Wilms Tumor (Nephroblastoma)

MARIAN MENDOZA RN, MAN

Wilms Tumor (Nephroblastoma)
 What is Wilms Tumor? 

• Wilms tumor is an adenosarcoma in the 

kidney region.
• The tumor arises from bits of embryonic tissue
that remain after birth.
• This tissue can spark rapid cancerous growth
in the area of the kidney.
 Wilms Tumor

• Wilms tumor is a rare kidney cancer that

mainly affects children. Also known as
nephroblastoma, it's the most common cancer
of the kidneys in children. Wilms tumor most
often affects children ages 3 to 4. It becomes
much less common after age 5, but it can
affect older children and even adults.
WILMS TUMOR
 the kidneys
• The kidneys are 2 bean-shaped organs
• The kidneys do a number of things:
• They filter the blood to remove excess water, salt, and waste
products, which leave the body as urine.
• They help control blood pressure.
• They help make sure the body has enough red blood cells.
• On top of each kidney is a small gland called an adrenal gland.
• The adrenal glands make hormones that have many functions,
including helping the body burn fat and protein and respond to
stress.
• Each kidney and adrenal gland is surrounded by fat and a thin,
fibrous capsule (known as Gerota’s fascia).
• They are protected by the lower rib cage.
• The kidneys are important, but we actually need less than one
complete kidney to do all of its basic functions.
• Most Wilms tumors are unilateral, which means they affect only
one kidney.
• Most often there is only one tumor, but a small number of children
with Wilms tumors have more than one tumor in the same kidney.
• About 5% to 10% of children with Wilms tumors
have bilateral disease (tumors in both kidneys).
• Wilms tumors often become quite large before they are noticed.
• Most Wilms tumors are found before they have spread
(metastasized) to other organs.
 Wilms Tumor

