What is the average size of a wilms tumor

Researchers have found that Wilms tumors with a favorable histology and changes in chromosome 1q are more likely to come back after treatment. In the future, biomarkers may be used to identify patients who are at an increased risk for recurrence. Tumor genetics. This gene plays a role in normal kidney development, but it is not active in about one-third of children with a Wilms tumor.

Studies on the importance of this gene are ongoing. Targeted therapy. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. New treatment approaches for tumors that have spread to the lungs. Researchers are trying to figure out if a Wilms tumor with a favorable histology that has spread to the lungs should be treated with radiation therapy if the lung tumors go away after 6 weeks of chemotherapy.

Researchers are also using a different chemotherapy, as well as radiation therapy to the lungs, to treat lung tumors that do not go away after 6 weeks. New treatment methods. Doctors are looking at the effect of using only surgery as a treatment for people with a small, stage I Wilms tumor. After surgery, patients are watched closely by their health care team for a recurrence. Clinical trials are underway to find better ways of reducing symptoms and side effects of current Wilms tumor treatments to improve comfort and quality of life for children.

If you would like additional information about the latest areas of research regarding Wilms tumors, explore these related items that will take you outside of this guide:. Please note that this link takes you to a separate ASCO website. The next section in this guide is Coping with Treatment. It offers some guidance on how to cope with the physical, emotional, social, and financial changes that cancer and its treatment can bring. This page includes several links outside of this guide to other sections of this website.

For many reasons, people do not experience the same side effects even when they are given the same treatment for the same type of tumor. This can make it hard to predict how your child will feel during treatment. As your family prepares to start treatment, it is normal to fear treatment-related side effects. It may help to know that your child's health care team will work to prevent and relieve side effects. Common physical side effects from each treatment option for a Wilms tumor are described in the Types of Treatment section.

Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Providing this information helps them find ways to treat or manage the side effects so your child feels more comfortable and can potentially keep any side effects from worsening. Learn more about why tracking side effects is helpful. Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects.

T Treating long-term side effects and late effects is an important part of care for childhood cancer survivors. Your family can have emotional and social effects after a cancer diagnosis. This may include dealing with difficult emotions, such as sadness, anxiety, or anger, or managing stress. Sometimes, people find it difficult to express how they feel to their loved ones.

Some have found that talking to an oncology social worker, counselor, or member of the clergy can help them develop more effective ways of coping and talking about cancer. You can also find coping strategies for emotional and social effects in a separate section of this website. Cancer treatment can be expensive. It is often a big source of stress and anxiety for families dealing with a cancer diagnosis.

Families are encouraged to talk about financial concerns with a member of their health care team. Learn more about managing financial considerations in a separate part of this website.

Family members and friends often play an important role in taking care of a child with a Wilms tumor. This is called being a caregiver. As a parent or guardian, you are the primary caregiver for your child. However, friends and family members can give your family valuable support, even if they live far away. When your child has cancer, you may have an additional range of responsibilities.

These may include giving medications or managing symptoms and side effects. However, it is important to seek help from others. Below are some of the responsibilities your family or friends could help with:. Be sure to tell your child's health care team about any side effects that happen during treatment and afterward, too.

Tell them even if you do not think that the side effects are serious. This discussion should include physical, emotional, social, and financial effects of cancer. Also, ask how much care your child may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan. Create a caregiving plan with this 1-page fact sheet that includes an action plan to help make caregiving a team effort. This free fact sheet is available as a PDF, so it is easy to print.

Net offers several resources to help you keep track of symptoms and side effects. Please note that these links will take you to other sections of Cancer. Net Mobile: The free Cancer. Net mobile app allows you to securely record the time and severity of symptoms and side effects. ASCO Answers Managing Pain: Get this page booklet about the importance of pain relief that includes a pain tracking sheet to record how pain affects your child.

The free booklet is available as a PDF, so it is easy to print. ASCO Answers Fact Sheets: Read 1-page fact sheets on anxiety and depression , constipation , diarrhea , and rash that provide a tracking sheet to record details about the side effect. These free fact sheets are available as a PDF, so they are easy to print, fill out, and give to your health care team.

The next section in this guide is Late Effects of Treatment. It describes some of the side effects that can occur long after treatment has finished. Although many children with a Wilms tumor are successfully treated for cancer, they often have an increased risk of developing other diseases or conditions later in life. This is because chemotherapy and radiation therapy can cause permanent damage to healthy parts of the body.

