Wilms tumour

• Wilms tumour:

  • Also called nephroblastoma
  • Type of kidney tumour that typically affects children under 5
• Key presenting feature is an asymptomatic abdominal mass, other features include:

  • Abdominal pain
  • Haematuria
  • Lethargy
  • Fever
  • Hypertension
  • Weight loss
• Diagnosis:

  • Abdominal ultrasound is the initial investigation
  • CT or MRI can be used to stage the tumour
  • Biopsy may be required to identify the histology and make a definitive diagnosis
• Management:

  • Surgical excision of the tumour, along with the affected kidney (nephrectomy) is the main treatment
  • Chemotherapy - before (neoadjuvant) or after (adjuvant) surgery may be used
  • Radiotherapy may be used after surgery
• Prognosis:

  • 5 year survival is around 90%
• Consider very urgent referral (for an appointment within 48 hours) for specialist assessment for Wilms' tumour in children with any of the following:

  • A palpable abdominal mass.
  • An unexplained enlarged abdominal organ.
  • Unexplained visible haematuria.
• Long term side effects of treatment:

  • Heart failure - especially with doxorubicin
  • CKD
  • Reduced fertility
  • Secondary cancers e.g. leukaemia