-40 hours) and
undergoes hepatic metabolism and renal excretion.
Doxorubicin: Administered intravenously, it has a
variable half-life (about 1-3 days), undergoes extensive
hepatic metabolism, and is excreted mainly through bile
and feces.

Medical-Surgical Management
Chemotherapy - uses strong medicines to
kill cancer cells throughout the body.
Radiation therapy- uses high-powered
energy beams to kill cancer cells. The energy
can come from X-rays, protons and other Complication
sources. ·The tumor may become quite large, but usually remains self-
Types of surgery: enclosed. Spread of the tumor to the lungs, lymph nodes, liver,
Radical nephrectomy- removal of the whole bone, or brain is the most worrisome complication.
kidney and some surrounding tissue, as well ·Removal of WT from both kidneys may affect kidney function.
Others:
as nearby lymph nodes.
kidney failure
Partial nephrectomy- removal of the tumor heart problem
and some of the surrounding healthy tissue, bowel obstruction
leaving as much of the kidney as possible. lung problem
second cancer

Nursing Diagnosis and Intervention

Anxiety of parents related to learning of diagnosis
Anxiety of child related to surgery and diagnostic tests

Be available to the parents when they want to discuss their feelings.

Offer kindness, concern, consideration, and sincerity toward the child and
parents; be a source of consolation.