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Introduce the topic Review anatomy and physiology
Define wilms tumor
Review the incidence
Enumerate the pathophysiology
List out the causes
Describe the ways of spreads
List down the stages
Enlist the histological classification of wilms tumordiscuss symptoms of wilms tumorExplain the diagnostic evaluation
Enumerate the treatment modalities for wilms tumor
\
List out the complications
discuss the prognosis
Explain the nursing care
Summarize the topic
Conclude the topic
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2 mintsINTRODUCTION OF THE TOPIC Good morning everybody .let me introduce the topic it is metastatic cancer which affect mainly kidney. it is common in children and rare in adult . What is the topic?ANATOMY AND PHYSIOLOGY Anatomy of the female urinary system showing the kidneys, adrenal glands, ureters, bladder, and urethra. Urine is made in the renal tubules and collects in the renal pelvis of each kidney. The urine flows from the kidneys through the ureters to the bladder. The urine is stored in the bladder until it leaves the body through the urethra.
The kidneys are responsible for removing wastes from the body, regulating electrolyte balance and blood pressure, and stimulatingred blood cell productionIntroduction
Wilms' tumor or Wilms' tumour or nephroblastoma is cancer of the kidneys that typically occurs in children, rarely in adults. Its common name is an eponym, referring to Dr. Max Wilms, the German surgeon (18671918) who first described this kind of tumor.
Alternative Names
Nephroblastoma; Kidney tumorDEFINITION
Nephroblastomatosis is a condition in which abnormal tissue grows on the outer part of one or both kidneys. Children with this condition are at risk for developing a type of Wilms tumor that grows quickly. Frequent follow-up testing is important for at least 7 years after the child is treated.
Incidence
Approximately 500 cases are diagnosed in the U.S. annually.The majority (75%) occurs in otherwise normal children; a minority (25%) is associated with other developmental abnormalities. The disease occurs in about 1 out of 200,000 to 250,000 children. It usually strikes when a child is about 3 years old. It rarely develops after age 8.
It is highly responsive to treatment, with about 90% of patients surviving at least five years.
Most nephroblastomas are unilateral, being bilateral in less than 5% of cases. They tend to be encapsulated and vascularized tumors that do not cross the midline of the abdomen. In cases of metastasis it is usually to the lung. A rupture of Wilms' tumor puts the patient at risk of hemorrhage and peritoneal dissemination of the tumor. In such cases, surgical intervention by a surgeon who is experienced in the removal of such a fragile tumor is imperative.
PATHOPHYSIOLOGY
When an unborn baby is developing, the kidneys are formed from primitive cells. Over time, these cells become more specialized. The cells mature and organize into the normal kidney structure. Sometimes, clumps of these cells remain in their original, primitive form. If these cells begin to multiply after birth, they may ultimately form a large mass of abnormal cells. This is known as a Wilms' tumor.
Wilms' tumor is a type of malignant tumor. This means that it is made up of cells that are significantly immature and abnormal. These cells are also capable of invading nearby structures within the kidney and traveling out of the kidney into other structures. Malignant cells can even travel through the body to invade other organ systems, most commonly the lungs and brain. These features of Wilms' tumor make it a type of cancer that, without treatment, would eventually cause death. However, advances in medicine during the last 20 years have made Wilms' tumor a very treatable form of cancer.
Wilms' tumor occurs almost exclusively in young children. The average patient is about three years old, although cases have been reported in infants younger than six months and adults in their early twenties. Females are only slightly more likely than males to develop Wilms' tumors. In the United States, Wilms' tumor occurs in 8.3 individuals per million in white children under the age of 15 years. The rate is higher among African-Americans and lower among Asian-Americans.
Causes and risk factorsThe cause of Wilms' tumor is not completely understood. Because 15% of all patients with this type of tumor have other heritable defects, it seems clear that at least some cases of Wilms' tumor are due to an inherited alteration. A genetic defect known as WT1, the Wilms' tumor suppressor gene has been identified in some patients on chromosome 11.Wilms tumor is the most common form of childhood kidney cancer. The exact cause of this tumor in most children is unknown.