Signs and symptoms of Wilms tumor

• Abdominal swelling, often toward one side.
• Fever.
• Abdominal pain.
• Constipation.
• High blood pressure (hypertension)
• Large swollen veins across the abdomen.
• Blood in the urine (hematuria)
• Fatigue.
 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.
 Types of Wilms tumor
• Favorable histology:  About 9 of 10 Wilms tumors
have a favorable histology. The chance of curing
children with these tumors is very good.
• Anaplastic histology: In these tumors, the cancer
cells varies widely, and the cells’ nuclei tend to be
very large and distorted. This is anaplasia. The
anaplasia is spread throughout the tumor (known
as diffuse anaplasia) are harder to treat than tumors
in which the anaplasia is limited just to certain parts
of the tumor (known as focal anaplasia).
 Types of Wilms tumor
Mesoblastic nephroma
• These tumors usually appear in the first few
months of life. Children are usually cured with 
surgery, but sometimes chemotherapy is given
as well. These tumors sometimes come back
soon after treatment, so children who have
had these tumors need to be watched closely
for the first year afterward.
 Types of Wilms tumor
Clear cell sarcoma of kidney (CCSK)
• These tumors are much more likely to spread
to other parts of the body than Wilms tumors,
and they are harder to cure. Because these
tumors are rare, treatment is often given as
part of a clinical trial. It's usually much like the
intensive treatment used for Wilms tumors
with anaplastic histology
 Types of Wilms tumor
Malignant rhabdoid tumor of the kidney
• These tumors occur most often in infants and
toddlers. They tend to spread to other parts of
the body quickly, and most have already
spread by the time they are found, which
makes them hard to cure. Because these
tumors are rare, treatment is often given as
part of a clinical trial, and usually includes 
chemotherapy with several different drugs.
 RISK FACTORS
• Age. Most children who get this type of cancer are between 3 and 5
years old.
• Gender. Girls are more likely to have it than boys.
• Race. Black children are slightly more likely to get a Wilms tumor than
children of other races.
• Family history. If someone in the family has had a Wilms tumor, the
odds are higher that the child will get it, too.
• Birth defects. These can include:
• Testicles that haven’t dropped (cryptorchidism)
• The opening of the penis is on the underside instead of on the tip
(hypospadias)
• A total or partial lack of the colored area of the eye (aniridia)
• An oversized arm or leg (hemihyphertrophy)
 RISK FACTORS
• Another health condition. A Wilms tumor sometimes
happens in children who have other rare conditions:
• WAGR syndrome causes problems in the urinary tract.
• Boys with Denys-Drash syndrome have testicles but
also have female traits.
• Microcephaly is when a baby is born with an
unusually small head.
• Beckwith-Wiedemann syndrome causes internal
organs that are larger than usual.
 Wilms Tumor Staging
• Stage I. only one kidney. Surgery can remove it
all.
• Stage II. Cancer has moved into the area around
the kidney, but surgery can remove it all.
• Stage III. Cancer hasn’t spread outside the child’s
abdomen. Surgery can’t remove it all.
• Stage IV. Cancer has spread to parts of the body
that are farther away, like the lungs, bones, or
brain, or to lymph nodes outside the belly.
• Stage V. There are tumors in both kidneys.
 Wilms Tumor Treatment
It can include surgery, chemotherapy, and radiation therapy.
Surgery
• Partial nephrectomy. removes the tumor and some healthy
tissue around it.
• Radical nephrectomy. removes the affected kidney, the
ureter, the adrenal gland on top of the kidney, and nearby
tissue.
• Removal of both kidneys. In some cases, the doctor will
need to take out both kidneys. The child would then need
to have dialysis, using a machine to filter waste out of their
blood. Once they’re healthy enough, they might have a
kidney transplant.
 Wilms Tumor Treatment
Chemotherapy
• Certain medications can fight or kill cancer cells inside the
child’s body. Most children who have Wilms tumors will get
chemo at some point during treatment. These drugs can
also affect healthy cells, leading to side effects including:
• Hair loss, Fatigue
• Mouth sores, Loss of appetite
• Nausea and vomiting, Diarrhea or constipation
• Bruising or bleeding easier than usual
• Higher chances of infection
 Wilms Tumor Treatment
• RADIATION
• Strong radiation can also kill cancer cells. A
machine focuses it onto the cancer.
• Doctors tend to use radiation for tumors that
are stage III and above. But it can also have
short-term and long-term side effects,
including tissue damage, so they’ll use as little
as possible.
 Nursing Management
Nursing Assessment
• 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.
 Nursing Management
Nursing Diagnoses
• 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.
 Nursing Interventions

1. Prevent transfer of microorganism. Perform 

hand washing prior giving care, utilize mask and gown when
needed, provide a private room, monitor for any signs and
symptoms of infection.
2. Prevent oral trauma. Instruct the use of a soft-sponge
toothbrush or gauze when rinsing the mouth;
• instruct to avoid foods which are hot, spicy, or high
in ascorbic acid (vitamin C);
• provide oral hygiene 30 minutes prior or after meals;
• instruct to refrain from eating or drinking for 30 minutes
after completion of oral hygiene;
• offer moist, soft, bland foods.
 Nursing Interventions
3. Prevent anxiety. 
• Have the parents to stay with the child or encourage
open visitation, provide a telephone number to call for
information;
• explain all procedures and care in simple, direct,
honest terms and repeat as often as necessary;
• reinforce physician information if needed and provide
specific information as needed;
• provide consistent nurse assignment with the same
personnel;
• encourage parents to participate in care.
 Nursing Interventions
4. Prevent injury. 
• Avoid any palpation of abdominal mass;
• post sign on bed stating not to palpate preoperatively;
• assess incision site for redness, swelling, drainage,
intactness, and healing and change dressing
when soiled or wet;
• assess oral and perineal area;
• encourage parents to appropriately dress child based
on weather conditions and to refrain from participating
on rough activities or sports.