Wilms Tumor

Cassidy Tigner
2 year old female treated at Vault 6
at the James
 Medical History Social History

Recently moved from

Delaware to Hilliard, OH.
Besides the Wilms tumor, patient has had unremarkable medical
history
Has a brother and sister that
also live with her parents.
No tobacco, alcohol or drug
abuse.
 Surgical History

Left nephrectomy (8/23/2016)

Could no fully resect the tumor because the IMA and L colonic
vasculature were enveloped by the disease
Presenting Signs & Symptoms

On August 17th, patient had decreasing appetite and abdominal pain.

Mother reported that the patient was more fussy, guarded her abdomen
and gradually developed abdominal distension
Epidemiology & Etiology
Diagnostic studies

Ultrasound of Abdomen in Emergency Department

Showed 12 cm mass in Left Lower Quadrant
CT of Chest/Abdomen/Pelvis
Showed hemoperitoneum and resulting ileus.
Hemoperitoneum- presence of blood in the abdominal cavity, specifically the
peritoneum.
Ileus- lack of movement in the intestines that could cause constipation and
blockage
Anatomy
Histopathology

Wilms tumors are malignant embryonal carcinomas of the kidney

Also known as nephroblastoma
Stage III

Residual nonhematogenous tumor confined to abdomen

Involved lymph nodes, diffuse tumor spillage or grossly unresected
tumor
Treatment

Most Common My Patient

Left Nephrectomy followed
by radiation and chemo.
Chemo: vincristine/D-
actinomycin
1st choice = nephrectomy

Followed by radiation by day 9 of chemo for later stage diseases

RT: 1050cGy in 7 fractions to
Chemo: actinomycin-D, vincristine & doxorubicin the whole abdomen with
RT: full field to1080cGy followed by boost to another 1080cGy boost to 1080cGy in 6
fractions
First day of chemo was on
9/06/16 and her first
treatment was on 9/07/16
Treatment Plan
Patient Positioning

A headrest
Arms akimbo and taped to the table
Legs straight

Difficulties:
Not much immobilization
Patient was under anesthesia and would sometimes move erratically
Possible Side Effects

Acute Chronic

Effects on bone growth

Skin redness/peelings
(spine)

Tiredness

Diarrhea/loose stool Damage to the kidney, liver

Nausea/vomiting
and bowels (rare)
Elevated liver enzymes

Low blood counts Second malignancy (very

rare)
Prognosis and Survival
Possible Metastatic Sites

Contralateral kidney
Lung
Lymph nodes (0/19)
Patient Viewpoints

Patients mother was apprehensive at first about going through with the
radiation. She was worried about side effects and infertility down the
line.
After she heard the benefits of the treatment she decided to proceed
with treatments.
Mother seems overwhelmed with two other children at home and a 2
year old being under treatment for cancer

Progress note informs us that the patient is in good spirits, sitting up in

bed coloring, alert and shows no erythema thus far in the treatment
area.
References

Hackworth R. Pediatric Tumor Presentation. 2016

Bussman-Yeakel L, Washington CM, Leaver D. Principles and Practices of
Radiation Therapy. 4th Edition. St. Louis, Missouri: Elsevier Inc.; 2016