13.3 Wilm's Tumor and Neuroblastoma

Question 1

Wilm’s Tumor (nephroblastoma)

Answer 1

• Intrarenal Abdominal Tumor
• Occurs before age 5
• Rapid growth (DOUBLES EVERY 11-13 DAYS) - Does not metastasize often

Question 2

Wilm’s Tumor Symptoms

Answer 2

• Typically asymptomatic with a firm lobulated mass on one side of the midline abdomen (does not cross midline)
• DO NOT PALPATE because it grows rapidly. Palpating can cause a tumor spill which causes tumor to leak out and proliferate even more rapidly.

Other Symptoms
- Hypertension (increased renin in kidney)
- Anemia
- Weight loss
- Hematuria
- Abdominal pain
- Fever

• It is possible to be bilateral but is usually unilateral
• Parents usually find this tumor by accident when they help their child.

Question 3

Wilm’s Tumor Nursing Care

Answer 3

• DO NOT PALPATE ABDOMEN
• Educate parents about chemotherapy and radiation.

Education (side effects)
- Mouth ulcers
- N/V
- Alopecia
- Fatigue

Question 4

Wilm’s Treatment

Answer 4

• Surgery to remove the kidney impacted by the tumor.

Surgical Complications
- Hemorrhage
- Bowel Obstruction
- Infection

• Chemo/radiation is usually done before surgery.
• Radiation can also be done after surgery to treat any tumor spill.

Question 5

Neuroblastoma

Answer 5

• Solid tumor that occurs outside of the cranium
• Characterized by smooth, firm, non tender mass that sits on top of the adrenal gland (on-top of kidney)
• Can also be found anywhere along the sympathetic nervous system chain (head, neck, cervical spine, pelvic area)
• CAN CROSS MIDLINE
• Do not palpate until we are positive it is a neuroblastoma and not Wilm’s Tumor
• Onset usually before age 1-2

The Issue
- Metastasizes frequently (known as the silent cancer because many patients have metastases before it is diagnosed)

Question 6

Neuroblastoma Diagnostic

Answer 6

CBC (for anemia or thrombocytopenia)

URINE CATECHOLAMINES
- Because it sits in adrenal gland on-top of kidneys things like dopamine and norepinephrine can be seen in the urine along with homovanillic acid and vanillylmandelic acid

Biopsy
Tumor markers
Imaging

Question 7

Neuroblastoma Treatment

Answer 7

• Surgery to remove tumor
• Chemotherapy/Radiation