Chapter 33: Wilms' Tumor (nephroblastoma) (Children)

Question 1

Wilms’ Tumor (nephroblastoma)

Answer 1

a tumor that originates in one kidney or both kidneys

• cause is unknown
• affects older children, girls and boys equally affected
• about 9 out of 10 children diagnosed are cured
• great deal of progress has been made in treating this disease with surgery, radiation, and chemotherapy

Question 2

Diagnosis

Answer 2

-between 2 to 5 years of age
-a child presenting with an abdominal mass needs a timely diagnostic work-up
>ongoing laboratory and diagnostic testing include urine and electrolyte analysis and a complete blood count, and a renal or abdominal ultrasound, CT scan, or MRI of the abdomen
-if metastasis is suspected, chest x-ray is ordered

Question 3

Signs and Symtoms

Answer 3

tumor is usually discovered on a routine physical exam or is felt or seen by a family member during bathing or routine care; the mass presents on one side and seldom (rarely) crosses the midline

• present with an abdominal mass that is usually painless
• hematuria (blood in urine), hypertension and pain occur infrequently
• other symptoms: aniridia (absence of the iris, the colored part of the eye), hemihypertrophy (an increased size of one-half of the body), or urinary defects such as cryptorchidism (failure of one or more testes to descend to the scrotum before birth) and hypospadias (a condition in which the opening of the penis is on the underside rather than the tip)

Question 4

Nursing Care

Answer 4

consists of a thorough health and history and nursing assessment

• foods high in calories and protein important
• if unable to eat or meet basic caloric requirements for growth and development, dietary supplements, allowing the child food choices, and ensuring that food textures can facilitate eating might help
• enteral or parental feeding may be provided if necessary

Question 5

Palpation of the Abdomen in a Child with Wilm’s Tumor

Answer 5

once diagnosed, NEVER palpate the abdomen or allow anyone else to do so

• palpating this kind of encapsulated tumor can cause it to rupture or lead to further metastasis
• place a warning sign on the hospital room door that says “no abdominal palpation”

Question 6

Medical Care

Answer 6

includes both chemotherapy and post-radiation care

• most common chemotherapy drugs for Wilm’s tumor are: actinomycin D (Dactinomycin), and vincristine (Oncovorin)
• for tumors in more advanced stages, those with unfavorable histology, or those that recur after treatment, the following drugs are used: doxorubicin (Adriamycin), cyclophosphamide (Cytoxan), etoposide, irinotecan, and/or carboplatin

Question 7

Surgical Care

Answer 7

a surgical removal of the mass, which usually involves taking the entire kidney, and biopsy are performed
-after surgical resection, post-operative care is similar to children undergoing other abdominal surgeries
>critical postoperative assessment of the remaining kidney is necessary to ensure its function; closely monitor urine output for amount, color, clarity, presence of clots, pain, and lab values

Question 8

Education/Discharge

Answer 8

• monitor incision site for signs of infection as well as the child for a fever
• be aware of nutritional intake and bowel movements
• follow-up appointments and clinic visits

Question 9

Most Common Chemotherapy Drugs for Wilms’ Tumor

Answer 9

• actinomycin D (Dactinomycin)

- vincristine (Oncovorin)

Question 10

The following drugs are used for tumors in advanced stages, those with unfavorable histology, or those that recur after treatment

Answer 10

• doxorubicin (Adriamycin)
• cyclophosphamide (Cytoxan)
• etoposide
• irinotecan
• carboplatin