2. What is Wilms’ Tumor?
- A rare, malignant tumor of the kidney
- The most common intra-abdominal tumor in children
- Tumor is usually unilateral, favoring the left kidney, 5% of cases affect both
kidneys
- Tumor remains encapsulated for a long time and does not cross the midline of
the abdomen
- Average age of diagnosis is 2 to 4 years old
- Approximately 500 cases are diagnosed in the U.S annually
- It is highly responsive to treatment with 90% of patients surviving at least 5
years
4. Risk Factors
Family history of Wilms’ tumor
African Americans have a higher incidence of WT (lower rate of disease in children of Asian
decent)
Increased rate of incidence in children with certain birth defects:
-Hypospadias - Aniridia
-Cryptorchidism - Hemihypertrophy
Often occurs as part of rare syndromes:
- Beckwith-Wiedemann Syndrome
- WAGR Syndrome
- Denys-Drash Syndrome
5. Signs and Symptoms
- Nontender, abdominal mass
- Abdominal swelling
- Abdominal pain
- Fever
- High blood pressure
- Vomiting
- Hematuria
- Loss of appetite
- Constipation
6. Diagnostic Testing
- Abdominal ultrasound, CT scan, or MRI to view tumor size,
location, and possible metastasis
- Inferior venocavogram to rule out involvement/obstruction of the
vena cava
- Bone marrow aspiration to rule out metastasis
- Excretory urography to assess kidney function
- CBC to reveal polycythemia if tumor secretes erythropoietin, BUN
and creatinine levels to determine overall kidney function of child
7. Doctors use a staging system to describe
the extent of a metastasized tumor
8. 5 Stages
Stage 1: Cancer is found in one kidney only. Size is less than 7cm. Tumor can be completely
removed by surgery. 41% of all Wilms’ tumors are discovered in Stage 1
Stage 2: Cancer is found in one kidney only. Size is larger than 7cm. Tumor can be completely
removed by surgery. 23% of all Wilms’ tumors are discovered in Stage 2
Stage 3: Cancer is found in one kidney only. It has spread to nearby lymph nodes or other
structures of the abdomen and it cannot be completely removed by surgery. 21% of WT
discovered in Stage 3
Stage 4: Cancer is found in one kidney only. It has spread to distant parts of the body; most
commonly, the lungs, liver, bone and/or brain and it cannot be removed by surgery. 10% of WT
discovered in Stage 4
Stage 5: Cancer is found in both kidneys (bilaterally). 5% of WT discovered in Stage 5
9. Medical Treatment
- Nephrectomy (surgery to remove the tumor and perhaps the
affected kidney in Stage 1 and Stage 2)
- Radiation (to shrink large tumors prior to resection or to treat
tumors that weren’t completely removed)
- Chemotherapy (treatment for tumors that have metastasized to
surrounding tissues)
10. Medications
- NSAIDs for pain management: acetaminophen (Tylenol) or
ibuprofen (Motrin)
- Cancer chemotherapy drugs used to slow or stop
cancerous cell growth: vincristine (Oncovin)
- Antinomycines, a class of antineoplastic chemotherapy
drugs: dactinomycin (Cosmegen)
- Antiemetics for chemotherapy induced nausea: dolasetron
(Anzemet)
11. NCLEX ALERT!
If you do get a question about Wilms’ Tumor on the NCLEX, it will almost
certainly revolve around abdominal palpation:
DON’T PALPATE THE ABDOMEN and prevent others from doing so. It may
disseminate cancer cells to other sites.
12. Nursing Care
Prior to Diagnostic Testing: Assess the child for allergies to dye or shellfish, Assist the child to remain
still, Instruct child to drink contrast medium if applicable, Sedate the child if prescribed
Prior to Surgical Resection: Do not palpate the abdomen, Provide emotional support, Provide
education to the child and family regarding treatment plan, ongoing therapy, and prognosis
Post Surgery: Administer prescribed analgesics, Monitor for signs of pain and infection, Monitor for
signs of hemorrhage, Monitor vital signs, Provide age-appropriate diversional activities, Keep child’s
skin clean and dry, Provide emotional support
Chemotherapy/Radiation: Medicate child with antiemetics prior to administration, Handle
chemotherapeutic agents carefully, Take care when radiation is in use (wear lead aprons), Observe
the mouth for mucosal ulcerations, Provide several food choices, allowing the child to choose
favorites, Offer cool fluids to prevent dehydration and soothe sore mucous membranes, Provide
education on side effects of chemotherapy/radiation, Use good hand hygiene, Instruct child to avoid
fresh fruits and vegetables, Avoid large crowds and sick visitors, Monitor for signs of bleeding, Avoid
invasive procedures and apply pressure to puncture sites for 5 mins.
13. 3 Nursing Diagnoses
Risk for Infection related to rupture of encapsulated tumor
Acute pain related to pressure from tumor
Nausea related to effects of chemotherapy medications
14. Risk for Infection r/t rupture of
encapsulated tumor
STG: PT’s nephroblastoma capsule will not
rupture throughout 8hr shift
LTG: PT’s nephroblastoma capsule will not
rupture for 48hrs during the preoperational time
period
Interventions:
1) Loosen clothing around the abdomen to
prevent external pressure
2) No palpation of the abdomen
Interventions:
1) Maintain PT in the supine position to prevent
pressure from PT’s body weight
2) Have a nurse stay in the room to continuously
monitor PT’s activity to prevent accidental self
palpation that could in turn rupture the
nephroblastoma
15. Acute Pain r/t pressure from tumor
STG: PT will be free of pain throughout the 8hr
shift
LTG: PT will show a decrease in pain related
behaviors as he/she progresses through the
hospital stay
Interventions:
1) Assess pain intensity level through use of
the FLACC Pain Assessment scale (q2h)
2) Administer prescribed analgesics as ordered
by the physician
Interventions:
1) Provide non-pharmacological comfort
measure such as therapeutic touch and
distractions to take a multidisciplinary
approach to analgesia
2) Apply EMLA cream to skin 60 minutes prior
to venipuncture
16. Nausea r/t effects of
chemotherapy medications
STG: PT will not show signs of nausea or
vomiting throughout 8hr shift
LTG: PT will not show signs of nausea or
vomiting throughout first series of
chemotherapy
Interventions:
1) Provide antiemetic medications
prophylactically as ordered by physician
2) Provide small, frequent meals that are low
in fat
Interventions:
1) Provide daily supplements of ginger root
capsules
2) Consider use of non-pharmacological
methods such as applying pressure bilaterally
at the P6 points
