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Wilm’s Tumor - Types, Symptoms, Causes, Risk, Diagnosis, and Treatment

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Wilm’s tumor is the most common type of cancer affecting kidneys in children. To know more about Wilm’s tumor, read the article given below.

Written by

Dr. Preetha. J

Published At March 12, 2022
Reviewed AtMay 30, 2024

What Is Wilm's Tumor?

Wilm's tumor is a rare kind of kidney cancer that occurs in children. It can occur in one or both kidneys. Around 500 children are newly diagnosed every year, and it is the fourth most common type of cancer among children. Wilm's tumor is also known as nephroblastoma. It is often noticed because of abdominal swelling or any mass in the kidney. Some patients with Wilms' tumors have congenital disabilities such as urinary tract abnormalities or lack of an iris in the eye.

What Are the Types of Wilm's Tumor?

  • Favorable Histology: The cancer cells in these tumors do not look normal, but there is no anaplasia. About 9 of 10 Wilm's tumors have a favorable histology. The chances of curing children with these tumors are excellent.

  • Anaplastic Histology: The cancer cells may vary widely in shape and size in these tumors. The nucleus of the cells (where the DNA is present) tends to be very big and altered, called anaplasia. The tumors in which the anaplasia spreads throughout the tumor, known as diffuse anaplasia, are more challenging to treat. The anaplasia is limited to certain parts of cancer, known as focal anaplasia.

What are the Symptoms of Wilm's Tumor?

The symptoms of Wilm's tumor include:

  • An abdominal mass.

  • Abdominal pain.

  • Abdominal swelling.

The other signs and symptoms may include:

  • Nausea or vomiting or both.

  • Fever.

  • Constipation.

  • Blood in the urine.

  • Loss of appetite.

  • Shortness of breath.

  • High blood pressure.

What Causes a Wilm's Tumor?

1. Genetic Factors

The following genetic factors might increase the risk of the child getting Wilm's tumor.

2. Race - Wilm's tumor is more commonly seen in African-American children, and it is less common in Asian-American children.

3. Gender - The risk is higher in females than males.

What Is the Pathology Behind Wilm's Tumor?

Wilms' tumor occurs due to alterations to genes such as the Wilm's tumor 1 (WT1) or Wilms Tumor 2 (WT2) genes. The kidney cells usually develop in the womb as the fetus grows, but some of the cells that fail to develop into mature cells remain the same. Usually, these cells will mature before the child reaches three to four years of age. When this does not occur, the cells might grow out of control and result in Wilm's tumor.

Who Are at Risk for Wilm's Tumor?

Wilm's tumor is most common in young children who are around three to four years of age and less common in older children. If any of the child's family members have had Wilm's tumor, then that child has an increased risk of acquiring the condition.

How to Diagnose and Stage Wilm's Tumor?

Wilm's tumor is diagnosed before the age of ten.

1. An ultrasound can be done first to confirm the presence of intrarenal mass.

2. CT (computed tomography).

3. MRI (magnetic resonance imaging).

4. Biopsy.

5. X-rays to look for metastasized areas, usually in the lungs.

6. Radioactive materials are used in smaller quantities to highlight the areas of diseased bone.

7. Laboratory tests like blood tests and urine tests are done to check a child's general health and detect any adverse side effects (like low red or white blood cell counts) of the treatment.

Doctors usually use a staging system to find the extent of cancer. There are about five stages:

Stages of tumor

  • Stage 1: The tumor is present in one kidney and can be removed entirely with surgery. There are about 40 to 45 percent of stage 1 Wilms' tumors.

  • Stage 2: The tumor spreads into the tissue and vessels around the kidney, but still, it can be completely removed with surgery. About 20 percent of Wilms' tumors are stage 2.

  • Stage 3: In this, the tumor cannot be completely removed with surgery, and some cancer remains in the abdomen. About 20 to 25 percent of Wilms' tumors are stage 3.

  • Stage 4: In this, cancer has spread to distant organs, such as the lungs, brain, or liver. About 10 percent of Wilms' tumors are stage 4.

  • Stage 5: The tumor is present in both kidneys at the time of diagnosis. About 5 percent of Wilms' tumors are stage 5.

How to Treat or Manage Wilm's Tumor?

Most of Wilm's tumors are of favorable histology, and they are easy to cure.

Surgery is the usual treatment for Wilms tumor. In a radical nephrectomy, the surgeon removes:

  • The tumor.

  • The entire kidney.

  • Ureter.

  • Adrenal gland (a gland that is on top of the kidney).

  • Surrounding fatty tissues.

  • Nearby lymph nodes.

When cancer is present in both kidneys, surgeons will usually remove the tumor and preserve the healthy kidney tissue to avoid kidney transplants. Treatment plans include both chemotherapy and surgery. More advanced stages also may require radiotherapy. Both treatments have short-term and long-term risks.

Short-term or temporary effects may include:

  • Nausea and vomiting.

  • Bleeding or bruising.

  • Loss of appetite.

  • Tiredness.

  • A weakened immune system.

  • Nephrectomy.

  • Mouth sores.

  • Hair loss.

Long-term effects may include:

  • The development of secondary cancers (such as leukemia).

  • The weakening of any internal organs, such as the heart.

What Is the Prognosis of Wilm's Tumor?

With proper treatment, children with Wilm's tumor have a 90 percent survival rate. However, the chances of recurrence are between 15 to 50 percent, depending on the original tumor's traits. The people who had Wilm's tumor may experience related health problems or late effects of their treatment in adulthood, such as heart disease, decreased kidney function, and additional cancer development.

How to Prevent Wilm's Tumor?