It is more common among some siblings and twins, which suggests a possible genetic cause. It appears that the tendency to develop a Wilms' tumor can run in families. In fact, about 1.5% of all children with a Wilms' tumor have family members who have also had a Wilms' tumor. The genetic mechanisms associated with the disease are unusually complex; it is thought as of 2004 that the tumor develops because the defective WT1 gene fails to stop its growth. Other genes that have been linked to Wilms' tumor are located on chromosomes 16q, 7p15, and 17q12.
Wilms' tumors are found more commonly in patients with other types of birth defects.These defects include:
Absence of the colored part (the iris) of the eye (aniridia)
enlargement of one arm, one leg, or half of the face (hemihypertrophy)
certain birth defects of the urinary system or genitals
certain genetic syndromes (WAGR syndrome, Denys-Drash syndrome, and Beckwith-Wiedemann syndrome) WAGR syndrome (Wilms tumor, aniridia, abnormal genitourinary system, and mental retardation).
Cryptorchidism.
Hypospadias.
Pathologically, a triphasic nephroblastoma comprises three elements:
blastema
mesenchyme
epithelium
Wilms' tumor is a malignant tumor containing metanephric blastema, stromal and epithelial derivatives.Characteristic is the presence of abortive tubules and glomeruli surrounded by a spindled cell stroma. The stroma may include striated muscle, cartilage, bone, fat tissue, fibrous tissue. The tumor is compressing the normal kidney parenchyma.
The mesenchymal component may include cells showing rhabdomyoid differentiation. The rhabdomyoid component may itself show features of malignancy (rhabdomyosarcomatous Wilms)THERE ARE THREE WAYS THAT CANCER SPREADS IN THE BODY. Through tissue. Cancer invades the surrounding normal tissue.
Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
when cancer cells break away from the primary (original) tumor and ravel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
STAGES Stage IIn stage I-the tumor was completely removed by surgery and all of the following are true:
Cancer was found only in the kidney and did not spread to blood vessels of the kidney.
The outer layer of the kidney did not break open.
The tumor did not break open.
A biopsy of the tumor was not done.
No cancer cells were found at the edges of the area where the tumor was removed.
Stage IIIn stage II, the tumor was completely removed by surgery and no cancer cells were found at the edges of the area where the cancer was removed. Before the tumor was removed, one of the following was true:
Cancer had spread out of the kidney to nearby soft tissue.
Cancer had spread to blood vessels of the kidney.
Stage IIIIn stage III, cancer remains in the abdomen after surgery and at least one of the following is true:
Cancer spread to lymph nodes in the abdomen or pelvis (the part of the body between the hips).
Cancer spread to or through the surface of the peritoneum (the layer of tissue that lines the abdominal cavity and covers most organs in the abdomen).
Chemotherapy was given before surgery and a biopsy of the tumor was done during surgery to remove it.
The tumor broke open before or during surgery to remove it.
The tumor was removed in more than one piece.
Stage IVIn stage IV, cancer has spread through the blood to organs such as the lungs, liver, bone, or brain, or to lymph nodes outside of the abdomen and pelvis.
Stage V and those at high risk of developing Wilms tumorIn stage V, cancer cells are found in both kidneys when the disease is first diagnosed In addition to the stages, Wilms tumors are described by their histology.
HISTOLOGICAL CLASSIFICATION OF WILMS TUMORThe histology (how the cells look under a microscope) of the tumor affects the prognosis and the treatment of Wilms tumor. The histology may be favorable or anaplastic (unfavorable). Tumors with a favorable
Histology has a better prognosis and respond better to chemotherapy than those with anaplastic histology. Tumor cells that are anaplastic divide rapidly and do not look like the type of cells they came from. Anaplastic tumors are harder to treat with chemotherapy than other Wilms tumors at the same stage.
