Audio Coursesby JellypodLesson 01 of 5
Overview
Mark Ellison: Hey everyone, welcome back to Nursing 101. I’m Mark Ellison, and today we’re putting kidney tumors under the microscope—well, not literally, but you get the idea. So, let’s start with some numbers. In the U.S., we see about 81,800 new cases of kidney tumors each year, and that includes both renal cell carcinoma—RCC for short—and other types. Sadly, around 14,890 people die from these cancers annually. That’s a lot of lives touched, and it’s why this topic matters so much for us as nurses.
Mark Ellison: Now, when we talk about kidney tumors, there’s a big difference between what we see in kids and adults. For children, Wilms tumor—also called nephroblastoma—is the most common. It actually makes up about 6% of all childhood cancers, which is, well, more than you might expect. Usually, it pops up in kids between two and five years old, and most of the time it’s just in one kidney, but it can be in both. The causes? Still kind of a mystery, though there’s a possible hereditary link.
Mark Ellison: In adults, it’s a different story. Renal cell carcinoma is the main player, and it tends to show up later in life. It’s less than 5% of all cancers in the U.S., but the numbers have been creeping up. Risk factors? The usual suspects—tobacco, genetics, certain jobs, and, interestingly, it’s more common in African American men.
Mark Ellison: I’ll never forget my first Wilms tumor patient. She was four, and her parents brought her in because they noticed a lump during bath time. I remember being more nervous than she was—she just sat there, calm as could be, clutching her stuffed giraffe. That moment really drove home how important early detection is, especially since these tumors can be sneaky and not show symptoms right away. And honestly, her bravery put my own nerves to shame.
Mark Ellison: So, what do these tumors actually look like in real life? Let’s start with Wilms tumor. A lot of times, kids don’t have any symptoms at all. When they do, it’s usually abdominal swelling or a mass—often off to one side of the belly. Sometimes there’s pain, maybe a bit of hematuria, which is blood in the urine, or even high blood pressure. That last one, hypertension, is thought to be from the tumor messing with the kidney’s blood flow and cranking up renin production. Oh, and don’t forget, you might see anemia or fever, and if it’s spread to the lungs, you could get chest pain or trouble breathing.
Mark Ellison: RCC in adults is a little different. Most folks don’t have any symptoms at all—about half of these cancers are found by accident, maybe during a scan for something else. But if there are signs, the classic one is painless hematuria. Sometimes there’s a dull ache in the back or a mass in the flank. Less commonly, you might see weight loss, anemia, or just general weakness, especially if the cancer’s already spread. I mean, it’s wild—sometimes the first clue is a symptom from a metastasis, not the kidney itself.
Mark Ellison: Diagnosing these tumors relies a lot on imaging. For Wilms tumor, we usually start with an abdominal ultrasound, then maybe a CT or MRI to check for spread. For RCC, CT and MRI are the gold standard—they help us figure out if the mass is malignant. Sometimes we’ll do a biopsy if things aren’t clear, or use IV urography to get a look at the urinary tract. Renal angiograms look at the renal vasculature or examine the blood flow- usually done prior to surgery to determine which veins and arteries are impacted. If they suspect metastasis a CXR and or liver function tests maybe completed. Remember these tests may be exhausting for patients already debilitated by the systemic effects of a tumor as well as for older patients and those who are anxious about the diagnosis and outcome so it is important as nurses we address clients physical, emotional, and mental needs. And staging is huge—it guides everything we do next.
Mark Ellison: I remember this one time, I was doing a routine physical on a guy who just wanted a refill on his blood pressure meds. He felt fine, but I noticed a little fullness in his flank. Long story short, it turned out to be RCC—he had no idea. That case really hammered home the value of thorough assessments. Sometimes, it’s the stuff you almost miss that matters most.
Mark Ellison: Alright, let’s talk treatment. For Wilms tumor, it’s usually a combo approach—surgery to remove the tumor, then chemotherapy, and sometimes radiation, especially if it’s a higher stage. The type of chemo and how long it lasts depends on the tumor’s histology and stage, but the prognosis is actually pretty good if it’s caught early and has favorable histology. We’re talking over 90% survival for stages one to three with favorable features. That’s, uh, pretty encouraging.
Mark Ellison: RCC is a bit trickier. If it’s localized, surgery—either partial or radical nephrectomy—is the mainstay, and it can be curative if there’s no spread. For more advanced or metastatic cases, we might use immunotherapy, like pembrolizumab, or even renal artery embolization if surgery isn’t an option. I am sure you are wondering what renal artery embolization is? During a renal artery embolization a catheter is advanced into the renal artery, and embolizing materials are injected into the artery to occlude the blood flow to the tumor mechanically. This decreases the local blood supply- (think ischemia and infarction here), making removal of the kidney (nephrectomy) easier.
Mark Ellison: Traditional chemo doesn’t really work for RCC, which is kind of frustrating, but immune checkpoint inhibitors are showing promise. On slide 75 of this week's learning guide you can find more information on some of the current research trials for RCC- be sure to check it out! Lastly, sometimes radiation is used, mostly for palliation.
Mark Ellison: Now that we have covered the various treatments let's talk complications. Complications that clients are at risk for relate to the client's treatment plan. For example, after a nephrectomy clients are at risk for postoperative nephrectomy complications. I know you already know what those from my previous episode. Clients are also at risk for complications of chemotherapy and radiation which was covered in nursing care 2. If you need to review the generalized complications of chemo and radiation you can find a link to a learning guide covering the very basics of caring for clients with any type of cancer on slide 76. Your faculty have also listed this learning guide in Canvas under this week's recitation module. And of course, these clients are at risk for the complications of metastasis and renal impairment- makes sense right?!
Mark Ellison: Now, nursing care—this is where we really make a difference. Nursing care is dependent on the client's treatment plan and the phase of treatment. Obviously, after surgery, monitoring is key- hopefully you remember this from my episode on renal surgery?! We’re watching for bleeding, infection, making sure urine output is good, and keeping an eye on electrolytes. We might also need to monitor for adverse effects of radiation and post infarction syndrome which can occur after a renal artery embolization. What is post infarction syndrome you ask?? It is experienced by clients typically for 2-3 days after a renal artery embolization. Signs and symptoms include abdominal or flank pain, low grade fever, and GI symptoms like nausea and vomiting. We typically treat it with supportive care such as IV fluids, tylenol, antiemetics you get the gist. If you are needing to review the adverse effects of the main types of cancer treatments as it was covered in Nursing Care 2 please see the learning guide. On slide 76 you will find a link to a learning guide which reviews the basics of caring for a client with cancer- hopefully most of this you recall! Now back to our roles as amazing nurses- As my good colleague Jackie always says education is huge, too—teaching patients and families about protecting the remaining kidney, avoiding contact sports, and signs or symptoms of complications to watch for. And, honestly, the emotional side can’t be ignored. Coping with cancer is tough, whether you’re four or forty.
Mark Ellison: I like to think of nursing care like roasting coffee—bear with me here. If you rush it, or don’t pay attention, you can ruin the whole batch. Too much intervention, and you might cause harm; too little, and you miss something important. It’s all about balance, patience, and a little bit of intuition. I mean, I still mess up a roast now and then, but with patients, you really want to get it right.
Mark Ellison: Alright, that’s our deep dive into kidney tumors for today. Thanks for sticking with me—these cases can be challenging, but they’re also where nurses shine brightest. Next time, we’ll tackle another big topic, so keep your coffee hot and your curiosity hotter. See you soon on Nursing 101. For references to this episode please see this week's learning guide located in Canvas.
