Neuroblastoma, Nephroblastoma

Neuroblastoma:

tumor of nerve tissue that develops in infants/children from the tissues that form the sympathetic nervous systems; in kidneys

Neuroblastomas can spread to:

lymph nodes, liver, bones, and bone marrow; anywhere w/ nerve tissues

S/S of neuroblastomas:

• most commonly detected by palpation → crosses the midline; it’s hard, painless and in the neck or abd

• masses of the thorax → seen on radiographs and are usually an incidental finding on a film to rule out pneumonia

• if large enough → the tumor can produce edema of the lower extremities r/t vascular compression

What’s unfortunate about a neuroblastoma dx?

75% of the pts have had spread of the cancer by the time it’s detected

Dx of a neuroblastoma:

MRI, CT; biopsy is the only clear dx; labs to detect catecholamine’s (these tumors produce these) → secreted in the urine

Nursing care for neuroblastomas:

complete nursing assessments to make sure the child doesn’t have an infection and that they’re remaining stable; pain relief; support of the child and fam on the dx; encourage fam to express their feelings about the dx

Medical care for neuroblastomas:

determined by the stage and age of child; initial tx - resection of the tumor followed by chemo; advanced - sometimes surgery can’t happen so they start w/ chemo; radiation CANNOT cure but it can help control tumor in conjunction w/ chemo and/or bone marrow transplant

Education/discharge for neuroblatsomas:

teach parents to → monitor incision site for infection, watch for fever, keep children away from large crowds and in ill ppl during the tx phase, comfort measures

Wilms’ tumor:

nephroblastoma; originates in one or both kidneys; cause is unknown

S/S of Wilms’ tumor:

abd mass that’s usually painless, hematuria, HTN, pain, aniridia, hemihypertrophy, urinary defects such as cryptorchidism and hypospadias

Aniridia:

basence of the iris

Hemihypertrophy:

increase in size in one half of the body

Dx of Wilms’ tumor:

tumor is usually discovered on a routine exam or when given a bath by a fam member (usually felt on one side); renal or abd ultrasound, CT, MRI, chest x-ray (if metastasis is suspected); ongoing labs and diagnostics → urine

Nursing care for Wilms’ tumor:

foods high in calories and protein, if child can’t eat → dietary supplements, allow child to choose foods, enteral or parenteral feeding may be provided if necessary

Medical care for Wilms’ tumor:

chemo and post-radiation

Sx care for Wilms’ tumor:

resection of tumor → usually taking the entire kidney and then a biopsy is performed

Post-op care for Wilms’ tumor:

postop assessment of the remaining kidney, typical postop measures, monitoring urine output (color, odor, clarity, amount, clots, pain, lab values)

Education/discharge for Wilms’ tumor:

monitor incision site, for fever, nutritional intake, BMs, importance of follow-up appointments