Description

The Wilms ' tumor is a rare type of kidney cancer that primarily affects children. Also known as nephroblastoma, is the most common cancer of the kidneys in children. Wilms ' tumor most often affects children ages 3 to 4. It is much less common after the age of 5, but can affect older children and adults.

The Wilms ' tumor mostly occurs in a single kidney. But sometimes it can be in both kidneys at the same time.

Through the years, advances in the diagnosis and treatment of Wilms ' tumor has greatly improved the prognosis for children with this disease. With treatment, the prognosis for most children with Wilms ' tumor is good.

Symptoms

The symptoms of Wilms tumor vary greatly. Some children don't seem to have any symptoms. But others with Wilms ' tumor have one or more of these symptoms:

  • A mass in the area of the stomach, which may be felt.
  • Swelling in the stomach area.
  • The pain in the stomach area.

Other symptoms may include:

  • Fever.
  • Blood in the urine.
  • Low red blood cell level, also known as anemia.
  • The high blood pressure.

When to see a doctor

Make an appointment with your doctor if you see symptoms that worry you. The Wilms ' tumor is rare. So it's likely that something else is causing the symptoms. But it is important to remove any concerns.

Causes

It is not clear what causes Wilms ' tumor.

Cancer begins when cells develop changes in their DNA. The cells DNA contains the instructions that tell cells what to do. The changes that tell the cells to grow and multiply quickly. Cancer cells live, while healthy cells die as part of their natural life cycle. With Wilms ' tumor, additional changes in the kidney cells that form the tumor.

Rarely, changes in the DNA passed from parents to children can increase the risk of Wilms tumor.

Risk factors

Factors that may increase the risk of Wilms tumor include:

  • Be Black. In North America and Europe, the Black children have a slightly higher risk of developing Wilms ' tumor, that the children of other races. Asian-American children seem to have a lower risk than children of other races.
  • Having a family history of Wilms ' tumor. Have someone in the family who had Wilms ' tumor, increases the risk of contracting the disease.

The Wilms ' tumor occurs most frequently in children who have certain conditions are present at birth, including:

  • Aniridia. In the aniridia (an-ih-RID-e-uh), the colored part of the eye known as the iris, forms, only in part, or not at all.
  • Hemihypertrophy. Hemihypertrophy (hem-e-hi-PUR-truth-rate) means one side of the body or a part of the body is bigger than the other side.

The Wilms ' tumor can occur as part of rare syndromes, including:

  • WAGR syndrome. This syndrome includes Wilms ' tumor, aniridia, genital and urinary system problems, and intellectual disability.
  • Denys-Drash Syndrome. This syndrome includes Wilms ' tumor, renal disease, and male pseudohermaphroditism (soo-do-your-MAF-roe-dit-iz-um). In male pseudohermaphroditism, a boy's genitals are not clearly male.
  • The Beckwith-Wiedemann syndrome. Children with this syndrome tend to be much larger than what is typical, known as macrosomia. This syndrome can cause organs in the stomach area, which is deep in the base of the umbilical cord, a large tongue, large internal organs, and the ears that form unusual form.

Prevention

The Wilms ' tumor can't be prevented.

If a child has any of the conditions that increase the risk of Wilms ' tumor, a health care provider may suggest that you make a kidney ultrasound at times to look for anything unusual in the kidneys. Although this test may not prevent the Wilms ' tumor, can help to detect the disease at an early stage.

Diagnosis

To diagnose Wilms ' tumor, a health care provider may take a history of the family and do the following:

  • A physical exam. The doctor will look for possible signs of a Wilms ' tumor.
  • Blood and urine tests. These lab tests can show how well the kidneys are working.
  • Imaging tests. The tests that create pictures of the kidneys help to find out if a child has a tumor in the kidney. Imaging tests may include ultrasound, computed tomography or magnetic resonance imaging and chest X-rays.

Cancer staging

After you find the Wilms ' tumor, the health care team may recommend other tests to see if the cancer has spread. This is called the stage of the cancer. A chest radiograph or a ct scan of the chest and bone scan can show if the cancer has spread beyond the kidney.

The stage of the cancer helps to decide the treatment. In the united States, the stages of Wilms ' tumor are:

  • Stage 1. The cancer is only in one of the kidneys. Surgery can remove everything.
  • Stage 2. The cancer has spread beyond the kidney, such as near the fat or blood vessels. But the surgery can remove everything.
  • Stage 3. The cancer has spread beyond the kidney to the nearby small bodies that fight infection, also known as lymph nodes. It may also have spread to other places within the abdomen. The cancer cells can leak into the abdomen before or during surgery, or surgery may not be able to remove all of the cancer.
  • Stage 4. The cancer has spread outside the kidney to other places in the body, like the lungs, liver, bones or brain.
  • Stage 5. Cancer cells are found in both kidneys. The tumor in each kidney is placed in the scene by itself.

Treatment

The treatment of Wilms ' tumor usually involves surgery and chemotherapy. Sometimes includes radiation therapy. The treatments depend on the stage of the cancer. Because this type of cancer is rare, a children's cancer center, which has dealt with this type of cancer might be a good option.

