m



c


Ƨ Also known as NEPHROBLASTOMA

Ƨ  s common name is ANEPONYM, referring o c

m ,
e
German surgeon (1867ʹ1918) w
o firs described
is kind of
umor
Ƨ diagnosed only w
en
e umor(s) is/are already big, bu
before
e cancer me as asize (spreads
roug
ou
e body)
Ƨ cancer of
e kidneys
a ypically occurs in c
ildren, rarely
in adul s
Ƨ usually s rikes w
en a c
ild is abou 3 years old
Ƨ risk of developing Wilms' umor is slig
ly
ig
er in girls
an in
boys
Ƨ S ages:
Y§ 
 - cancer is only found in
e kidney
Y§ 
 - cancer
as spread deeper in o o
er par s of
e kidney and o nearby blood vessels, bu
was comple ely removed by surgery. No cancer cells are found a
e edges of
e area w
ere
e
umor was removed.
Y§ 
 - cancer
as spread beyond
e kidney area o nearby lymp
nodes or o
er s ruc ures
wi
in
e abdomen
Y§ 
  - cancer
as spread o dis an s ruc ures suc
as
e lungs, liver or brain
Y§ 
 - cancer cells affec bo
kidneys

¬


Ƨ cue o loss or inac iva ion of a umor suppressor gene called m on c
romosome 11. Tumor suppressor
genes usually suppress
e grow
of umors and con rol cell grow
.

  

Ƨ According o
e Na ional Cancer ns i u e (2007),
e
ig
es incidence of kidney cancer occurs in
e
Uni ed S a es, Canada, Nor
ern Europe, Aus ralia, and New Zealand. T
e lowes incidence is found in
T
ailand, C
ina, and
e P
ilippines.
Ƨ n P
ilippines, C
ild
ood cancers are
e - disease killer of c
ildren - more
an as
ma, cys ic fibrosis,
diabe es, and pedia ric AcS combined.
Ƨ According o cOH, Wilm͛s Tumor§compromises G
 of all c
ild
ood cancers

×   


Ƨ A firm, non- ender mass in
e upper quadran of
e abdomen is usually
e presen ing sign.  may be
§

on ei
er side.
Ƨ Abdominal pain w
ic
is rela ed o rapid grow
of
e umor.
Ƨ As
e umor enlarges, pressure may cause cons ipa ion, vomi ing, abdominal dis ress, anorexia, weig

loss and dyspnea.
c ¬ 

Ƨ Abdominal ul rasound de ec s
e umor and assesses
e s a us of
e opposi e kidney

Ƨ C
es X-ray and CT scan may be done o iden ify me as asis
Ƨ MR or CT scan of
e abdomen may be done o evalua e local spread o lymp
nodes
Ƨ Urine specimens s
ow
ema uria; no increase in vanillylmandelic acid and
omovanillic acid levels as
occurs wi
neuroblas oma
Ƨ Comple e blood coun , blood c
emis ries, especially serum elec roly es, uric acid, renal func ion es s,
and liver func ions es s, are done for baseline measuremen and o de ec me as asis

•   

Ƨ ns ruc pa ien /SO o prac ice s ric
and was
ing before and af er ea ing or before and af er using
e
oile o preven
e spread of infec ion among
e family members and o reduce
e risk of wound
infec ion.
Ƨ Encourage pa ien o wear mask o preven in
aling microorganisms because pa ien is
immunocompromised.
Ƨ ns ruc pa ien ͛s mo
er o keep pa ien ͛s fingernails clean and s
or o preven from scra c
ing
a
resul s in skin injury.
Ƨ ns ruc pa ien /SO o clean
oroug
ly fres
frui s before ea ing o avoid from inges ion of pa
ogens
and any microorganisms.
Ƨ ns ruc SO o provide a smoke free and dus free environmen for
e pa ien o avoid nasal irri a ion

