WILMS’ TUMOR

NEPHROBLASTOMA
Nephroblastoma (Wilms’ Tumor) is a
malignant tumor that rises from the
metanephric mesoderm cells of the upper
pole of the kidney.
• Originates during fetal life from
undifferentiated embryonic tissues
• Accounts for 20% of solid tumors in
childhood.
• It may occur in association with
congenital anomalies.
• Gene mutation has been identified as
associated with the disease.
 • FIRM NONTENDER ABDOMINAL MASS.
• DOUBLE IN SIZE IN A MATTER OF HOURS.
• HEMATURIA
ASSESSMENT • LOW-GRADE FEVER
• ANEMIA
• HYPERTENSION
DIAGNOSTIC
EXAMINATIONS

CT SCAN KIDNEY FUNCTION

STUDIES
 MANAGEMENT

• SURGERY (NEPHRECTOMY )
• CHEMOTHERAPY (DACTINOMYCIN, DOXORUBICIN, VINCRISTINE,
CYCLOPHOSPHAMIDE)
• RADIATION
 NURSING MANAGEMENT
• DO NOT PALPATE ABDOMEN TO AVOID POSSIBLE DISSEMINATION OF CANCER CELLS.
• HANDLE CHILD CAREFULLY WHEN BATHING AND GIVING CARE.
• MONITOR KIDNEY FUNCTION, MIO
• MONITOR FOR INCREASE BP
• PROVIDE CARE FOR CLIENT FOR NEPHRECTOMY
• PREOP/POST-OP CARE
• PROVIDE CARE FOR A CHILD RECEIVING CHEMOTHERAPY AND RADIATION THERAPY.
• DISCHARGE TEACHINGS
• WATCH OUT FOR POSSIBLE COMPLICATIONS SUCH AS NEPHRITIS, SMALL BOWEL OBSTRUCTION
DAMAGED CAUSED FROM FIBROTIC SCARRING FROM RADIATION AND SCAR TISSUE FROM SURGERY
• DAMAGE TO OVARIES MAY RESULT TO STERILITY
RETINOBLASTOMA
RETINOBLASTOMA is
a malignant tumor of
the retina of the eyes.
• A rare tumor
Accounts 1 % to 3% of
childhood malignancies.
• Inherited autosomal
dominant pattern that
causes an alteration
on chromosome 13.
 ASSESSMENT
• TUMORS ARE LOCATED IN THE RETINA OR IN
VITREOUS FLUID OR MAY EXTEND
BACKWARD INTO THE CHOROID, THE OPTIC
NERVE AND THE SUBARACHNOID SPACE.
• CHILD’S PUPILS APPEARS WHITE (THE RED
REFLEX IS ABSENT “CAT’S EYES”
• LEUKOCORIA ( A CLOUDY WHITE PUPIL)
• STRASBISMUS
 DIAGNOSTIC EXAMINATIONS

• OPHTALMIC EXAM WITH FAMILY HX - YEARLY UNTIL THEY REACH 5 YEARS OF

AGE.
• CT SCAN
• MRI
• LUMBAR PUNCTURE, LIVER AND BONE MARROW BIOPSY FOR METASTASIS
DETECTION
 MANAGEMENT

• CRYOSURGERY – FREEZING OF THE TUMOR TO DESTROY LOCAL CELLS

• LASER SURGERY – TO DESTROY THE BLOOD VESSELS SUPPLYING THE TUMOR.
• RADIATION THERAPY
• CHEMOTHERAPY
• ENUCLEATION OF THE EYE – FOR LARGE TUMOR
ENUCLEATION
 NURSING MANAGEMENT
• IF ENUCLEATION IS PERFORMED OBSERVE FOR BLEEDING ON THE DRESSING AND VITAL SIGNS
FREQUENTLY
• PRESSURE DRESSING IS APPLIED
• KEEP YOUNG CHILDREN FROM TUGGING AT THE DRESSING AND REMOVING IT – NEED FOR
RESTRAINT
• EYE PATCH APPLICATION
• EYE PROSTHESIS IS FITTED ABOUT THREE WEEKS AFTER SURGERY
• EVALUATION AFTER RETINOBLASTOMA FOR CHILDREN MUST INCLUDE NOT ONLY WHETHER
METASTASIS CAN BE DETECTED BUT ALSO WHETHER THE CHILD IS ADJUSTING TO ANY LOSS
OF VISION
RHABDOMYOSARCOMA
RHABDOMYOSARCOMA – is a
tumor of striated muscle. It arises
from the embryonic mesenchyme
tissue that forms muscle,
connective, and vascular tissue.
• The peak age of incidence is 2
to 6 years with a second peak
occurring during puberty.
• common sites of occurrence
include the eye orbit, paranasal
sinuses, uterus, prostate,
bladder, retroperitoneum, arms
and legs.
 ASSESSMENT
COMMON SITES AND ASSOCIATED SYMPTOMS OF RHABDOMYOSARCOMA
SITE OF TUMOR SYMPTOMS
ORBIT Proptosis (extruding eye); visible and palpable conjunctival or eyelid mass
NECK Hoarseness, dysphagia, visible and palpable mass in neck
NASOPHARYNX Airway obstruction, epistaxis, dysphagia, visible mass in nasal or nasopharyngeal
passages.
PARANASAL SINUSES Swelling pain, nasal discharge, epistaxis
MIDDLE EAR Pain, chronic otitis media, hearing loss, facial nerve palsy, mass protruding into
external ear canal
BLADDER AND PROSTATE Dysuria, urinary retention, hematuria, constipation, pa[pable lower abdominal
mass
VAGINA Mass protruding from uterus or cervix into vagina, abnormal vaginal bleeding
TRUNK, EXTREMITIES Visible and palpable soft tissue mass
TESTICLES Visible and palpable soft tissue mass