Wilms’ Tumor (Nephroblastoma)

Description

• Wilms tumor is a type of kidney cancer that occurs in children.
• Is a malignant tumor.
• It accounts for 6% of all childhood cancers.
• It generally grows to a large size before it is diagnosed, usually before the child reaches age 5.
• The tumor expands the renal parenchyma, and the capsule of the kidney becomes stretched over the surface of the tumor.
• Staging if from I (limited to kidney) to IV (matastasis) and stage V, which indicates bilateral involvement (rare).
• The tumor may metastasize to the lymph nodes, lungs, liver, and brain.

Causes & Risk Factors

• Wilms tumor is the most common form of childhood kidney cancer. The exact cause of this tumor in most children is unknown.
• A missing iris of the eye (aniridia) is a birth defect that is sometimes associated with Wilms tumor. Other birth defects linked to this type of kidney cancer include certain urinary tract problems and enlargement of one side of the body, a condition called hemihypertrophy.
• It is more common among some siblings and twins, which suggests a possible genetic cause.
• The disease occurs in about 1 out of 200,000 to 250,000 children. It usually strikes when a child is about 3 years old. It rarely develops after age 8.

Assessment

1. A firm, non-tender mass in the upper quadrant of the abdomen is usually the presenting sign. It may be on either side.
2. Abdominal pain which is related to rapid growth of the tumor.
3. As the tumor enlarges, pressure may cause constipation, vomiting, abdominal distress, anorexia, weight loss and dyspnea.
4. Less common manifestation are hypertension, fever, hematuria, and anemia.
5. Associated anomalies includes aniridia (absence of the iris), hemihypertrophy of the vertebrae, and genitourinary anomalies.

Diagnostic Evaluation

1. Abdominal untrasound detects the tumor and assesses the status of the opposite kidney.
2. Chest X-ray and CT scan may be done to identify matastasis.
3. MRI or CT scan of the abdomen may be done to evaluate local spread to lymph nodes.
4. Urine specimens show hematuria; no increase in vanillylmandelic acid and homovanillic acid levels as occurs with neuroblastoma.
5. Complete blood count, blood chemistries, especially serum electrolytes, uric acid, renal function tests, and liver functions tests, are done for baseline measurement and to detect metastasis.

Primary Nursing Diagnosis

• Knowledge deficit of the disorder and therapy

Medical Management

• If your child is diagnosed with this condition, avoid prodding or pushing on the child’s belly area, and use care during bathing and handling to avoid injury to the tumor site.
• The first step in treatment is to stage the tumor. Staging helps doctors determine how far the cancer has spread and to plan for the best treatment. Surgery to remove the tumor is scheduled as soon as possible. Surrounding tissues and organs may also need to be removed if the tumor has spread.
• Radiation therapy and chemotherapy will often be started after surgery, depending on the stage of the tumor.

Nursing Interventions

• Observe the surgical incision for erythema, drainage or separation. Report any of theses changes.
• Monitor for elevated temperature or sign of infection post-operatively.
• Monitor I.V. fluid therapy and intake and output carefully, including nasogastric (NG) drainage.
• Encourage the parents to ask questions and to understand fully the risk and benefits of surgery.
• Prepare the child for surgery, explain the procedures at the appropriate developmental level.
• Continue supporting the parents during the postoperative period.
• Insert NG tube as ordered. Many children require gastric suction postoperatively to prevent distention or vomiting.
• When bowel sounds have returned, begin administering small amounts of clear fluids.
• Administer pain control medications as ordered in the immediate postoperative period.
• Allow the child to participate in the selection of foods.
• As the child recovers, encourage child to eat progressively larger meals.
• If unable to eat because of radiation and chemotherapy provide I.V. fluids, hyperalimentation, or tube feedings as indicated.
• Prepare child and family for fatigue during recovery from surgery and with radiation treatments. Plan frequently rest periods between daily activities.
• Prepare the child and parents for loss of hair associated with chemotherapy and encourage use of hat as desired. Reassure the hair will grow back.

Sources:
Nursingcrib.com
http://www.nlm.nih.gov/medlineplus