Therefore, it is important that children who have received treatment for a Wilms tumor are monitored closely for possible long-term or late effects of the treatment.

These may include:. Kidney failure. Because children who receive treatment for Wilms tumor usually have only 1 kidney, they have a slightly higher risk of kidney failure and will need to be monitored for the rest of their lives. They also need to keep well hydrated to help promote good kidney health.

There are some medications such as codeine and ibuprofen that should only be taken in small amounts to avoid kidney damage. Bowel obstruction. Children who have certain types of surgery may develop scar tissue that puts them at risk for developing a bowel obstruction throughout their lives.

A bowel obstruction will cause abdominal pain and vomiting. Heart problems. Children who receive doxorubicin have a higher risk of developing heart abnormalities , even years after treatment has ended. Children who receive doxorubicin and radiation therapy to the lungs have an even higher risk of developing heart problems. An echocardiogram may be used to check on the effects of doxorubicin on the heart.

Lung problems. Children whose cancer had spread to their lungs and who received radiation therapy to that location are at risk for developing lung problems after treatment has ended. Pulmonary function tests can be done to see if there are any changes to the lungs. Skeletal abnormalities. Scoliosis, or curvature of the spine, and underdevelopment of nearby soft tissue may happen in children who received radiation therapy.

This risk depends on the location and dose of the radiation therapy. Second cancer. Wilms tumor survivors have a small risk of developing another type of cancer within 15 years after the Wilms tumor was first diagnosed. The most important risk factors for a second cancer are whether treatment included radiation therapy and doxorubicin. For example, young girls who have radiation therapy to treat a Wilms tumor that has spread to the lungs have an increased risk of developing breast cancer.

Pregnancy concerns. Females who had abdominal radiation therapy for a Wilms tumor should be considered "high risk" during pregnancy and closely monitored by their doctors. Chemotherapy alone does not increase the risk of a miscarriage. Birth defects are also more common.

Fertility concerns. Young girls who received radiation to their entire abdomen for a Wilms tumor may experience fertility problems when older or experience premature menopause. They need to be monitored closely during puberty and may need to be referred to a reproductive endocrinologist, which is a fertility expert. Dental problems. Depending on the age of the child when they were diagnosed and treated for a Wilms tumor, they may experience dental issues , including problems with teeth formation, enamel issues, or missing teeth.

Regular dental care is very important. The next section in this guide is Follow-Up Care. It explains the importance of checkups after your child finishes cancer treatment. Care for children diagnosed with cancer does not end when active treatment has finished. This is called follow-up care.

All children who receive treatment for cancer, including a Wilms tumor, should have life-long, follow-up care. Follow-up care for a Wilms tumor includes regular visits to the doctor for physical examinations, blood and urine tests, and imaging tests, such as CT scans, ultrasounds, and x-rays. At first, these visits and tests will be frequent, such as every 3 months. The time between checkups will increase until 5 years after treatment, when your child will be scheduled for a follow-up visit once a year.

The goal of rehabilitation is to help survivors and their families regain control over many aspects of their lives and remain as independent and productive as possible.

Learn more about cancer rehabilitation. Learn more about the importance of follow-up care. One goal of follow-up care is to check for a recurrence, which means that the cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. A recurrence of a Wilms tumor is unlikely, but if it does happen, it is generally within the first 2 years after treatment ends.

Some children may have blood tests or imaging tests as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of tumor first diagnosed and the types of treatment given. The anticipation before having a follow-up test or waiting for test results can add stress to you or a family member. The more time that has passed since treatment ended, the less likely the tumor will return.

At this point, monitoring for late effects becomes a main part of follow-up visits. Late effects can occur almost anywhere in the body. They include physical problems , such as heart and lung problems or a second cancer, which is a new cancer that happens in someone who has had cancer before.

They also include emotional challenges , such as anxiety and depression, and problems with memory, thinking, attention , and learning. Based on the type of treatment your child received, the doctor will recommend the examinations and tests needed to check for late effects. Usually, people will have blood tests to make sure no changes have occurred in their kidney function. This is especially important for people who have 1 kidney or had a partial nephrectomy.

The Children's Oncology Group COG has studied the physical and psychological effects that childhood cancer survivors face. Based on these studies, COG has created recommendations for long-term follow-up care for childhood, adolescent, and young adult cancer survivors that can be found on a separate website. The doctor will help you create this. ASCO offers forms to help keep track of the cancer treatment your child received and develop a survivorship care plan when treatment is completed.

