CHILD HEALTH NURSING

Wilm’s tumor or Nephroblastoma

PRESENTED BY: Ms.VARSHAPRESENTED TO: Mrs.RAJITHA MAM

MANAGEMENT

MEDICAL MANAGEMENT Chemotherapy :

RADIOTHERAPY It is indicated for children with large

tumors ,metastasis , residual postoperative disease , unfavorable

histologic characterstics or recurrence .

PROGNOSIS Survival rates for wilm’s tumor are the

highest among all childhood cancers .Children with localised tumor(stage1&2)

have a 90% chances of cure with multimodal therapy .

Factors that favorably affect the success of further thearpy include initial treament with only vincristine and dactinomycin ,

relapse to the lungs only ,

Relapse in the abdomen of a patient who received no prior abdominal irradiation and

relapse more than 12 months after the diagnosis.

Wilm’s tumor may occur , especially in the lungs .

Both chemotherapy and radiotherapy can induce second malignancies , usuallly in

areas that have been irradiated.

SURGICAL MANAGEMENTSurgery is

scheluled as soon as

possible after confirmation

of a renal mass, usually awithin 24to

48hrs of admission .

TRANSABDOMINAL INCISION It is performed for optimal visualisation of the abdominal cavity . The tumor affected

kidney and adjacent adrenal gland are removed .

The contralateral kidney is carefully inspected for evidence of disease or

dysfunction . Regional lymph nodes are inspected ,

biopsy is performed when indicated . Any involved structures , such as part of

colon ,diphragm are removed .

PARTIAL AND TOTAL NEPHRECTOMY

If both kidneys are involved , the child may be treated with radiotherapy or

chemotherapy before surgery to decrease the size of tumor ,allowing more

conservative surgery . It may be possible partial nephrectomy on the less affected side of kidney ,with a total

nephrectomy on thepposite side . When a transplant is feasible such as forming a twin, sibling or parent bilateral

nephectomy is considered as a blast resort.

PARTIAL &TOTAL NEPHRECTOMY

PRE OPERATIVE CARE :-Assess and history taking .

Laboratory test .

POST OPERATIVE CARE :-