Diagnosis

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Wilms' tumor is a rare type of kidney cancer that primarily affects children. About one in every 10,000 children is affected by Wilms' tumor in the United States (Mar 23, 2018).

Wilms has a good survival rate, if caught early. However, many children, like Wills, go undetected for years and 10% do not respond to treatment as expected. 

The Wilms foundation of North America's goal is to ensure we cure 100% of children diagnosed. 

Wilms Cancer

Symptoms

The most common symptom of a Wilms’ tumour is a swollen stomach. This can occur quite suddenly and is usually painless to your child. Most Wilms' tumours are quite large when they are found. They are very often much bigger than the kidney itself. Fortunately, even though they are large, most of them have not spread to other parts of the body. Other less common symptoms include:

 

  • Bleeding inside the tumour causing pain

 

  • Blood in the urine – found in between 15 and 20 out of every 100 children (15 to 20%) with a Wilms' tumour

 

  • Raised blood pressure

 

  • High temperature (fever) and also regular low-grade fever (37.0-37.5)

 

  • Loss of appetite

 

  • Weight loss

 

  • Feeling or being sick

 

  • Shortness of breath and cough (only if the cancer has spread to the lungs)

 

  • Urinary symptoms

Diagnosis & Detection

The diagnosis of Wilms’ tumours usually involves a biopsy. A biopsy is where a sample of the tissue will be taken and examined under a microscope. Urine samples will be taken to check how your child’s kidneys are functioning and ultrasound or CT scans will be used to see whether the cancer has spread.

Treatment

The treatment of a Wilms’ tumour will depend on its size, whether or not it has spread to other parts of the body and the type of cells involved. In the USA children follow the NWTSG/COG protocol and are treated with surgery first and then chemotherapy. Children in Europe are usually treated with chemotherapy to shrink the tumour and then surgery.  Research has shown negliable differences between these two approaches.

Surgery

If possible, the tumour will be removed by surgery after a course of chemotherapy. This may involve removing part of or the entire kidney. Your child’s surgeon will aim to keep as much of the healthy kidney as possible. If Wilms’ tumours are in both kidneys then each kidney will be operated on separately.

Side-effects
Chemotherapy and radiotherapy

Chemotherapy involves using anti-cancer drugs to target the cancer cells. In the UK chemotherapy is given before surgery to shrink the tumour and then after surgery to stop the cancer from returning.


Radiotherapy may also be given, depending on the stage of the tumour. This involves targeting the tumour with high-energy rays.

If your child is undergoing chemotherapy, he or she may experience side-effects such as tiredness, sickness, diarrhoea and temporary hair loss. Your child may also be at greater risk of infections. Radiotherapy can also make your child feel tired and sick. He or she might experience skin irritation similar to sun burn and hair loss in the area that is being treated. Talk to your specialist or nurses about how you can manage these side-effects.

After treatment

Follow up

 

After your treatment is complete your child will still need to be seen regularly at an outpatient clinic. At this clinic, your child’s specialist will be looking for any signs that the cancer has returned (this is known as a relapse). They will also check that your child’s major organs, such as the heart and lungs, are still functioning correctly and haven’t been affected by the cancer treatment.

 

Long-term follow up

 

Once your child’s risk of relapse has reduced, the focus of on-going follow up changes to looking out for potential long term side effects of treatment. The risk of long term side effects depends on the type of cancer your child had and the treatment received. A personalized surveillance plan is usually created that outlines the specific long term follow up and on-going investigations that your child will require. Many people are at low risk of future health problems but some will have significant on-going health needs. Talk to your child’s specialist about the potential long-term side-effects of their treatment.

Long-term side-effects

 

When one kidney has been removed, the other will still function normally and will take over the work of the kidney that has been removed. Because Wilms’ tumours usually occur in one kidney only, very few children go on to have long-term kidney problems. Other late effects can include:

 

  • Heart or lung problems after receiving certain chemotherapy drugs or radiation therapy to these parts of the body

 

  • Slowed or decreased growth and development

 

  • Changes in sexual development and ability to have children (especially in girls)

 

  • Development of second cancers later in life (rare) 

Wills would like to personally thank the following organizations for there previous and current support:

Wilms Cancer Foundation of North America.

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