Wilms Tumor

About Wilms Tumor

It is the common kidney (renal) tumor in children seen around 2 years of age but can occur anytime below 5 years of age. It can rarely occur in older age groups. It can develop in a healthy child and in about 10% can be associated with syndrome where some other physical signs are present to give a hint of it.

 

How does it present

Abdominal mass – noted by parents or routine examination by your doctor
Abdominal pain
Hematuria – blood in urine
Hypertension (25%)- increase in blood pressure
Anorexia/Vomiting/Malaise

Certain syndromes can be associated with Wilms tumors like WAGR or Denys-Drash syndrome. They can have the following features-
 genitourinary malformation (hypospadias, cryptorchidism etc),
 aniridia,
 Hemihypertrophy/ overgrowth syndromes

Other tumors can look like Wilms tumor
Kidney tumor other than Wilms tumor
Leukemia and Burkitt lymphoma.
Neuroblastoma and other adrenal gland tumors

 

How to Diagnose

Laboratory investigation
Routine blood investigations will help to assess the overall clinical condition of a child Imaging.

Mostly commonly Ultrasound examination is done at first to see the nature of mass and once confirmed computed tomography (CT) scan is done. It helps to identify organ from which tumor is arising and its extent to other organs, major blood vessels and if it has gone to other organs of the body. It allows for the examination of the other kidney to rule out disease in it and rarely if the other kidney is absent. MRI can also be used for evaluating the disease. Till now there no evidence of doing Positron emission tomography (PET) scan in new case of Wilms tumor.

Biopsy – if your surgeon feels that on tumor cannot be easily removed then some tumor tissue is taken out (biopsy) to confirm about the tumor type. This is done under anesthesia/sedation using ultrasonography or CT scan. The chemotherapy is then started to decrease the size of the tumor. The tumor is operated later after 4-6 weeks of chemotherapy.

Surgery- if your surgeon plans to take out tumor after seeing your scans the treatment (chemotherapy) is started after that.

 

Staging

Local staging (stage1-3) of Wilms tumor is done after the removed from the body, depending on the local extent of the tumor. If the tumor has gone to other organs like the lungs and liver it is stage 4. Treatment is the planned accordingly to stage which would include chemotherapy with or without radiotherapy.

 

Treatment

The treatment of Wilms tumor involves surgery, chemotherapy with or without radiotherapy. The surgery can be done upfront or after chemotherapy after evaluating the extent of the tumor on the CT scans. Both ways the outcome are equal and is decided by the team managing your child.

 

Outcomes

The Wilms tumor has very good outcomes with lower stage (1-2) having 5 years survival of more than 90%. The outcome for stage 3-4 varies between 60-80% depending on the good or bad biology of the tumor.

 

To remember

Wilms tumor is a common renal tumor.
Awareness is important to identify a tumor in the early stage. It has a good outcome if proper treatment is taken.

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