|
Wilms' Tumor
Wilms' tumor
is a cancerous tumor of the kidney that occurs in children.
It is one of the most common tumors of the abdomen in children,
and its exact cause is unknown. It is associated with certain
birth defects including urinary tract abnormalities, absence
of the iris and hemihypertrophy (enlargement of one side of
the body). It is more common among siblings and twins, which
suggests some genetic cause. The tumor may become quite large,
but usually remains encapsulated (self-enclosed). It may spread
to other areas of the body, like the lungs. The peak time
of occurrence is three years of age, and it is rare after
age eight.
Symptoms may include abdominal pain, blood in urine, swelling
in the abdomen, fever, loss of appetite, nausea, vomiting,
general discomfort or tiredness, high blood pressure, constipation
or abnormal urine color.
Parents should avoid pressure on the abdomen and be careful
while bathing their children and engaging in other activities
with them.
Tests ordered by the doctor to diagnose the disease include
blood tests, urine tests, X-rays and CT scans, and an intravenous
pyelogram (IVP), which involves injecting dye into the bloodstream
and then taking X-rays to see where the dye goes.
The doctor will want to stage the tumor to see how advanced
it is and to determine a plan of treatment. Surgical exploration
and removal of the tumor is scheduled as soon as possible.
Sometimes it's necessary to remove the entire kidney if it
is damaged.
With the patient under general anesthesia, the surgeon makes
an incision on the abdomen or on the side with the affected
kidney. The tissue around the kidney that is infected will
be cut away and removed. If the kidney must be removed, the
surgeon will cut away the tubes connecting the kidneys to
the bladder and remove the kidney. The incision will then
be closed. This can be done laparoscopically, through tiny
incisions, in some cases.
The patient is given IV fluids and pain medication after surgery.
The surgery is often painful because of the positioning necessary
during surgery. The patient's blood pressure and urine output
are monitored carefully because these functions are controlled
in some way by the kidneys. Most likely, a urinary catheter
will be placed to drain urine temporarily. Patients do very
well with only one kidney.
As with any surgery, there is the possibility of breathing
problems related to anesthesia, blood clots or hemorrhage.
The physician also will talk to specialists in radiation therapy
and medical oncology to see if radiation therapy and chemotherapy
are necessary.
With treatment, this disease has a high cure rate. Children
with a tumor that hasn't spread have a 90 percent cure rate
when treated with surgery and chemotherapy or surgery, chemotherapy
and radiation.
The most feared complication is spread of the tumor to the
lung, bones, brain and liver. High blood pressure and kidney
damage may occur as the result of the tumor or its treatment.
Pediatric
urologic surgeons who treat Wilms' tumor:
Paul
F. Austin, M.D. Douglas
E. Coplen, M.D.
For
an appointment with a Washington University pediatric urologic
surgeon, call (314) 454-6034.
More information
on Wilms' tumor:
Washington University physicians are the medical staff of
Barnes-Jewish Hospital and St. Louis Children's Hospital
|