SYMPTOMSAbdominal pain
Constipation
Fever
General discomfort or uneasiness (malaise)
High blood pressure
Increased growth on only one side of the body
Loss of appetite
Nausea
Swelling in the abdomen (abdominal hernia or mass)
Vomiting
Note: Abnormal urine colour may also be associated with this disease.
DIAGNOSISChildren with Wilms' tumor generally first present to physicians with a swollen abdomen or with an obvious abdominal mass. The physician may also find that the child has fever, bloody urine, or abdominal pain. The physician will order a variety of tests before imaging is performed. These tests mostly involve blood analysis in the form of a white blood cell count, complete blood count, platelet count, and serum calcium evaluation. Liver and kidney function testing will also be performed as well as a urinalysis. Tests include:
Abdominal ultrasound
Abdominal x-ray
BUN
Complete blood count (may show anemia)
Creatinine
Creatinine clearance
CT scan of the abdomen
Intravenous pyelogram
UrinalysisInitial diagnosis of Wilms' tumor is made by looking at the tumor using various imaging techniques. Ultrasound and computed tomography scans (CT scans) are helpful in diagnosing Wilms' tumor. Intravenous pyelography, where a dye injected into a vein helps show the structures of the kidney, can also be used in diagnosing this type of tumor. Final diagnosis, however, depends on obtaining a tissue sample from the mass (biopsy), and examining it under a microscope in order to verify that it has the characteristics of a Wilms' tumor. This biopsy is usually done during surgery to remove or decrease the size of the tumor. Other studies (chest x rays, CT scan of the lungs, bone marrow biopsy) may also be done in order to see if the tumor has spread to other locations. Blood in the urine occurs in less than 25% of children.
TREATMENT Staging and treatment
Staging is determined by combination of imaging studies and pathology findings if the tumor is operable (adapted from www.cancer.gov). Treatment strategy is determined by the stage:
Stage I (43% of patients)
For stage I Wilms' tumor, 1 or more of the following criteria must be met:
Tumor is limited to the kidney and is completely excised.
The surface of the renal capsule is intact.
The tumor is not ruptured or biopsied (open or needle) prior to removal.
No involvement of renal sinus vessels.
No residual tumor apparent beyond the margins of excision.
Treatment: Nephrectomy +/- 18 weeks of chemotherapy depending on age of patient and weight of tumor. EG: less than 2 years old and less than 550g only requires Nephrectomy with observation
Outcome: 98% 4-year survival; 85% 4-year survival if anaplastic[ Stage II (23% of patients)
For Stage II Wilms' tumor, 1 or more of the following criteria must be met:
Tumor extends beyond the kidney but is completely excised.
No residual tumor apparent at or beyond the margins of excision.
Any of the following conditions may also exist:
Tumor involvement of the blood vessels of the renal sinus and/or outside the renal parenchyma.
The tumor has been biopsied prior to removal or there is local spillage of tumor during surgery, confined to the flank.
Treatment: Nephrectomy + abdominal radiation + 24 weeks of chemotherapy
Outcome: 96% 4-year survival; 70% 4-year survival if anaplastic
Stage III (23% of patients)
For Stage III Wilms' tumor, 1 or more of the following criteria must be met:
Unresectable primary tumor.
Lymph node metastasis.
Positive surgical margins.
Tumor spillage involving peritoneal surfaces either before or during surgery, or transected tumor thrombus.
Treatment: Abdominal radiation + 24 weeks of chemotherapy + nephrectomy after tumor shrinkage
Outcome: 95% 4-year survival; 56% 4-year survival if anaplastic
Stage IV (10% of patients)
Stage IV Wilms' tumor is defined as the presence of hematogenous metastases (lung, liver, bone, or brain), or lymph node metastases outside the abdomenopelvic region.
