WILM’S TUMOR

> Also known as nephroblastoma. Wilm’s tumor is the most frequent intra abdominal tumor of child
and the most common type of renal cancer. It is named after Max Wilm’s a german doctor who wrote
one of th first medical articles about Wilm’s Tumor.
> It is a form of kidney cancer that primarily develops in children and a highly malignant embryonal
neoplasm.
- It is a cancerous disease that spreads rapidly throughout the body.
- Embryonal tumors can occur at any age, but most often occur in babies and young children.
> Common type kidney cancer diagnosed in children.
CAUSES
> HEREDITARY
Cancer begins when cells develop errors in their DNA. The errors allow the cells to
grow and divide uncontrollably the accumulating cells form a tumor. In Wilms'
tumor, this process occurs in the kidney cells. In rare cases, the errors in DNA that
lead to Wilms' tumor passed from a parent to the child. About 1% to 2% of
children with Wilm’s tumor have one or more relatives with same cancer.
According to scientists, children inherit an abnormal gene from their parents,
increasing their risk of developing a Wilm's tumor.
> CHROMOSOMAL DELETION
A variety of disorders can develop when parts of chromosomes are missing.
Chromosomal deletion syndromes are the name for these conditions. They are
known to cause birth abnormalities as well as limited intellectual and physical
development. Defects can be severe in certain circumstances, and children
affected may die during infancy or childhood. Chromosomal deletion means
part of a chromosome is missing or deleted, which is the tumor suppressor. A
tumor suppressor gene is one that is expressed by a cell during cell division
and replication. However, if the tumor suppressor gene is missing or deleted,
babies may develop Wilm's tumor or other types of cancer.
How common is Wilms tumor?
> Wilms tumor is the most frequent kind of kidney cancer in children
and the fourth most common kind of childhood cancer.

> In the United States, about 500 new cases of Wilms tumor are
discovered each year, affecting about one in every 10,000 children.
Wilms tumors are seen in up to 5% of cancer cases each year. African
Americans have a higher risk of developing a Wilm's tumor than Asians.

> Children with Wilms tumor is usually diagnosed around 3 years old in
one kidney and children with Wilms tumor in both kidneys are usually
diagnosed around 2 years old.

> Males and females are equally affected.

SIGNS AND SYMPTOMS
Swelling or a hard mass in the abdomen (belly) it can bbe felt upon physical
examination like dressing, bathing or changing child’s diaper
Abdominal pain
Other possible symptoms: Some children with Wilms tumor may also have:
• Fever
• Nausea
• Loss of appetite
• Shortness of breath
• Constipation
• Blood in the urine
• A low number of red blood cells (anemia )
EPIDEMIOLOGY

Typically, the tumor is unilateral, affecting only one kidney.However, in 5% of cases, it is

bilateral, meaning it can be found in both kidneys at the same time.

The tumor involves left kidney more than right kidney. 

It affects children between 3-5 years of age and at the age of 6 Wilm’s tumor is
uncommon same as adult.
DIAGNOSTICS
• History-Ask the parents if there is a history of Wilm's tumor in their
family to see if it is inherited.
• Physical examination-This reveals the presence of an abdominal mass
or tumor, as well as the presence of symptoms of Wilm's tumor.
• Urinalysis - Lab tests can detect how well the kidneys are working, as
well as some kidney abnormalities or low blood counts, and the
presence of blood in the urine.
• X-ray of the chest - detects metastasis to the lungs if the tumor spreads
to the lungs. 
REVIEW OF ANATOMY AND PHYSIOLOGY
The kidneys are 2 bean-shaped organs that are attached to the back wall of the abdomen. Each
kidney is about the size of a fist. One kidney is just to the left and the other just to the right of the
backbone. The lower rib cage protects the kidneys. The kidneys’ main job is to filter the blood and
rid the body of excess water, salt, and waste products.

