Wilms’ tumor, or nephroblastoma, is the most common malignant renal and intraabdominal tumor of childhood.

1. Wilms’ Tumor
by
Ahmad Shalash Muhsin
Master in Pediatric Nursing

3. Table of Contents
1. Definition
2. Causes
3. Clinical Manifestations
4. Laboratory and Diagnostic Tests
5. Medical Management
6. Nursing Interventions
Preoperative Phase
Postoperative Care Phase
Radiation and Chemotherapy Phase
7. Complications

4. Definition
Wilms’ tumor, or nephroblastoma, is the most common
malignant renal and intraabdominal tumor of childhood.

6. Causes
• 1. Associated with several other congenital anomalies,
including cryptorchidism and hypospadias
• 2. Genetic inheritance

7. Clinical Manifestations
1. Flank mass
2. Pain
3. Hematuria
4. Hypertension
5. Fever
6. Malaise
7. Weight loss and anorexia
8. Shortness of breath
9. Constipation or diarrhea
10. Anemia

9. Laboratory and Diagnostic Tests
1. Computed tomography (CT)
2. Ultrasonography
3. Magnetic resonance imaging (MRI)
4. Liver function tests
5. Complete blood count (CBC)
6. Urinary catecholamine levels
7. Blood urea nitrogen, creatinine, and electrolyte levels to
assess renal function
8. Additional testing of liver, bone, and brain only if additional
symptoms indicate involvement

13. Medical Management
The usual treatment for unilateral Wilms’ tumor is
surgical resection of the affected kidney
(nephrectomy) followed by chemotherapy and, at
times, radiation.
The treatment used depends upon the extent of
disease and histology of the mass.

14. Nursing Interventions
•
Preoperative Phase
•
1. Avoid palpation of abdomen to prevent seeding of tumor.
•
2. Monitor child’s clinical status; observe for signs and
symptoms of complications:
•
a. Vital signs
•
b. Signs and symptoms of renal failure.
•
c. Bone pain
•
d. Anemia
•
e. Hypertension
•
3. Provide age-appropriate pre-procedural and pre-surgical
•
explanations to child to alleviate anxiety.
•
4. Encourage child and parents to express concerns,
questions, and fears about diagnosis.

15. Nursing Interventions Continue
•
Postoperative Care Phase
•
1. Monitor child’s clinical status.
•
a. Vital signs
•
b. Intake, output and weight
•
c. Hypertension
•
2. Monitor child’s abdominal functioning.
•
a. Patency of nasogastric (NG) tube
•
b. Bowel sounds and stool output
•
c. Signs and symptoms of obstruction
•
d. Postoperative adhesion formation long-term
•
3. Promote fluid and electrolyte balance.

16. Nursing Interventions Continue
•
4. Maintain and support respiratory status.
•
5. Monitor incisional site for appropriate healing.
•
6. Observe and record drainage for amount and color.
•
7. Monitor for signs and symptoms of infection (i.e.,
redness, warmth, inflammation, fever).

18. Nursing Interventions Continue
• Chemotherapy and Radiation Phase
• 1. Provide for child’s hygienic needs:
• a. Oral and rectal care.
• b. Assess skin, including line sites, and provide skin
• care.
• 2. Protect child from infection resulting from
immunosuppression.
• 3. Monitor side effects of radiotherapy:
• a. Nausea, vomiting, and diarrhea
• b. Fatigue
• c. Burn skin at site of radiotherapy

19. Nursing Interventions Continue
• 4. Monitor side effects of chemotherapy.
• 5. Maintain adequate nutritional status.
• 6. Monitor and alleviate child’s pain.
• 7. Provide education about symptoms of anemia and
thrombocytopenia and the risks and benefits of
transfusions when needed.

20. Complications
•
1. Metastasis to lungs, liver, contralateral kidney, bone
marrow.
•
2. Hepatic: local tumor extension resulting in lymphatic
blockage and causing ascites.
•
3. Cardiovascular: local tumor extension causing vena
cava clots.
•
4. Gastrointestinal: bowel obstruction from tumor, ileus,
adhesions.
•
5. Renal: renal dysfunction or failure; hypertension.
•
6. Short- and long-term adverse reactions to
chemotherapy and/or radiation therapy.