- also called Nephroblastoma, the most common malignant tumor of the kidneys affecting children
- a large, encapsulated tumor that rises from the metanephric mesoderm cells of the upper pole of the kidney
- usually unilateral, usually develops in the renal parenchyma of the left kidney
- occurs in association with congenital anomalies such as aniridia, cryptorchidism, hypospadias, pseudohermaphoditism, cystic kidneys, hemangiomas, and talipes disorders
- peak age of occurrence is between 1-3 years, rarely occurs in children older than 8 y.o.
- firm, non-tender abdominal mass, usually midline near the liver--> usually discovered when a parent dresses or bathes child
- hematuria (blood in urine)
- low-grade fever
- hypertension-->due to increased renin production
- possible anemia, weight loss, malaise, anorexia, stomach pain, nausea, and vomiting
- diagnostic tests
2. chest CT Scan, chest MRI, sonogram, bone scan, and chest X-ray-->may be ordered
to determine spread beyond kidneys
3. kidney function studies (e.g. GFR and BUN)--> done prior to surgery
-Stage II (tumor extending beyond the kidney but completely removed surgically)
-Stage III (tumor has spread to the nearby lymphnodes and to other areas within the
abdomen and it can't be completely removed surgically)
-Stage IV (the tumor has spread to distant structures such as the lungs, liver, or bone
-Stage V (tumor is in both kidneys)
- Postsurgical radiation--> for stages II, III, and IV; stage I may require radiation depending on histologic studies
- Postsurgical chemotherapy--> dactinomycin, vincristine, or doxorubicin may be used and usually given at varying intervals for as long as 15 months
- Wilms' tumor is removed by nephrectomy (surgical removal of kidney tissue). It is usually performed 24-48 hours after diagnosis as Wilms' tumor metastasizes rapidly owing to the large blood supply of the kidneys and adrenal glands.
- Nephrectomy may be simple (entire kidney is removed), partial (removal of tumor and kidney tissue surrounding it, or radical (removal of the kidney, surrounding tissues, and neighboring lymph nodes).
- do NOT palpate the abdomen as palpation and handling aids in metastasis
- instruct caregivers to bathe and dress child with care
- provide care for a client with a nephrectomy--> focus on urine output assessment, avoidance of pulmonary complications, signs of complications (flank pain on unoperative site, unexplained weight gain, decreased urine output)
- provide care for client receiving chemotherapy and radiation therapy--> avoidance of infection, promote nutrition and hydration, and care of radiation site
Overall five-year survival rate is 89.5%. Patients with tumors of mostly differentiated epithelial cells have a long-term survival rate of 93%. Prognosis is best for patients below 2 years old with stage I small-sized tumors.
Wilms' tumor is not preventable