There are various diseases and conditions that can affect the kidneys. Some of these conditions are life-threatening and can have serious consequences. One of these conditions primarily affects children and can lead to long-term medical care.
Wilms’ tumor is a rare kidney cancer that usually will affect children up to age 6. This condition is also known as nephroblastoma and it is the most common malignant tumor of the kidneys. Typically a child will be inflicted this disease between the ages of three and four. Usually one kidney will be affected but there is a chance both kidneys can be affected. Immature kidney cells are what are believed to be the cause of Wilms’ tumor. If you notice symptoms of this disease, it can help you determine whether or not your child is inflicted with it.
There are many different symptoms of Wilms’ tumor but sometimes a child could have the disease without knowing it. Wilms’ tumor might end up not getting detected at an early stage because the tumors might not be painful. Sometimes a tumor can develop quite large on a child and they might not experience any pain associated with the growth. Even though the tumors may get large, usually they will be found before they spread to other parts of the body. Your child might exhibit symptoms such as abdominal swelling, fever, blood in the urine, an abdominal mass, loss of appetite and high blood pressure. Stomach pains, nausea and constipation are also symptoms that your child might have if Wilms’ tumor is present. Some children might not develop any symptoms at all during the presence of this disease, so a diagnosis might not be made until it is more noticeable. You should take your child to see a doctor if you notice any mass in their abdomen or if you see blood in their urine. The other symptoms could be attributed to many different conditions, but your child should see a doctor as soon as they develop.
There is no exact cause of this medical condition but some people believe it happens when the child is in the womb. During this time, some of the cells that form the kidneys fail or develop improperly. When the cells fail or develop improperly, this will lead to the formation of tumors instead of normal cells. Usually by the time a child is about three or four, the tumors will become evident. There might also be changes in the child’s genes that control growth. The cancer could be caused by the genetic defect that is passed from a parent to child during fertilization. Some cases of Wilms’ tumor are related to a defect one of two different genes. Wilms’ tumor one and Wilms’ tumor two is how the disease is classified, depending on which gene is defective. Sometimes Wilms’ tumor is caused by an unknown event during early childhood development. If a gene is somehow changed during early childhood, this could lead to the cancer forming in the child’s body.
Wilms’ tumor usually has no clear risk factor but some things have become clear about the condition. Usually Wilms’ tumor will occur more in girls than boys, and black children are at a higher risk of developing the disease. Asian-American children are the group that is rarely affected by the disease. If someone in the family of the child has Wilms’ tumor, then that child will have a higher risk of developing it. Wilms’ tumor might also happen more frequently in children who have presented with other abnormalities. Some of these abnormalities include aniridia, hemi hypertrophy, undescended testicles and hypospadias. Aniridia is when the iris forms partially or not at all. Hemi hypertrophy is when one side of the body is very noticeably larger than the other. When you have undescended testicles, one or both of the testicles do not descend into the scrotum. Hypospadias is when the urinary opening is underneath the penis rather than on the tip of it.
There are various tests that the doctor will do to determine whether or not your child has Wilms’ tumor. A physical examination will be done to determine whether or not there are obvious signs of the cancer. Blood and urine tests are used to get a general idea of your child’s overall health. The blood and urine tests do not tell whether or not the cancer is present, but can indicate red and white cell levels in the child’s body. The blood and urine tests will also be able to rule out or confirm other possible diseases and cancers. An ultrasound might also be used during diagnostic testing to look for a tumor present. Computerized tomography or magnetic resonance imaging might be used also during the testing stage to determine whether a tumor is present in the kidneys.
Once your child’s doctor has confirmed the diagnosis then they can better tell you what stage of cancer it is. Knowing the stage of the cancer in your child can help you determine what treatment options would be the best for a good outcome. Stage one is when the cancer is just in the kidneys and it can be completely removed through surgery. Stage two is when the cancer has spread to surrounding structures and tissues near the kidney. Complete removal of the cancer is possible at stage two and the outcome is still very good. Stage three is when the cancer spreads from the kidney to surrounding lymph nodes or other structures in your child’s body. The cancer will usually be found in other locations in the abdomen and it can not always be completely removed with surgery. Stage four occurs when the cancer has spread to other parts of your child’s body that are further away from the kidney. Stage four might include the cancer spreading to the lungs or brain of your child, and surgery might not be a viable option. When your child is diagnosed with stage five then you are looking at cancer which has affected both kidneys. In stage five, there are limited things that can be done for treatment because usually the cancer has progressed too far for complete removal.