Some children continue to see their oncologist, while others transition back to the care of their family doctor or another health care professional.

This decision depends on several factors, including:. Details about the specific cancer treatment given are very valuable to the health care professionals who will care for your child throughout their lifetime. The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. In some ways, survivorship is one of the most complex aspects of the cancer experience because it is different for every child and their family.

After active cancer treatment ends, children and their families may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis.

One source of stress may occur when the child's frequent visits to the health care team end after completing treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and children and their families miss this source of support.

Every family faces different concerns and challenges. With any challenge, a good first step is being able to recognize each fear and talk about it. Effective coping requires:. It may be helpful for your child to join an in-person support group or online community of childhood cancer survivors. Support groups also exist for parents of children diagnosed with cancer.

This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of the health care team, individual counseling, or asking for assistance at the learning resource center of the place where your child received treatment.

Parents, other family members, and friends may also go through periods of transition. A caregiver plays a very important role in supporting a child diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis.

Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer. However, as treatment is completed, the caregiver's role often changes. Depending on the type of treatment being considered, further tests are needed in order to assess the condition of different organs. For example, prior to chemotherapy, the doctors will recommend an ultrasound of the heart echocardiography , a hearing test audiometry as well as special diagnostics for determining kidney function renal scintigraph.

Any changes occurring during the course of treatment can be assessed and managed better based on the results of those initial tests, which thus help to keep the risk of certain treatment-related side-effects as low as possible. If it is possible to obtain accurate diagnosis by diagnostic imaging, the doctors will recommend to first proceed with chemotherapy 4 - 6 weeks and obtain sample tumour tissue biopsy for microscopic and molecular genetic examinations later.

The biopsy is then usually performed during surgical tumour removal. Only in a few situations, tumour tissue is required to be taken prior to chemotherapy by means of surgery or fine needle aspiration biopsy. Good to know: Not all of the above-mentioned tests apply to every single patient.

On the other hand, additional tests not mentioned here may be required individually. Ask the doctor which diagnostics are necessary and why. After the diagnosis has been confirmed, therapy is planned. Also, the response of the disease to preoperative therapy has major impact on prognosis.

This response is partially dependent on stage and type of the disease. Scientists have also found out that, in addition to the microscopic characteristics of a Wilms tumour, its molecular genetics can also influence the course of the disease. Thus, certain gene and chromosome alterations in tumour cells appear to correlate with unfavourable outcomes.

When planning the treatment, the doctors consider all these individual factors in order to provide optimal therapy, thus best possible outcome for every patient. The stage of the disease at the time of diagnosis represents a major criterion for treatment planning. The extent of surgical tumour removal is another essential staging criterion. Hence, accurate definition of the tumour stage is only possible after surgery. It differentiates five stages of Wilms tumour see table below.

Wilms tumours may look very different under the microscope histologically , depending on which types of tissue they consist of and how mature differentiated the tumour cells are.

Based on how they appear under the microscope, Wilms tumours are classified into the following three histological groups reflecting the disease's degree of malignancy:. Certain subtypes of Wilms tumour are assigned to each of these groups. The exact way of assignment classification is based on whether tumour tissue is examined and assessed before or after chemotherapy. In Germany and other European countries, the removal and examination of tumour tissue usually i.

Treatment of children and adolescents with Wilms tumour should take place in a children's hospital with a paediatric oncology program. Only such a childhood cancer centre provides highly experienced and qualified staff doctors, nurses and many more , since they are specialised and focussed on the diagnostics and treatment of children and teenagers with cancer according to the most advanced treatment concepts.

The doctors in these centres collaborate closely with each other. Together, they treat their patients according to treatment plans protocols that are continuously optimised.

The major goal of treatment is to eliminate the cancer while keeping the risk of side-effects and late sequelae as low as possible. Treatment of children and adolescents with Wilms tumour mainly consists of a combination of surgery and chemotherapy. Only a few patients receive additional radiotherapy. Most patients with Wilms tumour receive chemotherapy first. The goal is to shrink the tumour to make it more easily removable by surgery. Some patients undergo surgery first.

Surgery aims at complete removal of the tumour and possible metastases. Usually, it is followed by another round of chemotherapy. Depending on the tumour staging after surgery and on possible spread, radiotherapy is required as well. The individual treatment choice is based on the special features the tumour reveals under the microscope subtype of Wilms tumour as well as on the tumour extent after surgery tumour stage. The majority of children have an asymptomatic and unilateral abdominal mass.

