Wilm's tumor, also known as nephroblastoma, is a highly malignant cancer that affects the kidneys in young children between ages 3-5 years. It is caused by abnormal development of kidney tissue and absence of tumor suppressor genes. While usually unilateral, it can be bilateral in 5% of cases. Staging determines treatment, which involves surgery to remove the tumor along with chemotherapy and sometimes radiation therapy. Nurses play an important role in pre- and post-operative care to monitor the child's condition and educate parents on follow-up treatment.
2. Definition
Wilm’s Tumor is also known as Nephroblastoma. It is
a highly malignant embryonal neoplasm.
It may involve one or both kidney.
3. INCIDENCE AND ETIOLOGY
Usually the tumor is unilateral, but in 5% cases it
may be bilateral.
The tumor involves left kidney more than right
kidney.
It affects children between 3-5 year of age.
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The disease occur in about 1 out of 2-2.5 lakh
children.
The exact cause of tumoris unknown, but it has
been identified that tumor suppressor gene acts to
promote normal kidney development. This gene
may be absent or missing in wilm’s tumor.
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6. PATHOPHYSIOLOGY
Mostly wilm’s tumor is unilateral but it can be bilateral in
5% of cases
Nephroblastoma are generally large and rapidly growing.
Tumor generally start growing in renal parenchyma or at the
tip of kidney.
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suppressionof normal tissue remaining
Majority of tumors present a as single encapsulated mass, that
separates the normal kidney and tumor.
Although the tumor is encapsulated but the membrane may be very
thin and get easily torn
Rupture of tumor put patient at the risk of hemmorhage and
dissemination of tumor
9. STAGESOFWILM’S TUMOR
STAGE I (43% CASES ) - Tumor limited to kidney and
completely resectable.
STAGE II (23% CASES) - Tumor extend beyond kidney ,into
nearby fatty tissue, but it is resectable.
STAGEIII (23% CASES)– Non hematogenous spread in
abdomen, like spread to lymph nodes in abdomen or pelvis,
but this stage tumor is not completely resectable.
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STAGEIV (10% CASES) - Hematogenous metastatis
to lungs and liver.
STAGE V (5% CASES)-Bilateral renal involvement.
12. DIAGNOSTIC EVALUATION
History- The child may have positive family history.
Physical examination reveals presence of abdominal mass.
Urinanalysis reveals presence of blood in urine.
Abdominal x-ray
14. MANAGEMENT
The management of children with wilm’s tumor include
:-
Radiation therapy
Chemothrapy
Surgical management
15. Radiation Therapy
Wilm’s tumor may be bilateral or large in size ,
may be inoperable, for such cases radiation
therapy may be used to reduce the size of
tumor, so that surgery can be performed.
16. CHEMOTHERAPY
The objective of chemotherapy is to treat any
metastatic lesions that may exist and destroy
any cells in blood stream, before they get
implanted.
The drugs used for chemotherapy are
Actinomycin D, Doxorubicin and Vincristine.
17. SURGICAL MANAGEMENT
Partial or complete nephrectomy is done for
unilateral and for bilateral partial nephrectomy is
done.
After surgical management, chemotherapy and
radiation therapy is given if indicated.
18. TREATMENT
Treatment for wilm’s tumor is based mainly on the
stages of the cancer:-
STAGEI- These tumor are still only in the kidney.
Standard treatment starts with surgery to remove the
part of kidney containing tumor. These children needs
to be watched closely because the chances of
recurrence are higher.The chemotherapy is given for
18 weeks.
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STAGEIII- Treatment is usually surgery followed by
radiation therapy to the abdomen over several days .
This is followed by chemotherapy for about 6
months.
STAGEIV- These tumors are already spread to distant
parts of the body at the time of diagnosis, so
standard treatment id surgery followed by radiation
and chemotherapy.
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STAGEV- In this stage usually tumor is bilaterally
present, standard treatment involves surgery,
radiation and chemotherapy repeatedly until normal
kidney tissue left behind. In case if not enough
kidney tissue is left after surgery that child may need
to place on dialysis. If there is no evidence of any
cancer after year or two, a donor kidney transplant
may be done.
21. NURSING MANAGEMENT
PREOPERATIVE CARE
Prepare the parents and child for surgery.
Expalin parents not topalpate the abdomen of the
child.
Explain child about post operative care , if he or sheis
old enough.
Caution should be taken while turning and handling
the child.
22. POSTOPERATIVECARE
Monitor vitals signs.
Monitor renal functioning by monitoring
weight, intake output and KFTvalues.
Obsesrve for the signs of functioning.
Use aseptic techniques while doingdressing
Explain parents about follow up and
continuing treatment at the time of discharge.