Treatment for Wilms’ tumor usually will involve your child undergoing surgery and chemotherapy. The stage and appearance of the cancer will also determine whether or not radiation therapy is needed as well. The doctor might tell you whether or not the child’s tumor has a favorable or unfavorable histology. If the histology is favorable this means that there is a better chance your child will survive the tumor. An unfavorable histology usually will indicate a decreased chance for a good outcome. It is possible though that a child with an unfavorable outcome can actually beat the cancer. The surgical removal of the kidney tissues is called nephrectomy and there are three different variations of this removal. A simple nephrectomy is when the entire kidney is removed by a doctor, leaving one kidney to filter the blood by itself. A partial nephrectomy is when the tumor itself is removed along with part of the tissues surrounding it. The partial is performed only when the other kidney has been removed or damaged. A radial nephrectomy is when the doctor will remove the kidney and surrounding tissues such as the ureter and adrenal gland. The lymph nodes that surround the cancerous tissues might also be removed as a precaution. The doctor will most likely look at both kidneys and surrounding tissues during surgery to determine exactly the extent of the cancer. The internal examination will also help the doctor figure out which tissues need to be removed and which tissues and organs are still functioning properly. The doctor will also inspect surrounding tissues for signs of cancer and then samples of other tissues might be taken for analysis. A child will need dialysis if both kidneys need to be removed until the child is healthy enough for a kidney transplant. The tumor cells will also be examined under a microscope to determine whether the cancer cells are aggressive or if they would respond to chemotherapy.
When someone gets cancer, they are often referred to chemotherapy for treatment. Chemotherapy is a process that uses medications to kill the cancer cells within the body and it affects rapidly dividing cells. This is why people who get chemotherapy often have side effects such as hair loss, nausea, vomiting and loss of appetite. A low white blood cell count might also be a side effect from the chemotherapy treatment and medications. Before your child starts chemotherapy, it is a good idea to ask the doctor what side effects might occur so that you can discuss those with your child. You might also see if any medications are available to treat the various side effects such as nausea and vomiting. The doctor should also go over with you the various long-term complications that your child might have from the cancer and treatment.
Radiation therapy is also used during treatment of many forms of cancer including Wilms’ tumor. X-rays and other high-energy rays are used to help kill the cancer cells that are in the body. Radiation is usually started less than a week after a surgical removal of the cancer and it requires you to be very still. If the child is very young, a sedative might be used to ensure that the child does remain still through the course of treatment. The area to be treated will be highlighted with a special dye and areas that do not need radiation are shielded. This means that only the area where the cancer cells are located get the radiation treatment while healthy areas remain unaffected. Nausea, fatigue and skin irritation might be possible side effects of radiation therapy. If the abdomen is the area getting radiation therapy, it is not uncommon for diarrhea to occur for a few days afterward. You could always ask your child’s doctor to prescribe or suggest a medication to you for the diarrhea symptoms.
Treatments for Wilms’ tumor often depend upon the stage of the cancer as well as age and general health of the child. Stage one or stage two is often treated just by surgery and radiation afterward. This is often the treatment as long as the cancer has not spread and as long as the cancer is not aggressive. Stage two cancers might be treated using radiation therapy if the cancer has not spread to surrounding tissues. Stage three and stage four cancers are treated with surgery and chemotherapy as well as radiation. If the cancer has not spread to the abdomen and if surgery removed it completely, then radiation might not be needed. Chemotherapy might be used on your child before the surgery to help reduce the size of the tumor and possibly eliminate the need for radiation. Stage five cancer treatment usually requires a more in-depth approach. If the tumor cells are in both of the kidneys then part of the cancer is removed during the first surgery. Lymph node tissue samples will be taken at that time to determine whether or not they are affected as well. Chemotherapy will then be used to shrink the tumors that are left in the kidneys before anything else is done. A follow-up surgery is required to remove as much of the remaining tumor as the doctor can get. The doctor will leave some of the kidney tissues behind so that the kidneys can function properly. Chemotherapy and radiation treatment will probably follow the second surgery.
No two children are the same when it comes to cancer and treatment options available to them. Some children will have a hard time adjusting to treatment such as chemotherapy or radiation therapy, while other children have no issues at all. You want to discuss all treatment options and side effects with your child’s doctor to determine the best course of action. You also want to make sure you understand the risks and benefits of each procedure before you give your consent for them to be administered on your child. It is also a good idea to talk to your child about Wilms’ tumor and about the effects of cancer and treatment.
A child’s prognosis will likely depend on the severity of the tumor, type of tumor and the stage of the cancer. If you get an early diagnosis then your child will have a better chance at recovery and living a healthy life. The most important thing to remember about Wilms’ tumor is that your child will develop signs of the cancer by the time they are six. Be aware of any changes in your child and report them to a doctor immediately so that a proper diagnosis can be made. When it comes to cancer of the kidney, early detection is vital for a successful treatment and prognosis.