Associated symptoms may include hematuria and abdominal pain. This last feature should alert to the risk of tumor rupture, a finding associated with local abdominal recurrence. However, large tumors, usually in advanced stages, did not present indication of surgical intervention and can benefit from preoperative chemotherapy.

This may lead to a tumor shrinkage and reduce the chance of complications as tumor rupture. It is now increasingly important to recognize tumors requiring minimal therapy in order to reduce the burden of treatment and the risk of late effects. The most significant unfavorable factors are high stage and the presence of anaplasia, especially in the diffuse form, which is highly resistant to chemotherapy.

This classification is based on the percentage of overall necrosis and the predominant cell type in the residual viable tumor. Therefore, currently only GPOH uses tumor volume as a parameter for risk stratification. The aim of our study was to investigate the relationship of the tumor volume after preoperative chemotherapy TVAPQ and before preoperative chemotherapy TVBPQ with overall survival at two and at five years, and lifetime.

Our sample consisted of consecutive patients evaluated in the period from to in an Onco-Hematology Service of a reference hospital in southern Brazil. All patients underwent the SIOP protocol treatment of chemotherapy. This protocol uses neoadjuvant chemotherapy to reduce the tumor volume and the risk of intraoperative rupture. As for staging, the stages I and II were grouped.

Histologic types were classified in low, intermediate and high-risk, according to the SIOP cltassification.

Epithelial and stromal predominant tumors and tumors presenting a predominantly rhabdomyomatous component were also identified. Tumors that either have or have not suffered rupture at time of surgery were also listed.

The lifetime was defined as the time from the end of the treatment until the outcome death or end of study. The association between categorical variables was performed using the chi-square test. Survival curves were obtained by Kaplan-Meier and compared by log-rank test. To evaluate the effect of the quantitative parameters, the Cox regression analysis was used.

During the assessment period, we identified 32 patients with data available on lesion volume, As for the staging, 3. As for histology, two patients were classified as low-risk completely necrotic tumor after chemotherapy , 27 as intermediate-risk, and two as high-risk one with a predominantly blastematous component after chemotherapy and the other with diffuse anaplasia.

In one patient it was not possible to apply the classification from the data described in the pathological report. Of the patients classified as intermediate risk, three had tumors predominantly epithelial, and three stromal. Only one patient with tumor of intermediate risk showed a predominantly rhabdomyomatous histological type. Only one patient had tumor rupture at the time of surgery. Five patients Of those patients, three were older than 4 years, 3 had stage IV disease, 3 had intermediate-risk histology, and 2 high-risk.

No patient presented a predominantly epithelial tumor or an associated rhabdomyomatous component. Three The operation usually involves removing the whole of the affected kidney nephrectomy. The treatment following surgery will depend on these risk groups. This group of high-risk tumours cannot be identified by looking at the biopsy because they occur when a particular type of early kidney cell survives the pre-surgery chemotherapy.

These cells are known as blastemal cells. Tumours, where most of these cells survive chemotherapy, are called blastemal tumours.

Other, less common types of kidney tumours may occur in children. These are usually only recognised after surgery to obtain a tumour sample. Congenital mesoblastic nephroma is a non-cancerous benign tumour that occurs in very young children; this type of tumour usually only needs surgery and no other treatment. Chemotherapy is the use of anti-cancer cytotoxic drugs to destroy cancer cells. Chemotherapy given before surgery is called neoadjuvant chemotherapy.

What doctors find out about the tumour after surgery - for example, how the cells look under the microscope and how far the cancer has spread - helps them to decide whether additional chemotherapy should be given adjuvant chemotherapy.

This is to help reduce the risk of the cancer coming back recurring. This chemotherapy may be given as inpatient or outpatient depending on tumour staging and risk group see above. Radiotherapy treats cancer by using high-energy rays to destroy the cancer cells, while doing as little harm as possible to normal cells.

For those that do, the area to be treated depends on the stage of the tumour at diagnosis. Some children receive radiotherapy to the area around the affected kidney or, less commonly, to the whole abdomen.

Radiotherapy may occasionally be used to shrink tumours that are too large to remove surgically. This will, ideally, allow an operation to be done. Radiotherapy can also be used when tumours have spread elsewhere in the body. Treatment usually involves surgery to both.

The aim of the treatment is to remove as much of the cancer as possible, while leaving as much healthy kidney as possible.

Chemotherapy is always given. Sometimes radiotherapy is needed as well. Many side effects are expected and managed effectively.