wilms tumor Flashcards
what is wilms tumor?
congenital renal tumor
2-5yo
mostly girls
affects L kidney more often
clinical manifeatstions?
usually asymptomatic
- Abdominal swelling or mass:
* Firm
* Nontender
* Confined to one side
- Hematuria (less than one fourth of cases)
- Fatigue and malaise
- Hypertension (occasionally)
- Weight loss
- Fever
- constipation (compression of mass)
- resp symptoms (increased abdo pressure+ mets)
how is wilms diagnosed?
- hx (congenital abnormalities, family hx and signs of malignancy)
- abdo U/S
- CBC, chem 7, LFT, BUN, Creatinine
- CT/MRI
What are the treatment options?
- surgery ASAP
- chemo (pre-op/post op)
- radiotherapy in some cases (not stage 1)
- transplant is feasible, such as from a twin, sibling, or parent
treatment decision is more complex if both kidneys involved
chemo and radio could be prior to sx or after depending on of they think they have removed all evidence of tumor or not
when and what type of surgery is done?
- done asap within 24-48h after admission
(parents dont rly have time to absorb info) - nephrectomy +/- adrenal glands
when is chemo done?
pre op:
- if intravascular disease, very large or bilateral (goal= reduce size of tumors0
post op:
- “cycle” given in intervals (6-15 mo)
post op considerations?
- monitor BP for HTN
- monitor GI activity (risk for intestinal obstruction)
- pain management
- strict I And o
- daily wts
- fluid levels (risk for UTI)
- chemo precautions
what are teaching points regarding the mass?
- dont palpate abdomen (put sign above bed)
- no big bear hug
- no pressure on belly
- child can still play w all toys
- can lay on stomach
- can still cuddle
what are teaching points regarding maintaining fx of the remaining kidney?
- avoid contact sports
- avoid UTI (increase fluids, wipe front to back, pericare, change diaper, monitor infection)
- prompt detecting/ tx of any GU symptoms
(burning, cloudy, smelly, dark behavioral changes)
what is important regarding alopecia teaching?
can be done post op if pre-schooler
