KIDNEY TUMOR/WILM’S

TUMOR/NEOBLASTOMA
DEFINITION:A MALIGNANT GROWTH IN THE
KIDNEY OR RENAL CELL CARCINOMA
CAUSES
CAUSES ARE UNKNOWN
PREDISPOSING FACTORS
 CIGARETTE SMOKING
 OCCUPATIONAL EXPOSURE TO TEXTILE DYES,
RUBBER, METALS, PAINT AND LEATHER
KIDNEY TUMOR/WILM’S TUMOR
PREDISPOSING FACTORS
FAMILY HISTORY
OTHER:
• GENETIC MUTATION
• GENETIC SYNDROMES WITH OTHER
GENETIC MUTATIONS
 KIDNEY TUMOR/WILM’S TUMOR
INCIDENCE
 IT IS THE MOST COMMON CHILDHOOD
ABDOMINAL MALIGNANCY
 A RELATIVELY RARE CANCER
 IT IS THE MOST COMMON CANCER OF THE CHILDREN
UNDER 6 YEARS
 ALSO COMMON BETWEEN 40 TO 70 YEARS
 IT OCCURS TWICE IN MEN AS IN WOMEN
 CURRENT TREARMENT APPROACHES HAVE IMPROVED
SURVIVAL RATES TO 80%-90%
KIDNEY TUMOR/WILM’S TUMOR
PATHOPHYSIOLOGY
GENE MUTATIONS
PRIMITIVE CELLS FAIL TO THRIVE
CLUSTER OF CELLS FORM IN KIDNEYS
THAT REMAIN PRIMITIVE
PRIMITIVE CELLS DIVIDE AT A RAPID RATE
(as in baby cell division)
KIDNEY TUMOR/WILM’S TUMOR
PATHOPHYSIOLOGY
 CELLS GROW OUT OF CONTROL, INVADING
BLOOD VESSELS
 CLUSTERS OF CELLS ACHIEVE ENOUGH MASS
ie CARCINOMA
 EXTENSIVE METASTASIS TO BONES, LUNGS,
LIVER
 KIDNEY TUMOR/WILM’S TUMOR
STAGING
STAGE 1
THE TUMOR IS LIMITED TO THE KIDNEY
 TUMOR MARGINS ARE WELL DEFINED AND
COMPRESS THE KIDNEY PARENCHYMA DURING
GROWTH.TUMOR IS SMALL
 UPPER POLE OF KIDNEY IS USUALLY INVOLVED
 RENAL CAPSULE IS INTACT
 KIDNEY TUMOR/WILM’S TUMOR
STAGING
STAGE 2
 TUMOR INVADES THE FAT SURROUNDING THE
KIDNEY.
 TUMOR IS CONFINED TO ONE MASS
STAGE 3
 TUMOR EXTENDS TO ADJACENT LYMPH NODES
EITHER THROUGH DIRECT EXTENSION OR
THROUGH THE RENAL VEIN OR LYMPHATICS
KIDNEY TUMOR/WILM’S TUMOR
STAGING :STAGE 4
THERE IS DISTANT METASTASIS ie TO THE
LUNGS, BONE OR LIVER, SPLEEN, OPPOSITE
KIDNEY OR BRAIN MAY BE INVOLVED
STAGE 5
BOTH KIDNEYS AFFECTED BY METASTASIS
TUMORS ORIGINATING FROM LUNGS AND
BREAST
KIDNEY TUMOR/WILM’S TUMOR
SIGNS AND SYMPTOMS
SYMPTOMS MAY NOT SHOW UNTIL THE MASS
IS QUITE LARGE
 PAINLESS HAEMATURIA WHICH IS OFTEN
INTEMITTENT, the most frequent sign
 DULL FRANK PAIN
 ABDOMINAL DISCOMFORT, from pressure,
anorexia, and loss of weight
KIDNEY TUMOR/WILM’S TUMOR
SIGNS AND SYMPTOMS contine
 UNEXPLAINED WEIGHT LOSS
 FEVER
 HYPERTENSION DUE TO STIMULATION OF
RETICULAR ACTIVATING SYSTEM
 PALPABLE KIDNEY MASS AS NEOPLASM
ENLARGES
 URETERIC COLIC DUE TO BLOOD CLOTS
KIDNEY TUMOR/WILM’S TUMOR
SIGNS AND SYMPTOMS contine
 GENERALISED IRRITABILITY AND CRANKINESS
 NAUSEA AND VOMITING
 ANOREXIA
 KIDNEY TUMOR/WILM’S TUMOR
DIAGNOSTIC STUDIES
 COMPREHENSIVE PHYSICAL EXAMINATION
 URINALYSIS
 BLOOD TESTS
IMAGING PROCADURES INCLUDE
 ULTRASOUND, IDENTIFIES SMALL TUMORS IN
PARENCHYMA
 COMPUTED TOMOGRAPHY (CT)
 MAGNETIC RESONANCE IMAGING (MRI)
KIDNEY TUMOR/WILM’S TUMOR
DIAGNOSTIC TESTS CONTINUE
 CT AND MRI CAN IDENTIFY PRESENCE, SIZE,
AND LOCATION OF THE TUMOR
 BIOPSY OF THE TUMOR FOR MICROSCOPIC
EXAMINATION
 RENAL ANGIOGRAPHY TO DIFFERENTIATE A
CYST FROM A TUMOR AND DETERMINE
EXTENT OF BLOOD VESSEL INVOLVEMENT
KIDNEY TUMOR/WILM’S TUMOR
MANAGEMENT
SURGERY
 IS THE TREATMENT OF CHOICE
