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Wilms Tumor
Also known as nephroblastoma
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Wilms tumor is a relatively uncommon cancer of the kidneys that usually affects children. It is the most common tumor of the kidneys in kids. The peak age of a Wilms tumor is about 3-4 years of age but is rare to happen after the age of six. Wilms tumor generally affects a single kidney but can happen in both kidneys. The origin of Wilms tumor is immature kidney cells that turn cancerous.
Wilms tumor is hard to find in the early stages and it can grow to a big size before any symptoms are noted. Many tumors fortunately are found before they metastasize, even when they're big so the prognosis is fairly good.
The major signs and symptoms of Wilms tumor include abdominal swelling, fever, blood in the urine, an obvious abdominal mass, decreased appetite, higher than normal blood pressure, nausea and vomiting, stomach pains and constipation.
The cause of Wilms tumor is not known but it is believed that this type of cancer begins to occur in utero. The cells of the kidney that are supposed to turn into normal kidney cells instead grow out of control and form cancerous cells. They multiply in the most primitive state and turn into a tumor that doesn't show up for three to four years.
There are genetic components to Wilms tumor. Some Wilms tumor patients have one of two genes abnormal. These genes are known as WT1 and WT2. Mutations in other chromosomes may also be acting in getting a diagnosis of Wilms tumor. Sometimes no obvious genetic defect is noted but the child gets Wilms tumor anyway.
Risk factors include gender in that more girls get Wilms tumor than boys. Black children have a higher than normal risk of getting Wilms tumor. Asian Americans have a lower risk than normal. If there is a family history of Wilms tumor, other children are at higher risk.
Certain diseases or abnormalities seen at birth or in infancy mean that a child has a higher risk of getting Wilms tumor. This includes the condition of aniridia, in which the iris membrane doesn't form properly or at all. Hemihypertrophy happens when a child is bigger on one side of the body than on the other. This increases the risk of Wilms tumor. Undescended testicles predispose a child to getting Wilms tumor. Hypospadias or a slit at the top of the penis can indicate a Wilms tumor.
Your doctor will perform a physical examination to look for signs of Wilms tumor. Blood tests and urine tests can see how healthy a child is at the time of diagnosis of Wilms tumor. An ultrasound can show the presence of a tumor on the kidney and a CT scan or MRI can also show the Wilms tumor. A bone scan can check for metastases of the cancer.
Wilms tumor has four stages. In stage I, the cancer is found only within the kidney. In stage II, the cancer has spread to nearby tissues outside of the kidney. It can sometimes be completely removed with surgery. Stage III cancer has spread to lymph nodes in the abdomen or to other structures in the abdomen. Stage IV Wilms tumor has spread to other body areas, including the bone, liver, lungs or brain. There is a stage V cancer that involves cancer in both kidneys.
The treatment of Wilms tumor involves surgery and chemotherapy. Sometimes surgery is all that it takes and the entire tumor is removed. The tumor can be graded. High grade tumors are worse than low grade tumors. Surgery involves a nephrectomy to remove the kidney and the tumor. In some cases, just a part of the kidney can be removed in what's called a partial nephrectomy. On the other hand, a radical nephrectomy removes the tumor, the entire kidney and surrounding lymph nodes. The ureter is removed as well along with the adrenal gland.
Chemotherapy is used to remove remaining cancer cells in the body. There are side effects of hair loss, nausea and vomiting, poor appetite and low white blood cell count but tend to kill fast growing cancer cells more rapidly. Radiation therapy can be used to kill localized areas of cancer cells that can't be removed surgically. Some side effects include fatigue, nausea and skin problems overlying the radiation site. Abdominal radiation can result in diarrheal illness.