Wilms tumor.pptx

Pediatric, child health nursing

1. Wilms tumor PRESENTED BY V.Parasakthi M.Sc. (N) Ist year Dept. of CHN CON-PIMS

2. DEFINITION A Wilms tumor (also called a nephroblastoma) is the most common  kidney cancer  in children. Most children with it have a tumor on one  kidney , but about 5% get a tumor on both.

3. INCIDENCE AND ETIOLOGY Usually the tumor’s is unilateral , but in 5% cases it may be bilateral. The tumor involves left kidney more than right kidney. It affects children between 3-5 years of age The disease occur in about 1 out of 2-2.5 lakh children. The exact cause of tumor is unknown , but it has been identified that tumor suppressors gene acts to promote normal kidney development. This gene may be absent or missing in wilm’s tumor

4. Risk Factors Age Most children who get this type of cancer are between 3 and 5 years old. Gender  Girls are more likely to have it than boys. Race   Black children are slightly more likely to get a Wilms tumor than children of other races. Family history   If someone in your family has had a Wilms tumor, the odds are higher that your child will get it, too . Birth defect Cryptorchidism, hypospadias

5. Types of Wilms Tumors There are two kinds of Wilms tumors , divided by how the cells look under a microscope . Favorable histology More than 9 out of 10 Wilms tumors fall into this group. It means there isn’t a lot of difference among the cancer cells. Children with this type have a good chance of being cured . Unfavorable or anaplastic histology  This type has a variety of deformed cancer cells . It can be much harder to cure .

6. pathophysiology Mostly wilm’s tumor is unilateral but it can be bilateral in 5% of cases Nephroblastoma are generally large and rapidly growing Tumor generally start growing in renal parenchyma or at the tip of kidney

7. It causes suppression of normal tissue remaining Majority of tumors presents a as single encapsulated mass, that separates the normal kidney and tumor. Although the tumor is encapsulated but the membrane may be very thin and get easily torn Rupture of tumor put patient at risk of hemorrhage and dissemination of tumor

8. Symptoms Belly pain Swelling in their belly A growth that you can see or feel in their belly Fever  Nausea Lack of appetite High blood pressure Blood in their pee Constipation Shortness of breath

9. Wilms Tumor Staging Stage I.  It’s in only one kidney. Surgery can remove it all. Stage II.  Cancer has moved into the area around the kidney, but surgery can remove it all. Stage III.  Cancer hasn’t spread outside the child’s abdomen. Surgery can’t remove it all . Stage IV.  Cancer has spread to parts of the bod y that are farther away, like the lungs, bones, or brain, or to lymph nodes outside the belly.

10. Stage V.  There are tumors in both kidneys.

11. diagnosis History the child may have positive family history Physical examination reveals presence of abdominal mass Urinanalysis reveals presence of blood in urine Abdominal X-ray Ultrasound Chest X-ray to detect metastasis to lungs A blood test to check kidneys and liver are working, their red and white blood cells, and their blood clotting.

12. Treatment Wilms tumor is treated depends on how much the cancer has spread. It can include surgery,  Chemotherapy  radiation therapy

13. Surgery Partial nephrectomy.  This removes the tumor and some healthy tissue around it. Radical nephrectomy.  This removes the affected kidney, the ureter (the tube that carries pee away from the kidney), the adrenal gland on top of the kidney, and nearby tissue. Removal of both kidneys.  In some cases, the doctor will need to take out both kidneys. Your child would then need to have dialysis, using a machine to filter waste out of their blood. Once they’re healthy enough, they might have a kidney transplant.

14. Chemotherapy Certain medications can fight or kill cancer cells inside your child’s body. Most children who have Wilms tumors will get chemo at some point during treatment. These drugs can also affect healthy cells, leading to side effects including: Hair loss Fatigue Mouth sores Loss of appetite Nausea and vomiting Diarrhea or constipation Bruising or bleeding easier than usual Higher chances of infection

15. Chemotherapy for 6 month Actinomycin D,vincristin,doxorubicin

16. Radiation Strong radiation can also kill cancer cells. A machine focuses it onto the cancer. Doctors tend to use radiation for tumors that are stage III and above. But it can also have short-term and long-term side effects, including tissue damage, so they’ll use as little as possible . Moderate radiation therapy for 5 days a week for several week. Each session for 15-30 minute

17. Nursing management Preoperative care Prepare the parents and child for surgery Explain parents not to palpate the abdomen of the child Explain child about post operative care , if he or she is old enough Caution should be taken while turning and handling the child

18. Post operative care Monitor vitals Monitor renal functioning by monitoring weight , intake & output and kidney function test values. Use aseptic techniques while doing dressing Explain parents about follow up and continuing about the tie of discharge.

19. CONCLUSION Wilms tumor is the most common renal malignancy in children. In the 1930s overall survival for children with wilms tumor was approximately 30%.Use of multidisciplinary therapy , guided by results from multi-institutional, has substantially improved overall survival to about 90%.

20. BIBLIOGRAPHY Rimple Sharma ,”text book of essential of pediatric nursing”,2 nd edition, jaypee brothers publication, page no:546-550. Parthasarathy.a,”text book of iap textbook of pediatrics “,2 nd edition (2008), jaypee brothers publication page no:1330-1332 Parul dutta , “text book of pediatric nursing “,2 nd edition (2008) , jaypee brothers publication ,page no: 439-444

21. Thank you