Guzy wilmsa – Objawy

Guzy wilmsa
Objawy

Guz Wilmsa (nerczak zarodkowy) jest najczęstszym nowotworem nerki u dzieci, diagnozowanym średnio w wieku 3-4 lat (jednostronne) lub 2-3 lat (obustronne). Charakterystycznym objawem jest bezbolesna masa w jamie brzusznej, występująca u około 80% pacjentów, często zauważana przez rodziców jako powiększenie brzucha. Inne objawy to ból brzucha (30-40%), nadciśnienie tętnicze (25%), krwiomocz makroskopowy (około 18%) i mikroskopowy (około 24%). Guz może osiągać masę około 0,5 kg przed pojawieniem się symptomów. Zaawansowanie choroby klasyfikuje się w pięć stadiów, od ograniczonego guza (stadium 1, 40-45% przypadków) do rozprzestrzenienia się na odległe narządy (stadium 4, 10%) oraz obustronnego zajęcia nerek (stadium 5, 5%). Obustronne guzy występują u 5-10% pacjentów, częściej u dzieci z predyspozycjami genetycznymi.

Guzy Wilmsa (Wilms tumor) – Objawy

Guz Wilmsa, znany również jako nerczak zarodkowy (nephroblastoma), jest najczęstszym nowotworem nerki występującym u dzieci, szczególnie przed 5. rokiem życia. Średni wiek w momencie diagnozy wynosi około 3-4 lata w przypadku guzów jednostronnych i około 2-3 lata dla przypadków obustronnych. Nowotwór ten charakteryzuje się specyficznymi objawami, które mogą różnić się w zależności od stadium zaawansowania oraz indywidualnych cech pacjenta.¹²

Najczęstsze objawy

Najczęstszym i często pierwszym objawem guza Wilmsa jest bezbolesna masa lub guz wyczuwalny w jamie brzusznej. Ten objaw występuje u około 80% dzieci w momencie prezentacji. Rodzice często zauważają powiększenie brzucha podczas kąpieli lub ubierania dziecka, niekiedy obserwując nagły wzrost rozmiaru pieluch u niemowląt. Warto podkreślić, że guzy Wilmsa mogą osiągać znaczne rozmiary przed wywołaniem jakichkolwiek objawów, a średnia wielkość guza w momencie diagnozy to około 0,5 kg.³⁴⁵

Inne częste objawy obejmują:

Ból brzucha – występuje u około 30-40% dzieci i może być pierwszym objawem prezentującym chorobę⁶⁷
Nadciśnienie tętnicze – obecne u około 25% dzieci w momencie diagnozy, przypisywane aktywacji układu renina-angiotensyna⁶⁷
Krwiomocz (krew w moczu) – występuje u 12-25% pacjentów, może być widoczny makroskopowo (około 18% przypadków) lub tylko mikroskopowo (około 24% przypadków)⁶⁷

Dodatkowe objawy

Poza głównymi objawami, u dzieci z guzem Wilmsa mogą występować również inne dolegliwości, które niekiedy są pierwszymi sygnałami choroby lub pojawiają się wraz z jej progresją:⁸⁹

Gorączka – może być niska lub wysoka, niekiedy utrzymująca się przez dłuższy czas bez innych objawów infekcji¹⁰¹¹
Nudności i wymioty¹²
Utrata apetytu lub zmniejszone przyjmowanie pokarmów¹⁰
Spadek masy ciała¹³
Zmęczenie i osłabienie (letarg)¹⁴
Zaparcia¹³¹⁵
Rozszerzone naczynia żylne widoczne na brzuchu¹³⁹
Anemia (niska liczba czerwonych krwinek)¹⁶¹⁰
Nawracające infekcje dróg moczowych¹³

Objawy zaawansowanej choroby

W przypadku rozprzestrzenienia się nowotworu poza nerkę (przerzuty), mogą pojawić się dodatkowe objawy w zależności od lokalizacji przerzutów. Najczęstszym miejscem przerzutów są płuca, a następnie wątroba, węzły chłonne i mózg.⁹¹⁷

