genito urinary disorder

1. WILMS TUMOR
Ms. K. Lavanya
MSc(N)-CHN
Associate Professor

2. Definition:
• Wilms tumor or nephroblastoma, is the common malignant renal and intra-abdominal tumor of
childhood described by German surgeon Max Wilms.
• It is associated with chromosomal deletions, especially from chromosomes 11 and 16. It is unilateral or
bilateral.
• It may be associated with other congenital anomalies, like hemi hypertrophy of the vertebrae,
genitourinary anomalies, aniridia, ambiguous genitalia etc.
• This tumor develops within the kidney parenchyma, distorting it and invading the surrounding tissues.

4. Etiology:
• Chromosomal
• Hereditary
• Risk Factors:
 African-American race
 Family history with wilm’s tumor

5. Pathophysiology:

6. Stages:
 Stage 1. The tumor is limited to kidney and is completely resected; the renal capsule is
intact; the tumor was not ruptured or biopsied prior to removal; the vessels of the renal
sinus are not involved, and no evidence of tumor is present at or beyond the margins of
resection.
 Stage 2. The tumor is completely resected; no evidence of tumor at or beyond the
margins of resection is noted; and the tumor extends beyond the kidney (penetration of
renal capsule, involvement of renal sinus).
 Stage 3. A residual, nonhematogenous tumor is present following surgery and is
confined to the abdomen; positive lymph nodes in the abdomen or pelvis are noted;
penetration through the peritoneal surface is observed; peritoneal implants are present;
gross or microscopic tumor remains postoperatively, including positive margins of
resection; tumor spillage is noted, including biopsy; the tumor is treated with
preoperative chemotherapy; and the tumor is removed in more than 1 piece.

7. Stages:
 Stage 4. Hematogenous metastases (eg, lung, liver, bone, brain) or lymph node
metastases beyond the abdomen or pelvis are noted.
 Stage 5. Bilateral renal involvement by the tumor is present at diagnosis.

8. Clinical Manifestations:
 Abdominal mass. The most common manifestation of Wilms tumor is an
asymptomatic abdominal mass; an abdominal mass occurs in 80% of children at
presentation.
 Abdominal pain. Abdominal pain or hematuria occurs in 25%.
 Tumor hemorrhage. A few patients with hemorrhage into their tumor may present
with hypotension, anemia, and fever.
 Fatigue
 Metastasis, symptoms of lung involvement:
 Dyspnea
 Cough
 Shortness of breath
 Chest pain

9. Diagnostic Evaluation:
 History of illness
 Physical Examination
 X-ray- chest and abdomen
 Radiographic tests include- Abdominal ultrasound
 Abdominal and chest CT scan
 Hematological studies
 Biochemical studies
 Urinalysis
 Bone marrow aspiration to rule out metastasis
 Inferior venacavagram- to rule out tumor involvement adjacent to the venacava.

10. Management:
• Treatment consists of surgical removal as soon as possible, after the growth
is discovered, combined with radiation and chemotherapy.
•
 stage I-III Wilms tumors and diffuse anaplastic stage I Wilms
tumors. Nephrectomy followed by vincristine, actinomycin-D, and
doxorubicin in addition to local radiotherapy.
•
 Stage IV Wilms tumors and diffuse anaplastic stage II-III
tumors. Patients undergo the same treatment, with the addition of
cyclophosphamide, etoposide, and carboplatin.

11. Contd….
 Stage IV diffuse anaplastic Wilms tumors. More aggressive treatment is delivered;
nephrectomy is followed by initial irinotecan and vincristine administration, which in turn
is followed by actinomycin-D, doxorubicin, cyclophosphamide, carboplatin, etoposide, and
radiotherapy.
 Activity. No precautions regarding activity are advised, although the patient and his or her
parents should be aware that the patient will have only 1 kidney after therapy; activities that
carry an inherent risk of kidney injuries, such as boxing and hockey, should be avoided.

12. Contd….
 Antineoplastics. These chemotherapeutic agents used to treat
patients with Wilms tumor depend on the stage and histology of
disease; commonly used agents include dactinomycin, vincristine,
doxorubicin, cyclophosphamide, etoposide, and carboplatin;
the dosage depends on the particular stage of the disease and on
the child.

13. Nursing Management:
Nursing Assessment
• Assessment of the child with Wilms tumor include:
• Assess for bleeding. Assess for bleeding from any site and febrile episodes;
Monitor WBC, platelet count, hematocrit, absolute neutrophil count.
• Assess the oral cavity. Assess oral cavity for pain ulcers, lesions, gingivitis, mucositis or
stomatitis and effect on the ability to ingest food and fluids.
• Assess for anxiety. Assess source and level of anxiety and need for information
and support that will relieve it.

14. Nursing Management:
 Ineffective protection related to antineoplastic agents, radiation therapy, or leukopenia.
 Impaired oral mucous membrane related to chemotherapy.
 Anxiety related to change in health status and threat of death.
 Risk for injury related to side effects of medications and complications.