Treatment: Nephrectomy + abdominal radiation + 24 weeks of chemotherapy + radiation of metastatic site as appropriate
Outcome: 90% 4-year survival; 17% 4-year survival if anaplastic
Stage V (5% of patients)
Stage V Wilms tumor is defined as bilateral renal involvement at the time of initial diagnosis. Note: For patients with bilateral involvement, an attempt should be made to stage each side according to the above criteria (stage I to III) on the basis of extent of disease prior to biopsy. The 4-year survival was 94% for those patients whose most advanced lesion was stage I or stage II; 76% for those whose most advanced lesion was stage III.
Treatment: Individualized therapy based on tumor burden
Stage I-IV Anaplasia
Children with stage I anaplastic tumors have an excellent prognosis (80-90% five-year survival). They can be managed with the same regimen given to stage I favorable histology patients.
Children with stage II through stage IV diffuse anaplasia, however, represent a higher-risk group. These tumors are more resistant to the chemotherapy traditionally used in children with Wilms tumor (favorable histology), and require more aggressive regimens.
Four types of standard treatment are used:
SurgeryRadiation therapyChemotherapyBiologic therapyNew types of treatment are being tested in clinical trials.
Watchful waitingHigh-dose chemotherapy with stem cell transplantFour types of standard treatment are used:SURGERYWilms tumor and other childhood kidney tumors are usually treated with nephrectomy (surgery to remove the whole kidney). Nearby lymph nodes may also be removed.
If cancer is found in both kidneys, surgery may include a partial nephrectomy (removal of the cancer in the kidney and a small amount of normal tissue around it). Partial nephrectomy is done to keep the kidney working.
In the United States, treatment for Wilms' tumor almost always begins with surgery to remove or decrease the size of the kidney tumor. Except in patients who have tumors in both kidneys, this surgery usually will require complete removal of the affected kidney. During surgery, the surrounding lymph nodes, the area around the kidneys, and the entire abdomen will also be examined. While the tumor can spread to these surrounding areas, it is less likely to do so compare to other types of cancer. In cases where the tumor affects both kidneys, surgeons will try to preserve the kidney with the smaller tumor by removing only a portion of the kidney, if possible. Additional biopsies of these areas may be done to see if the cancer has spread. The next treatment steps depend on whether/where the cancer has spread. Samples of the tumor are also examined under a microscope to determine particular characteristics of the cells making up the tumour.
Chemotherapy may be given before surgery to make the tumor smaller so less kidney tissue needs to be removed and there are fewer problems after surgery. This is called neoadjuvant chemotherapy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Sometimes, a second-look surgery is done to see if cancer remains after chemotherapy or radiation therapy.
Information about the tumor cell type and the spread of the tumor is used to decide the best kind of treatment for a particular patient. Treatment is usually a combination of surgery, medications used to kill cancer cells (chemotherapy), and x rays or other high-energy rays used to kill cancer cells (radiation therapy). These therapies are called adjuvant therapies, and this type of combination therapy has been shown to substantially improve outcome in patients with Wilms' tumor. It has long been known that Wilms' tumors respond to radiation therapy.
RADIATION THERAPY Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated and whether a biopsy was done before surgery to remove the tumor.
CHEMOTHERAPY Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Combination chemotherapy is treatment using two or more anticancer drugs. some types of chemotherapy have been found to be effective in treating Wilms' tumor. These effective drugs include dactinomycin, doxorubicin, vincristine, and cyclophosphamide. In rare cases, bone marrow transplantation may be used.
BIOLOGIC THERAPY Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
New types of treatment are being tested in clinical trials..
WATCHFUL WAITING Watchful waiting is closely monitoring a patients condition without giving any treatment until symptoms appear or change.
HIGH-DOSE CHEMOTHERAPY WITH STEM CELL TRANSPLANT. High-dose chemotherapy with stem cell transplant is a method of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These re-infused stem cells grow into (and restore) the body's blood cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
FOLLOW-UP TESTS MAY BE NEEDED. Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
COMPLICATIONS The tumor may become quite large, but usually remains self-enclosed. Spread of the tumor to the lungs, liver, bone, or brain is the most worrisome complication. High blood pressure and kidney damage may occur as the result of the tumor or its treatment.