> The products and extra water that are filtered from the kidney are changed into urine. The slender
tubes are called ureters, and they connect to the bladder. Urine produced by the kidney flows down
from the ureters to the bladder, where it is stored until the person urinates.
 PATHOPHYSIOLOGY OF WILM’S TUMOR

Wilm’s Tumor

Deletion of WT1 11p13 and pax6 Deletion of 11p13 11p15.5

WAGR DENIS DRASH SYNDROME BECKWITH WIEDEMANN

> Wilm’s Tumor > Gonadal Dysgenesis > Genomic Imprinting

> Aniridia > Diffuse Mesangial Sclerosis > Maternal Imprinting
> Genital Urinary Abnormalities > Uniparental/ Paternal Disomy
> Retardation
 WAGR SYNDROME

DENIS DRASH SYNDROME

BECKWITH-WIEDEMANN
STAGES OF WILM’S TUMOR
• Stage 1 (43%) Cases - The tumor is found in 1 kidney and can be
completely removed with surgery
• Stage 2 (23%) Cases - Cancer is found in the kidney and in the fat, soft
tissue, or blood vessels near the kidney completely removed with
surgery.
• Stage 3 (23%) Cases - Cancer is found in areas near the kidney and
cannot be completely removed with surgery
• Stage 4 (10%) Cases - Cancer has spread to other more distant organs
• Stage 5 (5%) Cases - Cancer cells are in both kidneys at the same time.
Treatment for Wilm’s Tumor
Stage Surgery Chemotherapy Radiation Therapy
Stage 1 and 2 Nephrectomy Vinca Alkaloids + NO
Antitumor antibiotic
+ Anthracycline
Stage 3 and 4 Nephrectomy Vinca Alkaloids + YES
Antitumor Antibiotic
+ Anthracycline +
PodoPhyllotoxin
derivatives
Stage 5 Nephrectomy Vinca Alkaloids + YES
(Removing the most Antitumor Antibiotic
severely afflicted + Anthracycline +
kidney) Alkylating Agents +
Podophyllotoxin
derivatives
 DRUG STUDY
NAME(Generic Name) MECHANISM OF DOSAGE ROUTE INDICATION CONTRAINDICATION ADVERSE EFFECT NURSING
ACTION AND FREQUENCY RESPONSIBILITY
Vinca Alkaloids Vinca alkaloids Vinca alkaloids They've been Anemia Nausea and vomiting Before any vincristine
work by binding be administered used to treat Decreased blood platelets Hair loss is administered, the
tubulin and by rapid diabetes, high Low levels of a type of white Mouth sores intravenous needle or
preventing it from intravenous blood pressure, blood cell called neutrophils Headache catheter must be
polymerizing into injection, possibly and disinfectants, Charcot-Marie-Tooth disease Constipation appropriately
microtubules to through a running among other Disorder of peripheral nerves positioned. Leakage of
stop dividing cells parenteral things. Cancer- Peripheral neuropathy Vincristine Sulfate
from entering infusion. fighting effects of Peripheral motor neuropathy Injection, USP
metaphase. the vinca Disease affecting muscles and (vincristine sulfate)
alkaloids are also nerves into adjacent tissue
necessary. Abnormal liver function tests following intravenous
injection may cause
significant discomfort.

Antitumor Anthracyclines are Injectable Advanced Anthracycline Black/tarry or bloody The decision to use an
antibiotic a class of potent Intravenous endometrial hypersensitivity. ... stools. anthracycline is based
(anthracyclines) and widely used Intraarterial - Not carcinoma. Hepatic disease. ... Seizures. on the baseline cardiac
cytotoxic drugs, FDA approved for Metastatic Pre-existing cardiac Tissue necrosis or death. function, overall
derived from chemotherapy; hepatocellular conditions. ... Cardiac arrhythmias. health status, and the
antibiotics that used for hepatic cancer. Multiple Gender. ... Anemia. availability of
inhibit DNA and artery myeloma. Age. ... Neutropenia. equivalent non-
RNA synthesis by chemoembolizati Advanced renal Reports of prepubertal Shortness of breath due anthracycline-based
intercalating on cell carcinoma growth inhibition/failure and to congestive heart alternative regimens
between base pairs Intravesical - Used (with sarcomatoid gonadal impairment in failure.
of the DNA/RNA in early bladder features) children and adolescents. Edema in ankles or feet
strand. cancer due to congestive heart
failure
Alkylating act by cross-linking I t is usually given used to treat many Pregnancy and Alkylating agents depress Nursing care of the
strands of DNA, through a vein by different cancers, lactation. Severe bone marrow function patient receiving
Agents particularly at the N-7 injection or infusion including cancers of the effects to fetus and and cause gastrointestinal chemotherapy
position of guanine. (intravenous, IV) lung, breast, and ovary neonate. disturbances such as includes patient
They are nonspecific as well as leukemia, Known allergy to nausea and vomiting. As education and drug
for cell cycle phase lymphoma, Hodgkin drugs. Caution is bone marrow is administration, as well
and are thus active disease, multiple exercised to responsible for the as ongoing
during most parts of myeloma, and sarcoma. prevent production of red blood assessment, early
the cell cycle. hypersensitivity cells, white blood cells identification, and
reactions. and platelets when it is intervention for side
Bone marrow depressed symptoms of effects.
suppression. ... anaemia, infection and
Suppressed renal or bleeding respectively, may
hepatic function occur

