Wilms’ tumor

Diagnosis

These tests may be done to diagnose Wilms’ tumor:

• Physical assessment. Doctor will be examined physically to look for any manifestations of Wilms’ tumor.
• Laboratory tests. There are no blood and urine test that can diagnose Wilms’ tumor. However, these tests can determine if the kidney function is deteriorating, or blood counts have decreased.
• Imaging tests. Ultrasound, Computerized Tomography (CT) Scan, or Magnetic Resonance Imaging (MRI) can show images of the kidneys to detect any masses in a child’s kidney.

Staging

Once the specialist confirmed the diagnosis of Wilms’ tumor, then the following step is to know the extent (stage) of the disease.

A chest X-ray or chest CT scan and bone scan may be done to check if the cancer has invaded other parts of the body.

Treatment will be determined based on the cancer stage. The following are the five stages of Wilms’ tumor based on National Wilms Tumor Study of the Children’s Oncology Group in The United States:

• Stage I. Only one kidney is affected and it is localized only in the kidney. Surgery can completely remove it at this stage.
• Stage II. In this stage the cancer has already invaded nearby structures outside the kidney but surgery can still treat it.
• Stage III. The cancer at this stage has already spread to the lymph nodes around them or other areas of the abdominal cavity. The tumor may have spread in the abdomen pre or post-surgery or not totally eradicated by surgery.
• Stage IV. The cancer has invaded other structures that are farther away from the kidney such as the liver, lungs, brain or bones.
• Stage V. Wilms’ tumor has been detected in both of the kidneys (bilateral).

A 3-D printer may be utilized to produce a copy of the body structure of the patient in some cases in order to find out how to remove Wilms’ tumor through a very complicated surgery.

Treatment

Surgery, chemotherapy and/or radiation therapy may be done to treat Wilms’ tumor based on its stage and treatment will be monitored in a children’s cancer center.

Surgery

Surgery may be done to remove Wilms’ tumor from the kidney or a part of the kidney (partial nephrectomy) and sending a tissue sample to the laboratory to evaluate for any malignancy cells and determine the type of cancer. These surgical techniques may be done to remove Wilms’ tumor:

• Partial nephrectomy. Removes only a portion of the kidney and a small part of the tissue nearby. This is an option if the tumor is tiny or if only one kidney of the child is functional.
• Radical nephrectomy. Removal of the kidney and tissues around it which may include nearby lymph nodes, a portion of the ureter or the adrenal gland in some cases. The other kidney that is left needs to function alone by filtering the blood.
• Removing all or part of both kidneys. The surgeon may take out the most part with cancer if both of the kidneys are affected by cancer. Both kidneys may require removal in some cases which entails the child having to undergo hemodialysis or receive a kidney transplant.

Chemotherapy

Chemotherapy utilizes specific medication to destroy cancer cells all over the body. Wilms’ tumor is usually treated using a combination of medications administered intravenously to destroy cancer cells. Talk to your doctor on what will be the side effects of the treatment and the long-term complications. Side effects of chemotherapy is manifested based on which medication used. Nausea, vomiting, hair loss, loss of appetite and immunosuppression are the usual side effects.

Chemotherapy may shrink the tumor before the surgery which makes them more accessible to remove or to eradicate the remaining cancer cells after the surgery. If the cancer is already in its advanced stage, chemotherapy is also an option to control cancer if surgery is no longer an option. Chemotherapy may be done prior to surgery if both of the kidneys have cancer so that at least one kidney may be saved and regain its function.

Radiation therapy

Radiation therapy utilizes high powered energy beams to destroy cancer cells. It may be done based on the stage of cancer. The child will be positioned on a table and the machine will be navigated around the body and aiming for the area of cancer. Side effects may include fatigue, nausea, diarrhea, and skin irritation that looks like a sunburn.
Proton beam therapy is a high target precision beam therapy that kills cancer cells and preserving healthy tissues.

Radiation therapy may be done to destroy cancer cells that remain after surgery or used if the cancer has metastasized to other parts of the body.