There is no prevention for Wilms's tumor, but the kids at risk for Wilms's tumor should undergo an ultrasound screening every three months until about six or seven years of age. Those at high risk may get screened until they are a little older.

What Could Be the Complications of Wilm’s Tumor?

Complications of Wilms' tumor can include:

  • Metastasis: If not treated early, the cancer can spread to other organs.

  • Recurrence: Even after successful treatment, Wilms' tumor can sometimes recur.

  • Kidney problems: If the tumor affects both kidneys or requires their removal, it can lead to kidney function issues.

  • Treatment side effects: Chemotherapy, radiation, and surgery can cause short and long-term side effects, including infertility and secondary cancers.

Conclusion:

Wilms' tumor is a type of kidney cancer that primarily affects children. It's typically treated with a combination of surgery, chemotherapy, and sometimes radiation therapy. With prompt diagnosis and appropriate treatment, the prognosis for Wilms' tumor is generally favorable, but it requires ongoing monitoring and follow-up care to detect any recurrence or potential complications.

Frequently Asked Questions

1.

Does Wilm’s Tumor Have a Cure?

Wilm’s tumor, also referred to as nephroblastoma, is the most common form of kidney cancer affecting children between three and five years of age at high prevalence. The tumor can affect both kidneys, generally one kidney. Wilm’s tumor is curable in most cases with appropriate treatment.

2.

What Includes the Signs of Wilm’s Tumor?

Abdominal mass feeling and abdominal swelling are the predominant features of Wilm’s tumor. In addition, the child may experience a few of the following symptoms.
- Blood in the urine
- Fever
- Constipation
- Loss of appetite
- Nausea
- Vomiting
- Breathlessness
- High blood pressure

3.

Who Is More Likely to Get Wilm’s Tumor?

Wilm’s tumor is a common form of kidney cancer in younger children. So, children within three to four years of age are more likely to develop Wilm’s tumor. The condition is less prevalent in older children and rare in adults. Wilm’s tumor occurrence is slightly greater among African American children than among white ones in the United States. 

4.

What Includes the Complications of Wilm’s Tumor?

Wilm’s tumor is a cancerous condition of the kidney in children. It includes the following complications.
- Spread of the tumor from kidneys to lung, liver, bone, lymph nodes, and brain.
- High blood pressure
- Kidney damage
- Removal of Wilm’s tumor might influence and affect kidney function. 

5.

Is Wilm’s Tumor a Leukemia?

Individuals with Wilm’s tumor are at risk of developing lymphomas and leukemias. In addition, Wilm’s tumor 1 has been involved and implicated in acute myeloid leukemia. So, clinical findings describe that it has been mutated and overexpressed in distinct types of acute myeloid leukemia. 

6.

Is Wilm’s Tumor a Type of Kidney Disease?

Wilm’s tumor is one of the most common forms of kidney cancer in children. Though it is rare kidney care predominantly concerning children, it is considered the most common cancerous form of kidneys. 

7.

Is Wilm’s Tumor a Birth-Related Defect?

Wilm’s tumor is a common renal cancer developing in younger children. Though it is clearly associated with genetic factors and congenital syndromes, birth defects are less common in most of the cases of Wilm’s tumor. 

8.

Does Wilm’s Tumor Require Chemo Treatment?

Wims’ tumor is known as a cancerous condition in children initiated from the kidneys. The treatment for Wilms’s tumor is based on the stage of the tumor. However, the intervention includes surgical management and chemotherapy. 

9.

Does Wilm’s Tumor Occur on a Genetic Basis?

Most of the cases of Wilm’s tumor are not associated with inherited genetic determinants and family history. Nevertheless, somatic mutation or epigenetic alterations are the reason behind the development of Wilm’s tumor in about ninety percent of cases. 

10.

Is Wilm’s Tumor Inevitably Cancerous?

Wilm’s tumor is always and inevitably a cancerous condition. It is the most common form of kidney cancer seen in children. It is a malignant type of tumor that can spread from the kidneys to other aspects such as bone, lymph nodes, liver, lungs, and brain. 

11.

Will Wilm’s Tumor Be Cured Without Surgical Intervention?

Wilm’s tumor is a malignant and common form of kidney cancer requiring immediate attention and appropriate treatment. The intervention is based on the stage of the tumor. Surgery is an initial option for Wilm’s tumor that is followed by chemotherapy and radiation therapy. 

12.

How Long Is a Chemo Treatment for Wilm’s Tumor?

The intervention for Wilm’s tumor is surgery initially if it can be proceeded. This is followed by a certain period of radiation therapy. Then, the doctors prescribe chemotherapy for over six months. 

13.

What Is the Survival Rate of a Child With a Wilm’s Tumor?

The survival rate is solely dependent on the stage of Wilm’s tumor. Clinical studies show that about 93 % is evident with a five-year survival rate in children with Wilms’ tumor. Recurrence is also evident with this condition. 

14.

Does Wilm’s Tumor Recur?

Wilm’s tumor, a cancerous condition of kidneys in children, can recur. It is evident that the condition can recur in about sixteen to forty percent of cases. The tumor recurs concerning the tumor bed and lung. Relapses occur within two years from diagnosis.

15.

Does Wilm’s Tumor Metastasis to the Brain?

Wilm’s tumor can metastasize to the brain but with a rare prevalence. Wilm’s tumor metastasis of the brain can occur in about one to two percent of cases. It can be diagnosed with the tonic-clonic type of seizure attack. 
Dr. Samer Sameer Juma Ali Altawil
Dr. Samer Sameer Juma Ali Altawil

Urology

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