WILMS TUMOR IS A CANCEROUS TUMOR OF THE KIDNEY THAT USUALLY OCCURS IN YOUNG

CHILDREN
CAUSES :- THE EXACT CAUSE IS NOT KNOWN

PATHOPHYSIOLOGY:-
WHEN AN UNBORN BABY IS DEVELOPING, THE KIDNEYS ARE FORMED FROM PRIMITIVE CELLS THE
CELLS MATURE &ORGANIZE INTO THE NORMAL KIDNEY STRUCTURE SOMETIMES ,CLUMPS OF THESE
CELLS REMAIN IN THEIR ORIGINAL, PRIMITIVE FORM IF THESE CELLS BEGIN TO MUITIPLY AFTER BIRTH
THEY MAY UITIMATELY FORM A LARGE MASS OF ABNORMAL CELLS. THIS IS KNOWN AS A WILMS
TUMOR.

CLINICAL MANIFISTATION:
1) THE USUAL PRESENTATION IS AN ASYMPTOMATIC
2) ABDOMINAL PAIN
3) HEMATURIA
4) HYPERTENSION
5) FEVER
6) ANAEMIA
7) WEIGHT LOSS
8) ANOREXIA
9) VOMITING
10) ON EXAMINATION, MASS WITHIN THE ABDOMEN
11) IF METASTASIS HAS OCCURRED SYMPTOMS OF LUNG INVOLVEMENT SUCH AS DYSPNEA, COUGH,
SHORTNESS OF BREATH & PAIN IN THE CHEST MAY BE PRESENT.

DIAGNOSIS:
1) HISTORY
2) PHYSICAL EXAMINATION
 A SWOLLEN ABDOMEN OR WITH AN OBVIOUS ABDOMINAL MASS .
3) BLOOD ANALYSIS
4) URINALYSIS
5) ULTRASOUND ABDOMEN
6) C T SCAN
7) INTRAVENOUS PYELOGRAPHY
8) BIOPSY FINAL DIAGNOSIS
9) OTHER STUDIES CHEST –XRAY ,CT SCAN OF THE LUNGS,BONE MARROW BIOPSY MAY ALSO BE
10) MRI

STAGING
STAGE 1: - TUMOR CONFINED TO KID NEY & COMPLETELY EXCISED .
STAGE 2 : - TUMOR EXTENDS BEYOND KIDNEY BUT COMPLETELY EXCISED
STAGE 3: - TUMOR INFILTRATES RENAL FAT RESIDUAL TUMOR AFTER SURGERY LYMPHNODE
INVOLVEMENT OF HILUM ,PARA-AORTIC OR BEYOND
STAGE 4:- METASTASIS IN LUNG OR LIVER RARELY IN BONE AND BRAIN
STAGE 5:- BILATERAL RENAL INVOLVEMENT

Standard treatment:
STAGE 1 and STAGE 2: FAVOURABLE HISTOLOGY TUMOR- SURGERY TO REMOVE THE CANCER
FOLLWED BY CHEMOTHERAPY .
UNFAVOURABLE TUMOR - SURGERY TO REMOVE THE CANCER FOLLWED BY RADIATION THERAPY
PLUS CHEMOTHERAPY

STAGE 3- FAVOURABLE OR AN UNFAVOURABLE HISTOLOGY TUMOR- SURGERY TO REMOVE THE

CANCER FOLLWED BY RADIATION THERAPY PULS CHEMOTHERAPY.

STAGE 4:- FAVOURABLE OR UNFAVOURABLE HISTOLOGY TUMOR -SURGERY TO REMOVE THE CANCER
FOLLOWED BY RADIATION THERAPY.
STAGE 5:- TAKE OUT A PIECE OF THE CANCER IN BOTH KIDNEYS AND REMOVE SOME LYMPH NODES
AROUND THE KIDNEY .
FOLLOWING SURGERY, CHEMOTHERAPY
. A SECOND OPERATION IS THEN PERFORMED
.SURGERY MAY BE FOLLOWED BY MORE CHEMOTHERAPY AND /OR RADIATION THERAPY

NURSING MANAGEMENT:
(A) PRE-OPERRATIVE CARE
1. BASIC PRE OPERATIVE CARE
2. PROMOTING UNDERSTANDING OF THE PARENTS ABOUT THE PLANNED SURGICAL INTERVENTIONS
BY EXPLANATION ACCORDING TO LEVEL OF UND -ERSTANDING
3. PERPARING FOR NECESSARY DIAGNOSTIC PROCEDURES.
4. INVOLVING THE PARENTS IN CHILD CARE.

(B) POST OPERATIVE

1. OBSERVE THE SURGICAL INCISION FOR ERYTHEMA, DRAINAGE REPORT ANY OF THESE CHANGES.
2. MONITOR FOR ELEVATION TEMP OR SIGN OF INFECTION POST- OPERATIVELY.
3. MONITOR IV FLUIDSTHERAPY AND INTAKE – OUT PUT CARE FULLY ,INCLUDED NASOGASTRIC
DRAINAGE INSERT NGT AS ORDERD MANY CHILDREN REQUIRE GASTRIC SUCTION POST OPERATIVELY
TO PREVENT DISTENTION OR VOMITING .
4. CONTINUE SUPPORTING PARENTS DURING THE POST OPERATIVE PERIOD.
5. WHEN BOWEL SOUND RETURNED BEGIN ADMINISTERING SMALL AMOUNT OF CLEAR FLUIDS .
6. ALLOW THE CHILD TO PARTICIPATE IN SELECTION OF FOOD
7. AS CHILD RECOVERS ALLOW THE CHILD TO EAT PROGRESSIVELY LARGER MEALS FLUIDS OR TUBE
FEEDINGS AS INDICATED.
8. ADMINISTER PAIN CONTRL MEDICATIONS AS ORDERED IN THE IMMEDIATE POST OPERATIVE
9. IF UNABLE TO EAT BECAUSE OF RADIATION AND CHEMOTHERAPY PROVIDE IV PERIOD.
10. PREPARE CHILD AND FAMILY FOR FATIGUE DURING RECOVERY FROM SURGERY AND WITH
RADIATION TREATMENT ,PLAN FREQUENTLY REST PERIODS BETWEEN DAILY ACTIVITIES.
11. PREPARE THE CHILD AND PARENTS FOR LOSS OF HAIR ASSOCIATED WITH CHEMOTHERAPY AND
ENCOURAGEUSE OF HAT AS DESIRED.
12. REASSURE THE HAIR WILL GROW BACK.