Podophyllot It is used on the skin Intravenous or oral A podophyllotoxin Irritation of tissue Check the patient's
as a topical treatment routes derivative used to treat surrounding the medical record for an
oxin of external genital testicular and small cell application site, including allergy or
derivatives warts, caused by lung tumors. burning, redness, pain, contraindication to the
some types of the itching, swelling. prescribed medication.
human papillomavirus ...
(HPV), and other Prepare medications
warts. for one patient at a
time.
Educate patients about
their medications
NCP
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective Imbalanced > The patient > Create daily > To monitor By eating
The mother nutrition less will be able to weight, food the patient’s nutritious
verbalized that than body achieve a and fluid chart daily nutritonal foods and
her baby is requirement weight within > Discuss about intake and monitoring on
sudden weight related to his/her normal the nutrition weight goals his weight, the
loss, loss of abdominal BMI range nd weight goals > To patient was
appetite, the pain, loss of to the parents understand the able to
baby's fever appetite and of the baby short and long maintain a
won't go away. weight loss > Help the term of healthy weight.
And while she parents to nutrition
was dressing choose > To promote
her, she felt a appropriate nutrition and
firm mass on food for the healthy food
the belly of the baby habits
baby. > Monitoring, > To To check
Objective managing and the changes of
Baby has firm evaluate the food intake
mass on impact of the
his/her nutrients to the
abdomen baby
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective Risk for injury > The baby will > Assess urinary > Indicates The baby was
The mother related to not experience output for possible renal able to; Not
verbalized that enlargement of injury presence of impairment experienced
her baby is the abdomen cloudy, foul- and/or urinary injury so the
sudden weight and side effect smelling urine bladder goal was
loss, loss of of medications > Avoid any infection partially met
appetite, the palpation of > Prevents
baby's fever abdominal mass trauma to the
won't go away. > Monitor for tumor site
And while she increase blood > To provide
was dressing pressure hours information
her, she felt a > Encourage and about vital signs
firm mass on the instruct the that caused by
belly of the parents to check tumor
baby. the urinary > to check for
Objective pattern of the genitourinary
Baby has firm baby problems in
mass on his kidney.
abdomen
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION
Subjective Deficient The parents will > Explain what > To provide At the end of
The mother knowledge be able to Wilm’s tumor is information in a the health
verbalized “ ano related to a new understand and its simplest way on education the
po ba ang wilm's tumor Wilm's tumor symptoms wilm’s tumor parents
Wilm’s tumor” diagnosis as and how to treat > Educate the and its demontrate
and she added verbalized by it at the end of parents about pathophysiology sufficient
that her baby is the parents the health the medications > To understand knowledge
sudden weight education > Use an open the possible side about Wilm’s
loss, loss of session. ended questions effect of the tumor
appetite, the medications
baby's fever > To assist the
won't go away. parents to
And while she manage their
was dressing lifestyle while
her, she felt a their baby has
firm mass on the wilm’s tumor
belly of the
baby.
Objective
Baby has firm
mass on his
abdomen