What is Wilms tumor?
Wilms tumor, also called nephroblastoma, is a cancerous tumor that starts in the cells of the kidney. It is the most common type of kidney cancer in children and accounts for about 5% of all childhood cancers.
Approximately 500 children in the U.S. are diagnosed with Wilms tumor each year.
The disease can occur at any age between infancy and 15 years, but in most cases, the tumor is found by the age of 3 or 4. It is slightly more common among girls and African-Americans.
The tumor can be very large before it's noticed and it may spread metastasize to other body tissues. The most common site for Wilms tumor to spread to is the lungs, but it may also spread to the liver, the other kidney, the brain, and/or bones. In approximately 5% of children with Wilms tumor, both kidneys are involved.
What causes Wilms tumor?
It is uncommon for Wilms tumor to run in families. Only 1% to 2% of cases will have an affected relative. Most cases of Wilms tumor occur by chance with no clear cause and are the result of genetic defects that affect cell growth in the kidney. These defects generally show up after birth, but, in some cases, children are born with a genetic defect that predisposes them to cancer.
A small percentage of patients with Wilms tumor have genetic syndromes, including the following:
WAGR syndrome. The acronym WAGR stands for the 4 diseases present in WAGR syndrome: Wilms tumor, aniridia (absence of the iris, the colored part of the eye), genitourinary malformations (defect of the kidneys, urinary tract, penis, scrotum, clitoris, testicles, or ovaries), and intellectual disability. This syndrome is caused by a loss or a turning off of a tumor suppressor gene called WT1 on chromosome 11. Tumor suppressor genes usually suppress the growth of tumors and control cell growth. When altered, they no longer control cell growth, and tumors may form.
Denys-Drash syndrome. This syndrome is characterized by kidney failure when the child is very young, genitourinary malformations, and abnormal development of the reproductive organs.
Beckwith-Wiedemann syndrome. This syndrome is characterized by large birthweight and a large liver, spleen, and tongue; low blood sugar right after birth, defects around the ear, uneven growth of the body, abdominal wall defects near the navel , and tumors of the liver and adrenal glands. This is thought to be caused by a genetic defect on chromosome 11. Oncogenes control cell growth, but, if mutated, uncontrolled cell growth may result.
What are the symptoms of Wilms tumor?
The following are the most common symptoms of Wilms tumor. However, each child may experience symptoms differently. Symptoms may include:
A nontender mass, or lump, felt or seen in the belly
Swelling of the belly
Blood in the urine
Pain in the abdomen from pressure on other organs near the tumor
Weakness or tiredness
High blood pressure
If a tumor is suspected in the child's belly, it is important not to apply pressure to this area. Careful bathing and handling of the child is necessary before and during any tumor evaluation. Rupture of the tumor may lead to cancer cells spreading to other tissues in the body.
These symptoms of Wilms tumor may resemble other medical conditions or serious illnesses. Always see your health care provider as soon as possible for a diagnosis.
How is Wilms tumor diagnosed?
In addition to a complete medical history and physical examination, diagnostic procedures may include, but are not limited to, the following:
Abdominal ultrasound. A diagnostic imaging technique that uses high- frequency sound waves and a computer to create images of blood vessels, tissues and organs; can provide an outline of the kidneys, the tumor, and determine if there are problems in the renal or other major veins in the abdomen. It can also determine if there are any tumors in the opposite kidney.
Abdominal computed tomography scan (also called a CT or CAT scan). A diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than X-rays.
Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. MRI can determine if there are metastases (tumors that have spread to other parts of the body), if there are any cancer cells in the lymph nodes, and/or if any other organs are involved. (Wilms tumors can compress other organs in the area and affect how well they work.)
Chest X-ray. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs on film. A chest X-ray can determine if there are metastases (spread) in the lungs.
Blood and urine tests. Tests done to evaluate kidney and liver function and get a general idea of the the child's health.
Biopsy. A small piece of tissue is removed and examined under a microscope. A biopsy of the tumor is done to evaluate cells, extent of disease, and make a diagnosis.
Surgical removal of the tumor and kidney (nephrectomy). Surgery may be necessary for a definitive diagnosis and to determine the extent of the disease.
Treatment for Wilms tumor
Specific treatment for Wilms tumor will be determined by your child's health care provider based on:
Your child's age, overall health, and medical history
Extent of the disease
Your child's tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Treatment may include (alone or in combination):
Surgery (to remove all or part of the affected kidney and any involved structures)
Biopsy of the tumor (if the tumor is too large or involved in surrounding structures to be removed; a biopsy is also necessary for diagnosis and staging the disease)
Chemotherapy (to shrink the remaining tumor, or to treat metastasis and/or recurrent disease)
Radiation (to shrink the remaining tumor or to treat metastasis and/or recurrent disease)
Medications (to control side effects like pain, hypertension, nausea, and infections)
Blood pressure monitoring
Continuous follow-up care (to determine response to treatment, watch for signs that the disease has come back after treatment, evaluate function of remaining kidney, and manage late effects of treatment)
Long-term outlook for Wilms tumor
The factors for determining the prognosis and long-term survival of children with Wilms tumor include the following:
Histology, favorable or unfavorable
Extent of the disease
Age and overall health of the child at diagnosis
Size of the primary tumor
Response to therapy
Your child's tolerance of specific medications, procedures, or therapies
New developments in treatment
As with any cancer, prognosis and long-term survival can vary greatly from child to child.
Prompt medical attention and aggressive therapy are important for the best possible outcomes. Continued follow-up care is essential for the child diagnosed with Wilms tumor. Side effects of chemotherapy and radiation, as well as second cancers, can occur in survivors of cancer. New methods are continually being discovered to improve treatment and to decrease side effects.