Removal of Wilms tumor from both kidneys may affect kidney function.
PROGNOSISTumor-specific loss-of-heterozygosity (LOH) for chromosomes 1p and 16q identifies a subset of Wilms' tumor patients who have a significantly increased risk of relapse and death. LOH for these chromosomal regions can now be used as an independent prognostic factor together with disease stage to target intensity of treatment to risk of treatment failure. Genome-wide copy number and LOH status can be assessed with virtual karyotyping of tumor cells (fresh or paraffin-embedded). The overall prognosis with surgical removal is positive. Early removal tends to promote positive outcomes.Certain factors affect prognosis (chance of recovery) and treatment options.The prognosis (chance of recovery) and treatment options depend on the following:
How different the tumor cells are from normal kidney cells.
The stage of the cancer.
The type and size of the tumor.
The age of the child.
Whether the tumor can be completely removed in surgery.
Whether the cancer has just been diagnosed or has recurred (come back).
Whether there are any abnormal chromosomes or genes.
Whether the patient is treated by paediatric experts with sexperience in treating patients with Wilms tumor. NURSING CARE
PREOPERATIVE CARE
Provide routine preoperative care . Report abnormal laboratory values to the surgeon.
Bacteriuria, blood coagulation abnormalities, or other significant
abnormal values may affect surgery and postoperative
care.
Discuss operative and postoperative expectations as indicated,
including the location of the incision and
anticipated tubes, stents, and drains. Preoperative teachingabout postoperative expectations reduces anxiety for the client and family during the early postoperative period.
POSTOPERATIVE CARE
Provide routine postoperative care Frequently assess urine color, amount, and character, noting
any hematuria, pyuria, or sediment. Promptly report oliguria
or anuria,as well as changes in urine color or clarity. Preserving
function of the remaining kidney is critical; frequent assessment
allows early intervention for potential problems.
Note the placement, status, and drainage from ureteralCatheters, stents, nephrostomy tubes, or drains. Label each
clearly. Maintain gravity drainage; irrigate only as ordered.
Maintaining drainage tube patency is vital to prevent potential
hydronephrosis.Bright bleeding or unexpected drainage may indicate
a surgical complication.
Support the grieving process and adjustment to the loss of a
kidney. Loss of a major organ leads to a body image change and
grief response. When renal cancer is the underlying diagnosis,
the client may also grieve the loss of health and potential loss
of life.
Provide the following home care instructions for the client
and family.
a. Teach the importance of protecting the remaining kidney
by preventing UTI, renal calculi, and trauma. See
Chapter 26 for measures to prevent UTI and calculi.
Damage to the remaining kidney by UTI, renal calculi, or
trauma can lead to renal failure.
b. Maintain a fluid intake of 2000 to 2500 mL per day. This
important measure helps prevent dehydration and maintain
good urine flow.
c. Gradually increase exercise to tolerance, avoiding heavy
lifting for a year after surgery. Participation in contact
sports is not recommended to reduce the risk of injury
to the remaining kidney. Lifting is avoided to allow full tissue
healing. Trauma to the remaining kidney could seriously
jeopardize renal function.
d. Teach care of the incision and any remaining drainage
tubes, catheters, or stents. This routine postoperative instruction
is vital to prepare the client for self-care and prevent
complications.
e. Instruct to report signs and symptoms to the physician,
including manifestations of UTI (dysuria, frequency, urgency,
nocturia, cloudy, malodorous urine) or systemic
infection (fever, general malaise, fatigue), redness,
swelling, pain, or drainage from the incision or any
catheter or drain tube site. Prompt treatment of postoperative
infection is vital to allow continued healing and prevent compromise of the remaining kidneyHOME CARE
Before leaving the hospital
Before leaving the hospital, your childs nurse will explain to you the medications your child will take home. It is important that your child takes the medicine as prescribed until the doctor says it is all right to stop.
