04.03 Nephroblastoma

Hi guys, in this lesson we are going to talk about the pediatric cancer called nephroblastoma or Wilms Tumor.

Nephroblastoma is the most common renal tumor in children <5 years of age. Diagnosis usually peaks between 2-3 years.

Treatment is surgical followed by chemotherapy and radiation. It is very responsive to treatment and if the tumor is localized there is a 90% cure rate.

The first symptom is usually an abdominal mass. On palpation it is usually non-tender, firm, confined to one side and quite deep. The left kidney is affected more often than the right. Most of the time it is discovered by a parent while they are bathing or dressing their child.

Most of the time there aren’t any other noticeable symptoms, but sometimes the tumor pressing on the kidney can cause hematuria. The child may also be anemic if there is bleeding occurring inside the tumor. And blood pressure changes can happen because the additional renal cells found in the tumor are secreting extra adrenal hormones like, Renin, which can cause the blood pressure to go up.

Therapeutic management of Wilms Tumor usually starts with surgery. The tumor, the affected kidney and the adrenal gland are all removed. This is called a nephrectomy. This is followed by chemotherapy and radiation. Now, one thing to note is that treatment is usually started really quickly after the mass is found, like within 24-48 hours. So within 2 days of finding the tumor, the child is in surgery to have it removed, so there isn’t much time for families to process what is happening. Honestly these parents will look like deer in headlights, trying to process everything that’s happening - so make sure you are there to provide support and educate them on what is going on.

Nursing-wise you want to make sure that no one palpates the abdomen! This is so important that it’s worth putting a sign up over the bed. These tumors are usually encapsulated which means all those awful cancer cells are held in place and aren’t spreading all over the body. If the tumor is moved around too much it can break that capsule and spread those cancer cells. This means baths and patient movements need to be done gently as well.

It’s also important during this brief pre-op time to keep an eye on the blood pressure - which like I mentioned could be high because of increased renin production.

After surgery you’ll need to monitor bowel function and urine output closely. Remember this is an abdominal surgery so they are at risk for bowel obstruction. They have also lost a kidney so its important to monitor urine output closely. For most young kids this means weighing their diapers. When you are weighing diapers remember that 1 gram of weight on the scale is roughly equal to 1 ml - just make sure subtract the weight of a dry diaper.

After surgery, the patient will undergo chemotherapy and radiation. Your nursing interventions for these two things will be similar to those discussed in the pediatric leukemia lesson so listen to that one to hear more on those.

These kids will be monitored for the rest of their lives for complications associated with treatment and also for relapse. The most common location for a relapse is in the lungs.

Your priority nursing concepts for a pediatric patient with Nephroblastoma are Cellular Regulation, Elimination and Comfort.
Okay guys, that’s it for our lesson on Nephroblastoma or Wilms Tumor. This is a very straight forward lesson and it overlaps a lot with your other lessons on cancer so make sure you refresh on nursing care for chemotherapy and radiation if you need to. Your major take away points for this lesson are 1) Knowing that the tumor is growing from renal cells and is usually found on a kidney in kids ages 2-5 years. 2) The first, and sometimes only symptom is a abdominal mass. This mass is encapsulated, which is preventing it from spreading so remember, no one should be palpating the abdomen to make sure it stays encapsulated. 3) Treatment usually starts with a nephrectomy, which is removal of the tumor, kidney and adrenal gland, and it is major abdominal surgery so these patients need to be monitored closely for standard post op complications like a bowel obstruction. We also need to be monitoring their urine output and kidney function as they now only have one kidney.

That’s it for our lesson on the pediatric cancer, Nephroblastoma. Make sure you check out all the resources attached to this lesson. Now, go out and be your best self today. Happy Nursing!