They have specialists on-call every day, 24 hours a day, to help you and your child during and after treatment. Your child will be going through a lot during this time. You can make things a little bit easier for them by trying the following suggestions:.
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Learn more about how and when immunotherapy is used for kidney cancer, along with side effects and other things to consider. Health Conditions Discover Plan Connect. Medically reviewed by Yamini Ranchod, Ph. Coping and support. Abdominal Film X-Ray. Renal Cell Cancer. Russell Silver Syndrome. Read this next. Hemihyperplasia Formerly Hemihypertrophy. Medically reviewed by Stacy Sampson, D. Medically reviewed by Jeanne Morrison, Ph. These tumors usually appear in the first few months of life.
Children are usually cured with surgery , but sometimes chemotherapy is given as well. These tumors sometimes come back soon after treatment, so children who have had these tumors need to be watched closely for the first year afterward. These tumors are much more likely to spread to other parts of the body than Wilms tumors, and they are harder to cure. Because these tumors are rare, treatment is often given as part of a clinical trial. It's usually much like the intensive treatment used for Wilms tumors with anaplastic histology see Treatment of Wilms Tumors by Type and Stage.
According to current knowledge, environmental factors do not play a role in Wilms tumour development. Wilms tumours do not cause any health problems or pain for quite a while. Children typically present with a rounded tummy, which may sometimes be misdiagnosed as a sign of good nutrition.
Less common symptoms indicative of Wilms tumour may include tummy pain, blood in the urine, fever, nausea, vomiting and indigestion, as well as weight loss, hypertension and persistent cough as a result of lung metastasis.
Close collaboration between various specialists such as paediatric oncologists, paediatric neurosurgeons, paediatric radiologists, to name a few is required, both to find out whether the patient indeed suffers from a kidney tumour and, if so, to determine the tumour type and the extent of the disease. Knowing these details is absolutely essential for optimal treatment planning and prognosis. Besides physical exam, diagnostic imaging procedures such as abdominal ultrasound, magnetic resonance imaging MRI and computed tomography CT play a major role in Wilms tumour diagnostics.
Other cancers, such as lymphoma and neuroblastoma, can be found in the kidney area as well. For obtaining the accurate diagnosis by imaging, however, high-quality equipment is required as well as an experienced radiologist to analyse the results. These are essential prerequisites, since according to German treatment protocols for children with nephroblastoma, therapy usually begins with a preoperative chemotherapy and not with surgery.
Sometimes, diagnostic imaging alone is not sufficient to accurately differentiate Wilms from other tumours, such as neuroblastoma. For those patients, the doctors may recommend special additional tests: for example, a MIBG scan I-mIBG scintigraphy — which helps trace a neuroblastoma by means of a radio-labelled substance called iodo-meta-iodobenzylguanidine, or the search for tumour markers in a blood sample that are characteristic for neuroblastoma, but not nephroblastoma.
Other additional tests help determine whether the tumour has spread and, if so, where. For example, searching for lung metastases requires a chest X-ray or CT scan.
Depending on the type of treatment being considered, further tests are needed in order to assess the condition of different organs. For example, prior to chemotherapy, the doctors will recommend an ultrasound of the heart echocardiography , a hearing test audiometry as well as special diagnostics for determining kidney function renal scintigraph.
Any changes occurring during the course of treatment can be assessed and managed better based on the results of those initial tests, which thus help to keep the risk of certain treatment-related side-effects as low as possible. If it is possible to obtain accurate diagnosis by diagnostic imaging, the doctors will recommend to first proceed with chemotherapy 4 - 6 weeks and obtain sample tumour tissue biopsy for microscopic and molecular genetic examinations later.
The biopsy is then usually performed during surgical tumour removal. Only in a few situations, tumour tissue is required to be taken prior to chemotherapy by means of surgery or fine needle aspiration biopsy. Good to know: Not all of the above-mentioned tests apply to every single patient. On the other hand, additional tests not mentioned here may be required individually. Ask the doctor which diagnostics are necessary and why.
After the diagnosis has been confirmed, therapy is planned. Also, the response of the disease to preoperative therapy has major impact on prognosis. This response is partially dependent on stage and type of the disease.
Scientists have also found out that, in addition to the microscopic characteristics of a Wilms tumour, its molecular genetics can also influence the course of the disease. Thus, certain gene and chromosome alterations in tumour cells appear to correlate with unfavourable outcomes. When planning the treatment, the doctors consider all these individual factors in order to provide optimal therapy, thus best possible outcome for every patient.
The stage of the disease at the time of diagnosis represents a major criterion for treatment planning. The extent of surgical tumour removal is another essential staging criterion. Hence, accurate definition of the tumour stage is only possible after surgery.
It differentiates five stages of Wilms tumour see table below. Wilms tumours may look very different under the microscope histologically , depending on which types of tissue they consist of and how mature differentiated the tumour cells are. Based on how they appear under the microscope, Wilms tumours are classified into the following three histological groups reflecting the disease's degree of malignancy:.
Certain subtypes of Wilms tumour are assigned to each of these groups. The exact way of assignment classification is based on whether tumour tissue is examined and assessed before or after chemotherapy.
In Germany and other European countries, the removal and examination of tumour tissue usually i. Treatment of children and adolescents with Wilms tumour should take place in a children's hospital with a paediatric oncology program. Only such a childhood cancer centre provides highly experienced and qualified staff doctors, nurses and many more , since they are specialised and focussed on the diagnostics and treatment of children and teenagers with cancer according to the most advanced treatment concepts.
The doctors in these centres collaborate closely with each other. Together, they treat their patients according to treatment plans protocols that are continuously optimised.
The major goal of treatment is to eliminate the cancer while keeping the risk of side-effects and late sequelae as low as possible. Treatment of children and adolescents with Wilms tumour mainly consists of a combination of surgery and chemotherapy.
Only a few patients receive additional radiotherapy. Most patients with Wilms tumour receive chemotherapy first. The goal is to shrink the tumour to make it more easily removable by surgery.
Some patients undergo surgery first. Surgery aims at complete removal of the tumour and possible metastases. Usually, it is followed by another round of chemotherapy. Depending on the tumour staging after surgery and on possible spread, radiotherapy is required as well.
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