Eating and drinking as usual
While at home, encourage your child to drink plenty of fluids. There are no restrictions on what your child can eat.
Changing your childs bandage
Change your childs bandage every day for2 to 3days, then you may leave it off unless otherwise instructed.
Bathing
Your child should be able to bathe normally when you go home. Check with your nurse about this before you leave.Going back to regular activitiesMake sure your child avoids rough play or contact sports until your follow-up appointment.
Your child may go back to school 1 week after coming home from hospital.Your childshould be excused from gym class until the after follow-up appointment. It is normal for your child to need extra rest during the first few days at home.
Who to call if you have any concerns
If you have questions about your childs care while you are at home, call the Urology clinic at the hospital where you child had the surgery.
Write down the phone number of your child's Urology clinic here:SUMMARY So for we have discussed definition , incidence , causes , types ,transmission , stages , pathophysiology , signs and symptoms investigation , management and nursing management of Wilms timor. CONCLUSIONS
Wilms tumor is malignant types of the cancer and can spreads to other part of the body. It is highly responsive to treatment.
POST EVALUATION
1. What are all the causes of wilms tumor?
2. explain the stages of wilms tumor?
3. What are the syptoms of wilms tumor?
4. What are all the treatment modalitie for wilms tumor?BIBLIOGRAPHY1. Hocken et al wongs essetial paediatric nursing , 6 th edition ,lippincott publications
2. Marulow et al text book of paediatric nursing, 6 th edition, cbs publications.3. Www. Ggogle com Introduce the topicAsking questions and explaining
explaining
Explaining
Explaining with OHP
questioning and explainingExplainig
Explainig with chart
Explaining
Questioning and explaining
Explaining with black board
Questioning and ExplainingQuestioning and explainig
Explainig
Questioning and explaining
Summarize the topic
conclude the topic
questioning
Listening and answering
Listening and answeringListening and taking notes
Listening and taking notes
Listening and taking notes
Anwsering and listening
Listening and taking notes
Listening &taking notes
L
istening
Answering and listeningListening and taking notes
Listening
Answering and listening
Answering and listening
Listening and taking notes
Answering
and listening
Answering
What is the function of the kidney?
Define wilms tumor ?
how the wilms tumor occur?
What are all the causes of wilms tumor?
How the cancer spreads from one organ to another organ?
What are all the stages of wilms tumor?
List out histological classification of wilms tumor?
What are all the syptoms of wilm Tumor?How can diagnosis wilm tumor?
What are all the treatment for wilms tumor?
What are all
The complications of wilm tumor?
What is the nursing measure wilms tumor?
LESSON PLAN ON WILMS TUMOURNAME OF THE TEACHER: MS G.SARITHA
SUBJECT : CHILD HEALTH NURSING
UNIT : IV
TOPIC : WILMS TUMOR
DURATION : 1 HOUR CLASS : 3 rd Year
NO OF STUNENTS : 43
TEACHING METHOD : LECTURE CUM DICUSSION TEACHING AIDS : BLACK BOARD, OHP & CHERTS
VENUE : LECTURE HALL-3GENERAL OBJECTIVES:
At the end of the class the students will be able to acquire knowledge regarding Wilms tumor and they can be able to apply this knowledge, develop attitude and skills in practicing these in their day today life both personal and professional career.
SPECIFIC OBJECTIVES:
At the end of the class the students will be able to
define wilms tumor
review the incidence of wilm tumor
list out causes of wilms tumor
enumerate pathophysiology of Wilms tumor
describe way of spreads of cancer
list down stages of Wilms tumor
enlist hislogical classification of wilms tumor
discuss symptoms of wilms tumor
explain the diagnostic evaluation of wilms tumor List out the complications Enumerate the treatment modalities for Wilms tumor List out the complications discuss the prognosis explain the nursing care
.
LESSON PLANONWILMS TUMOR
