Nephroblastoma

Rahul Dhaker
M.Sc. N. II year
Introduction
 Nephroblastoma is a type of cancer which develops in the
kidneys.
 This cancer is also called Wilms tumor, and is the most
common type of kidney cancer to develop in children.
 In the 1950s and 1960s, most children with nephroblastoma
had a very poor prognosis, but treatment for the cancer has
advanced significantly in the intervening decades.
 The success rate for Wilms tumor treatment is now
approximately 90%, largely due to the practice of combining
surgery with radiotherapy or chemotherapy.
Cont….

 Wilms' tumour was named after Dr Max Wilms, who first

described it. It's a type of kidney cancer.

 It's thought to come from very specialised cells in the embryo

known as metanephric blastema.

 These cells are involved in the development of the child's

kidneys while they're in the womb.

 These cells usually disappear at birth, but in many children

with Wilms' tumour, cells called nephrogenic rests can still be
found.
 Definition
 A Wilms tumor is a
malignant tumor (cancer)
which means it has the
ability to grow and
spread. The places it
usually spreads to include
the lungs, liver and
nearby lymph nodes.
 Causes

 In most children the causes of Wilms' tumour are unknown.

 In 1 in 100 people with Wilms' tumour, another family
member will also have Wilms' tumour.
 Nephroblastoma has a global incidence rate of 0.8 cases per
100,000 people.
 Most children with this cancer are diagnosed between three
and four years of age. Children commonly have tumors in
one kidney only; in around 6% of cases tumors grow in both
kidneys.
Signs & Symptoms
 Signs and symptoms of neuroblastoma vary depending on

what part of the body is affected.

 Neuroblastoma in the abdomen

 Neuroblastoma in the chest

Cont…

 Neuroblastoma in the • Neuroblastoma in the

abdomen :- chest :-
 Abdominal pain
• Wheezing
 A mass under the skin that
• Chest pain
isn't tender when touched
• Changes to the eyes,
 Changes in bowel habits,
including drooping
such as diarrhea
eyelids and unequal
 Swelling in the legs
pupil size
Other signs and symptoms that may indicate
neuroblastoma include

 Lumps of tissue under the skin

 Eyeballs that seem to protrude from the sockets

(proptosis)

 Dark circles, similar to bruises, around the eyes

 Back pain

 Fever

 Unexplained weight loss

 Bone pain
 history and physical
 Urinalysis:-
 blood, sugar, protein and bacteria infection

 Blood tests:-
 Radiology studies
 Ultrasound
 CT scan
 X-ray of the abdomen

 Biopsy
 Treatment
 In general, this type of cancer is curable. If the tumor is only in the

kidney (typical), it can be removed along with the whole kidney (a

nephrectomy). During the operation, the surgeon checks if the

other kidney has a tumor.

 If there are tumors in both kidneys, a piece of the tumor will be

removed. After the surgery, the child is given some chemotherapy

drugs like Dactinomycin (trade name Cosmegen).

Cont…

 Children 16 years old or older have higher mortality rates

within their stages. This is due to them being treated less

aggressively and consistently.

 Adjuvant chemotherapy is sometimes used.

 Surgery

 Chemotherapy

 Radiotherapy

 Stem cell transplant

Surgery
 vincristine and actinomycin D are recommended for all
stages
Stage
 Stage I
 Tumor is limited to the kidney and is completely excised.

 The surface of the renal capsule is intact.

 Treatment: Nephrectomy +/- 18 weeks of chemotherapy

depending on age of patient and weight of tumor.
 Stage II
 Tumor extends beyond the kidney but is completely excised.

 Tumor involvement of the blood vessels of the renal sinus

and/or outside the renal parenchyma.

 Treatment: Nephrectomy + abdominal radiation + 24

weeks of chemotherapy
 Stage III
 Unresectable primary tumor.

 Lymph node metastasis.

 Tumor is present at surgical margins.

 Tumor spillage involving peritoneal surfaces either before or

during surgery, or transected tumor thrombus.

 Treatment: Abdominal radiation + 24 weeks of

chemotherapy + nephrectomy after tumor shrinkage
 Stage IV

 Stage IV Wilms' tumor is defined as the presence of

hematogenous metastases (lung, liver, bone, or brain), or
lymph node metastases outside the abdomenopelvic
region.

 Treatment: Nephrectomy + abdominal radiation + 24

weeks of chemotherapy + radiation of metastatic site as
appropriate
 Stage V
 bilateral renal involvement at the time of initial diagnosis

 Treatment: Individualized therapy based on tumor burden

 Depending on the stage of the tumour at diagnosis,

radiotherapy may also be given to the area of the affected

kidney or to the whole abdomen.

 Radiotherapy treats cancer by using high-energy rays to

destroy the cancer cells, while doing as little harm as possible

to normal cell.
 Children with high-risk neuroblastoma may receive a transplant
using their own blood stem cells (autologous stem cell transplant).
The bone marrow produces stem cells, which mature and develop
into the red and white cells and platelets that make up the blood.

 Child undergoes a procedure that filters and collects stem cells from
his or her blood. Then high doses of chemotherapy are used to kill
any remaining cancer cells in child's body. child's stem cells are
then injected into child's body, where they can form new, healthy
blood cells.
 Side effects
 feeling sick (nausea) and being sick (vomiting),

 hair loss,

 bruising and bleeding,

 tiredness,

 diarrhoea and

 an increased risk of infection.

Nursing Management
 Prognosis
 Effective diagnosis, staging, and multimodality therapy has

dramatically reduced the morbidity and mortality in children

with nephroblastoma

 Poor prognostic factors in children include the presence of

bone metastases and tumor spillage during surgery