Surgery

The treatment of Wilms ' tumor can begin with the surgery to remove all or part of a kidney. The surgery also confirms the diagnosis. The tissue removed during surgery is sent to a lab to find out if it is cancerous, and what type of cancer tumor.

Surgery for Wilms ' tumor may include:

  • The removal of part of the kidney. Known as partial nephrectomy, this involves removing the tumor and a small part of the kidney around. This could be done if the cancer is very small, or for a child who only has one working kidney.
  • Remove the kidney and surrounding tissue. Known as the radical nephrectomy, this type of surgery also involves the removal of nearby lymph nodes, the part of the urethra and, sometimes, the adrenal gland. The kidney, the left can take on the work of both kidneys.
  • The removal of all or part of both kidneys. If the cancer affects both kidneys, the surgery involves removing as much of the cancer as possible of both. Sometimes, this means the removal of both kidneys. The child would then be the need for dialysis or a kidney transplant.

Chemotherapy

Chemotherapy uses strong drugs to kill cancer cells throughout the body. The treatment of Wilms ' tumor usually involves the use of more than one medicine to kill cancer cells. The medicine is given through a vein.

Side effects of chemotherapy depend on the drugs used. Common side effects include nausea, vomiting, loss of appetite, hair loss and an increased risk of infections. Ask your child's health care team what side effects can occur during treatment. Ask if you can have long-term problems as a result of treatment.

If administered before the surgery, the chemotherapy can shrink tumors and make them easier to remove. After the surgery, you may kill cancer cells that remain in the body. Chemotherapy may also be an option for children whose cancers are too far to be removed completely with surgery.

For children who have cancer in both kidneys, the chemotherapy is given before surgery. This may make it more likely that one of the kidneys to be saved.

Radiation therapy

Some children may have radiation therapy. Radiation therapy uses high-powered energy beams to kill cancer cells. The energy can come from X-rays, protons, and other sources.

During radiation therapy, the child is placed in a table. A large machine that moves around the child, pointing to the energy rays at the cancer. Possible side effects include nausea, diarrhea, fatigue, and sunburn-like skin irritation.

Some children have radiation therapy after surgery to destroy any cancer cells that are left. It can also be used to control the cancer that has spread to other areas of the body. Ask if you can have long-term problems as a result of the radiation therapy.

Coping and support

Here are some suggestions to help guide your family through a cancer treatment.

In the hospital

When your child has a medical appointment, or stays in the hospital:

  • Bring a favorite toy or book for office or clinic visits, to keep your child occupied while you wait.
  • Stay with your child during a test or treatment, if possible. Describe what is going to happen with the words that the child knows.
  • Include time of play in your child's schedule. The main hospitals tend to have a games room for the children that are being treated. Often, games room, staff training in child development, recreation, psychology, or social work. For children who must stay in their rooms, a child life specialist or recreational therapist might be able to visit.
  • Ask for the support of the clinic or the hospital staff members. Look for organizations of parents of children with cancer. Parents who have been through this can provide support, hope and good advice. Ask your child's health care team about local support groups.

Home

After leaving the hospital:

  • Monitor your child ' s level of energy out of the hospital. If your child feels well enough, urging you to take part in regular activities. Also make time for rest, especially after chemotherapy, or radiation.
  • Keep a daily record of your child's body temperature, energy level, sleep, medications used and the side effects. Share this information with your doctor.
  • Plan of a typical diet , unless your provider suggests otherwise. To make favorite food. Chemotherapy can affect the desire to eat. Increase fluids.
  • To promote the care of the mouth. A mouthwash may be useful to the sores or areas that are bleeding. Use the lip balm to soothe chapped lips. Ideally, your child should have needed dental care before starting the treatment. After consulting with your provider before scheduling the visits to the dentist.
  • Check with the provider prior to vaccination. Treatment for the cancer affects the immune system.
  • Talk to your other children about the disease. Tell them about the changes that could be seen in the child who has cancer, such as hair loss and low energy. Listen to their concerns.

Preparing for your appointment

If your child is diagnosed with Wilms tumor, you may be referred to a specialist. This could be a doctor who treats cancer, which is called an oncologist or a surgeon who specializes in surgery of the kidney, which is called a urologist.

What you can do

To prepare for the appointment:

  • Make a list of all the medications, vitamins, herbs, oils, and other supplements you are taking, including dosage.
  • Ask a family member or friend to come with you to help you remember the information that is obtained during the appointment.
  • Write a list of questions to ask your child's health care provider.

For Wilms ' tumor, some questions are:

  • What evidence does my child need?
  • What stage is my son's cancer?
  • What treatments are available, and which do you recommend?
  • What types of side effects from these treatments can cause?
  • I need to limit my child's activity or a change in the diet during the treatment?
  • What is my child's outlook?
  • What is the probability that the cancer will come back?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Don't hesitate to ask other questions you have.

What to expect from your doctor

Your child's health care provider is likely to ask you a questions, such as:

  • When he noticed the symptoms of your child?
  • There is a history of cancer, including childhood cancer, of your family?
  • Does your child have any family history of birth defects, especially of the genitals or urinary tract?
Symptoms and treatment of Wilms ' tumor