 CONTRAINDICATED WHEN THERE ARE RISKS
WITH SURGERY
OR
 WHEN METASTSIS IS EXTENSIVE
KIDNEY TUMOR/WILM’S TUMOR
MANAGEMENT
NEPHRECTOMY
 IS SURGERY TO REMOVE THE AFFECTED
KIDNEY
 IT CAN BE DONE THROUGH TRANS-
ABDOMINAL, FLANK, LUMBAR, OR
THORACOABDOMINAL APPROACH
 KIDNEY TUMOR/WILM’S TUMOR
MANAGEMENT
SURGERY
NEPHRECTOMY
IS SURGERY TO REMOVE THE AFFECTED KIDNEY
OR SECTION OF THE KIDNEY
RADICAL NEPHRECTOMY
IS REMOVAL OF KIDNEY, ADRENAL
GLAND, PROXIMAL URETER, RENAL ARTERY
AND VEIN AND SURROUNDING FAT
KIDNEY TUMOR/WILM’S TUMOR
MANAGEMENT
SURGERY
PARTIAL NEPHRECTOMY
ONLY A PORTION OF A DISEASED KIDNEY IS
REMOVED AND A DRAIN PLACED TO REMOVE
SEROUS FLUID FROM THE PREVIOUSLY
OCCUPIED SPACE
KIDNEY TUMOR/WILM’S TUMOR
MANAGEMENT
SURGERY
OPEN NEPHRECTOMY
AN INCISION IS MADE THROUGH SEVERAL
LAYERS OF THE MUSCLES ON THE SIDE OR
FRONT OF THE ABDOMEN
KIDNEY TUMOR/WILM’S TUMOR
MANAGEMENT
SURGERY
LAPARASCOPIC NEPHRECTOMY
A MINIMALLY INVASIVE PROCEDURE THAT
UTILISES INSTRUMENTS ON LONG, NARROW
RODS TO VIEW, CUT AND REMOVE THE KIDNEY
KIDNEY TUMOR/WILM’S TUMOR
NEPHRECTOMY
RISKS
 INCLUDE
 INFECTION
 BLEEDING (HAEMORRHAGE)
 POST OPERATIVE PNEUMONIA
 KIDNEY FAILURE
 KIDNEY TUMOR/WILM’S TUMOR
MANAGEMENT
RADIATION THERAPY
 IS USED POSTOPERATIVELY FOR RESIDUAL OR
RECURRENT TUMORS
CHEMOTHERAPY
 SEVERAL CHEMOTHERAPEUTIC AGENTS ARE
USED
 IS IMPORTANT TO REDUCE PROGRESSION OF
CANCER AND CONTROL SYMPTOMS
 KIDNEY TUMOR/WILM’S TUMOR
NURSING CARE
PREOPERATIVELY
 HAVE ALL X-RAYS AVAILABLE FOR USE IN
PROCEDURE
 HAVE AVAILABLE UNITS OF BLOOD IN BLOOD
BANK
 DISCUSS OPERATIVE AND POSTOPERATIVE
EXPECTATIONS INLUDING LOCATION, AND
ANTICIPATED TUBES AND DRAINS
KIDNEY TUMOR/WILM’S TUMOR
NURSING CARE
PREOPERATIVELY
PREOPERATIVE TEACHING ABOUT
POST-OPERATIVE EXPECTATIONS TO
REDUCE ANXIETY FOR THE CLIENT AND
FAMILY
 KIDNEY TUMOR/WILM’S TUMOR
NURSING CARE
POST-OPERATIVELY
 ROUTINE POST-OPERATIVE CARE ie
 Observations,
 urine color amount and
Character, noting hematuria
 Op site evaluation for bleeding
noting drainage color and amount
KIDNEY TUMOR/WILM’S TUMOR
NURSING CARE
POST-OPERATIVELY
 REPORTOLIGURIA AND ANURIA
IMMEDIATELY
AND CHANGES IN URINE COLOR AND CLARITY
 FREQUENT ASSESSMENT OF REMAINING
KIDNEY FUNCTION TO ALLOW EARLY
INTERVENTION FOR POTENTIAL PROBLEMS
KIDNEY TUMOR/WILM’S TUMOR
NURSING CARE
POST-OPERATIVELY
 MAINTAIN GRAVITY DRAINAGE
 IRRIGATE AS ORDERED TO MAINTAIN
DRAINAGE TUBE PATENCY TO PREVENT
POTENTIAL HYDRONEPHROSIS
BRIGHT BLEEDING OR UNEXPECTED DRAINAGE
MAY INDICATE A SURGICAL COMPLICATION
 KIDNEY TUMOR/WILM’S TUMOR
NURSING CARE
POST-OPERATIVELY
 SUPPORT THE GRIEVING PROCESS AND
ADJUSTMENT TO LOSS A KIDNEY-CLIENT MAY
GRIEVE LOSS OF HEALTH AND POTENTIAL LOSS
OF LIFE
 ENCOURAGE PATIENT TO JOIN HOME
SUPPORT GROUPS
 KIDNEY TUMOR/WILM’S TUMOR
NURSING CARE
POST-OPERATIVELY
PATIENT EDUCATON ON
 IMPORTANCE OF PROTECTING THE REMAINING
KIDNEY BY PREVENTING INFECTIONS UTIs, RENAL
CALCULI AND TRAUMA
 MAINTAINING FLUID INTAKE OF 2000 TO 2500 mls
PER DAY TO PREVENT DEHYDRATION AND
MAINTAIN GOOD URINE FLOW