a mig
aggrava e pa ien ͛s condi ion.
Ƨ ns ruc SO o c
ange bed linens
rice a week o preven o preven dwelling of microbes, dus and
viruses in
e linens.
Ƨ Clean skin surface wi
running wa er and mild soap af er c
ange of dressing o reduce skin
con aminan s.
Ƨ f pa ien canno ake a ba
, offer
im regular sponge ba
ing w
en clien verbalized feeling of
discomfor o promo e comfor and well-being.
Ƨ Tell
e mo
er o make sure
a
er c
ild avoid vigorous exercise or ac ivi ies and ex
aus ion and
always
ave res periods.
Ƨ ns ruc pa ien o limi body movemen s, especially bending
is back.
Ƨ Avoid prodding or pus
ing on
e c
ild's belly area o avoid injury o
e umor si e.
Ƨ Encourage walking soon af er surgery for early re urn bowel func ion, promo es effec ive brea
ing,
mobilizes secre ions, improves circula ion, preven s s iffness of join s and relieves pressure
Ƨ nform
e mo
er o inspec surgical si e/size, no ing c
arac eris ics and in egri y o recognize early or
delayed
ealing/developing complica ion may preven a more serious si ua ion suc
as infec ion.
Ƨ Moni or surgical dressing, placemen , and bleeding o make appropria e referrals if
ere are significan
findings suc
as
ypovolemic s
ock.
Ƨ Moni or
e vi al signs especially
e empera ure because pa ien mig

ave infec ion already.
Ƨ Measure and record
e abdominal gir
of
e pa ien because s
e
as
ig
er risk of
aving
spleenomegaly and
aepa omegaly due o
e condi ion.
Ƨ Prepare favori e foods o gain weig
for upcoming c
emo
erapy because
er appe i e may decrease
Ƨ Avoid legumes because i is
ig
in purines w
ic
produce uric acid
a can deposi in
e kidneys in
e
form of ura e s ones.
Ƨ ns ruc
e mo
er o follow
e medica ion program carefully. T
e drugs prescribed o pa ien are
designed o preven various complica ions and o rea
e condi ion.
 Ƨ S ric ly ins ruc
e mo
er no o give any medicines, over-
e-coun er drugs, vi amins,
erbs, or food
supplemen s o
er c
ild wi
ou firs alking o p
ysician.
Ƨ Teac

e SO on
ow o adminis er
e medica ion, i s correc rou e, dosage, and iming.

M M  

Ƨ   

Surgery is
e main rea men approac
used in pa ien s wi
Wilms' umor in
e USA. n Europe,
e
pa ien undergoes surgery af er
ey receive c
emo
erapy.

Surgical removal of
e kidney issue is called nep
erec omy. T
ere are four ypes of nep
erec omy
performed in pa ien s wi
Wilms͛ umor:

Y§   . curing
is surgery,
e doc or removes
e en ire kidney w
ere
e umor is
presen .
Y§ Ã

 
curing
is surgery,
e doc or removes
e umor oge
er wi

e
surrounding kidney issue.
Y§

. curing
is surgery,
e doc or removes
e umor oge
er wi

e en ire
kidney,
e ure ers (
in ube
a carries
e urine from
e kidney o
e urine bladder),
e adrenal
gland,
e fa issue
a capsules
e kidney, and some imes wi

e adjacen lymp
nodes.
Y§ • 
  
curing
is surgery,
e doc or ries o remove only
e umor wi
as li le
damage o
e kidney issue as possible.

Ƨ Ñ


C
emo
erapy is a sys emic rea men (affec s cells
roug
ou
e en ire body)
a uses drugs ei
er o
s op
e abnormal grow
and dividing process of
e cancer cells, or o kill
e cancer cells. T
is rea men can be
adminis ra ed as pills,
roug
injec ions, or
roug
a ca
e er placed in a blood vessel.

Ƨ




T
is is a rea men approac
w
ic
uses
ig
-energy rays or par icles o des roy cancerous cells. T
e mos
common ype of radia ion
erapy used in pa ien s wi
Wilms' umor is  


w
ic
uses an
ex ernal device (linear accelera or) o genera e
ig
-energy rays
a focus on
e umor.

T
is ype of rea men is of en use along wi
surgery in advanced s ages of Wilms' umor pa ien s (s age
1
, V, and V) or in early s ages (s age  a nd ) if
e umor
as an unfavorable
is ology.

ñ