NurseSavvy Cheat SheetDisease
Wilms Tumor (Nephroblastoma)
Pathophysiology & Risk Factors
Wilms tumor, or nephroblastoma, arises from embryonic kidney tissue that failed to mature. It is the most common kidney cancer in children and is usually diagnosed between two and five years of age. The tumor grows inside a capsule, which is what makes it both survivable and fragile: while the capsule holds, the disease is contained, and once it is breached cancer cells can spread through the abdominal cavity. Most cases are sporadic, though a minority are associated with congenital anomalies of the genitourinary tract.
Signs & Symptoms
EarlyProgresses →
firm painless mass on one side of the abdomen Hallmark
usually found by a parent during bathing or dressingthe mass does not cross the midline Hallmark
unlike neuroblastoma, which often doesabdominal swelling
hypertension Hallmark
the tumor disturbs renal blood-pressure regulationblood in the urine
Late / Severe
fever and fatigue
weight loss
Interventions & Priorities
Suspected Wilms tumor — what happens in order
- Stop palpatingthe capsule must stay intact
- Sign on the bedso nobody examines the belly
- Tell the familyno bathing or handling over the mass
- Monitor blood pressurehypertension is common
- Prepare for surgerythe kidney is removed early
Treatments & Medications
surgical removal of the affected kidney Hallmark
usually performed soon after diagnosischemotherapy Hallmark
radiation therapy
for higher-stage diseaseantihypertensive treatment
Patient Teaching
do not press on or massage the child's abdomen Hallmark
the prognosis is generally very good Hallmark
protect the remaining kidney from injury and infection
no contact sports; report urinary symptomsexpect hair loss and nausea with chemotherapy
report fever during chemotherapy immediately
keep every oncology follow-up appointment
Report Nowescalate immediately
anyone palpating the abdomen before surgery Hallmark
sudden abdominal pain or a rapidly enlarging belly Hallmark
possible capsule rupture or bleedingrising blood pressure
visible blood in the urine
fever during chemotherapy
neutropenic fever is an emergencyClinical Pearl
Do not palpate the abdomen. Put the sign on the bed, tell the family, and tell every person who walks into the room.