Wilms Tumour

Question 1

What is a Wilm’s tumour?

Answer 1

Wilms’ tumour is a specific type of tumour affecting the kidney in children, typically under the age of 5 years.

Question 2

How does Wilm’s tumour present?

Answer 2

Consider a Wilms tumour in a child under the age of 5 years presenting with a mass in the abdomen. The parents may have noticed the mass, or they may present with signs and symptoms of:

Abdominal pain
Haematuria
Lethargy
Fever
Hypertension
Weight loss

Question 3

Diagnosis of Wilm’s tumour?

Answer 3

The initial investigation is an ultrasound of the abdomen to visualise the kidneys. A CT or MRI scan can be used to stage the tumour. Biopsy to identify the histology is required to make a definitive diagnosis.

Question 4

Management of Wilm’s tumour?

Answer 4

Treatment involves surgical excision of the tumour along with the affected kidney (nephrectomy).

Adjuvant treatment refers to treatment that is given after the initial management with surgery. This depends on the stage of the disease, the histology and whether it has spread. The main options are:

Adjuvant chemotherapy
Adjuvant radiotherapy

Question 5

Prognosis of Wilm’s tumour?

Answer 5

Early stage tumours with favourable histology hold a good chance of cure (up to 90%). Metastatic disease has a poorer prognosis.