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Wilms' Tumour

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Wilms tumor is also known as nephroblastoma. It is common kidney cancer and the fourth most common childhood cancer. Almost 90% of kidney cancers in children are nephroblastoma. In most cases, this cancer affects only one kidney. However, both kidneys are affected with nephroblastoma in 5% of the cases. It mostly affects children who are aged between 3 to 4 years old. It is less common in children over the age of 5 years.

Types of Wilms Tumour

There are two types of Wilms tumors depending upon the appearance of cells under the microscope.

  • Favorable histology: It is most common and accounts for 90% of total Wilms tumor cases. Children of this type have a favorable prognosis.
  • Anaplastic or unfavorable histology: There is a deformed appearance of cancerous cells under the microscope. This type is hard to cure.

Symptoms of Wilms Tumour

Some of the symptoms of Wilms tumor are:

  • Abdominal pain and swelling
  • Presence of abdominal mass
  • Constipation
  • Blood in urine
  • Shortness of breath
  • Loss of appetite
  • High blood pressure
  • Nausea and vomiting
  • Fever

Causes of Wilms Tumour

The exact cause of Wilms tumor is not known. However, it is believed that heredity has a crucial role in the development of this condition. Certain factors increase the risk of Wilms tumor, such as:

  • Family history of Wilms tumor
  • Age as it mostly affects children between 3-5 years of age
  • Girls are at increased risk than boys
  • Increased risk in black children compared to children of other races
  • Presence of birth defects, such as cryptorchidism, hypospadias, aniridia, and hemihypertrophy
  • Presence of other health conditions, such as Denys-Drash syndrome, WAGR syndrome, Beckwith-Wiedemann syndrome, and microcephaly

Diagnosis of Wilms Tumour

The doctor may diagnose Wilms tumor with the following techniques:

  • Physical examination: The physician will perform a physical examination to determine the symptoms of Wilms tumor.
  • Blood tests: The doctor may also advise blood tests to determine the level of red blood cells and status of kidney functioning, evaluate chemistry profile and perform coagulation studies.
  • Urinalysis: A urine examination is also advisable to determine the presence of blood in the urine.
  • Imaging tests: Several imaging studies can be performed to diagnose Wilms tumors. These include renal ultrasound, MRI, and CT scan. Sometimes, the doctor advises chest X-ray to rule out lung metastases.
  • Cytogenetics: The doctor may advise cytogenetic testing to determine 1p and 16q deletion.
  • Biopsy: The surgeon may perform a laparotomy to remove a kidney mass and send it to the laboratory for evaluation for cancer.

Treatment for Wilms Tumour

HCG Manavata is the best cancer center for Wilms tumor treatment in Nashik. We have multiple treatment options available for managing Wilms tumors:

Surgery: Surgery is performed for both diagnosis and treatment. It is a treatment for all the stages of Wilms tumor. The surgery aims to preserve the maximum possible part of the kidney. At HCG, we have some of the best Wilms tumor specialists in Nashik; they are skilled in the surgical management of this condition. The surgery for Wilms tumor is of two types:

  • Radical nephrectomy: The surgeon removes the complete kidney and the lymph nodes surrounding the affected kidney during the radical nephrectomy. The other tissues, such as part of the ureter or adrenal gland, may sometimes be removed. The other kidney increases its functioning to cover up the work of the removed kidney. If cancer affects both kidneys, the surgeon may remove both kidneys. In such a case, the child may need dialysis. Kidney transplantation is the only option in these cases to avoid dialysis.
  • Partial nephrectomy: The surgeon removes the tumor from the kidneys and the small tissues surrounding the tumor. It is a preferable option in cases of small tumors.

Chemotherapy: In patients with nephroblastoma, the oncologists may also deliver chemotherapy to kill the cancerous cells. Combination chemotherapy is implemented in cases of an aggressive tumor. When the child suffers from bilateral disease, immediate nephrectomy is generally not recommended. Some doctors prefer to use high-dose chemotherapy to kill cancerous cells and preserve the kidneys. The doctor may also perform repeated biopsies to determine if the patient is responding to chemotherapy.

Radiation therapy: Radiation therapy involves using high-energy radiation to kill cancer cells. This therapy is generally used with surgery and chemotherapy for advanced cancer. It is also used in the early stages of Wilms tumors with anaplastic or unfavorable histology.

Frequently Asked Questions

What is the prognosis of Wilms tumor?

The prognosis of Wilms tumor depends upon the type and stage of the tumor. Depending upon the stage, children with favorable histology have a survival rate of 99% to 86%. Similarly, the survival rate of unfavorable histology is 84% to 38% based on stage. Unfortunately, there is end-stage renal failure in around 1% of patients with Wilms tumors.

What are the complications of Wilms tumor treatment?

The complications depend upon the type of treatment received by the child. For example, the chemotherapy drugs used for Wilms tumors have increased the risk of secondary malignancies. There is also an increased risk of ototoxicity, cardiotoxicity, and peripheral neuropathy. Radiation therapy also increases the risk of secondary malignancies. In addition, children undergoing radiation therapy are more likely to get osteoporosis.

What would my child expect during postoperative care?

The child undergoes a comprehensive examination of blood pressure, urine output, and electrolyte balance soon after the surgery. The usual follow-up schedule is every three months for two years from the diagnosis. During the follow-up visit, the doctor may look for any mass that indicates recurrence, thyroid growth, and lung examination to evaluate metastasis and check for peripheral neuropathy.

How can parents support children during their fight against Wilms tumor?

Parents play an important role in assisting children fight against Wilms tumors. Stay with your child during treatment and diagnosis, and monitor and maintain the energy level of the child. The parents should encourage optimal oral hygiene and plan a healthy diet.

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