Objawy związane z przerzutami mogą obejmować:

Duszność i kaszel – przy przerzutach do płuc¹⁸¹⁹
Odkrztuszanie krwi (krwioplucie)¹⁷
Ból w klatce piersiowej²⁰
Bóle głowy – mogą być związane z nadciśnieniem lub przerzutami do mózgu²¹²²
Krwawienie do oka – rzadki objaw związany z bardzo wysokim ciśnieniem tętniczym²¹²²
Zmiana stanu świadomości – w skrajnych przypadkach bardzo wysokiego ciśnienia²²

Progresja choroby

Guz Wilmsa wykazuje specyficzny wzorzec progresji, który wpływa na objawy, leczenie i rokowanie. Zrozumienie stadiów choroby jest kluczowe dla właściwego zarządzania procesem terapeutycznym.²³

Stadia zaawansowania

Klasyfikacja stadiów guza Wilmsa opiera się na rozległości nowotworu i zajęciu okolicznych struktur:²³

Stadium 1: Guz ograniczony do jednej nerki i można go całkowicie usunąć chirurgicznie. Około 40-45% guzów Wilmsa jest diagnozowanych w tym stadium.
Stadium 2: Guz rozprzestrzenił się na tkanki i naczynia wokół nerki, ale nadal może być całkowicie usunięty chirurgicznie. Około 20% guzów Wilmsa to stadium 2.
Stadium 3: Guza nie można całkowicie usunąć chirurgicznie, a część nowotworu pozostaje w jamie brzusznej. Około 20-25% guzów Wilmsa to stadium 3.
Stadium 4: Nowotwór rozprzestrzenił się do odległych narządów, takich jak płuca, wątroba lub mózg. Około 10% guzów Wilmsa to stadium 4.
Stadium 5: Guz występuje w obu nerkach w momencie diagnozy. Około 5% guzów Wilmsa to stadium 5.

Obustronne zajęcie nerek

Około 5-10% pacjentów z guzem Wilmsa ma obustronne lub wieloogniskowe guzy w momencie diagnozy. Występowanie obustronnych guzów jest częstsze u osób z genetycznymi predyspozycjami niż u tych bez predyspozycji. Choroba obustronna może być synchroniczna (obie nerki dotknięte jednocześnie) lub metachroniczna (jedna po drugiej) i występuje odpowiednio u 6,3% i 0,85% pacjentów z guzem Wilmsa.²⁴²⁵

Średni wiek w momencie diagnozy dla przypadków obustronnych wynosi około 31 miesięcy, w porównaniu do 44 miesięcy w przypadkach jednostronnych.¹

Nawroty choroby

Mimo właściwego leczenia, istnieje ryzyko nawrotu guza Wilmsa (recydywy). Prawdopodobieństwo nawrotu zależy od początkowego stadium i histologii, ale średni wskaźnik nawrotów wynosi około 10-15%. W przypadkach z niekorzystnymi czynnikami rokowniczymi, ryzyko nawrotu może sięgać 15-50%.²⁶¹⁴²³

Nawroty guza najczęściej występują w ciągu pierwszych 2 lat po leczeniu i rozwijają się w nerkach lub innych tkankach, szczególnie w płucach lub wątrobie.¹³¹⁴

Czynniki wpływające na progresję

Oprócz stadium zaawansowania, na progresję choroby wpływają również:²⁷²⁴

Wiek dziecka – młodszy wiek diagnozy często wiąże się z bardziej agresywnym przebiegiem
Zmiany genetyczne w komórkach guza – szczególnie niekorzystne jest zwiększenie 1q, które dotyczy 28% guzów Wilmsa i jest najsilniejszym predyktorem wyniku leczenia
Histologia guza – guzy o histologii anaplastycznej (występujące w 3-7% przypadków) mają gorsze rokowanie
Rozmiar guza – większe guzy są trudniejsze do całkowitego usunięcia chirurgicznego
Odpowiedź na leczenie – słaba odpowiedź na wstępną chemioterapię może sugerować bardziej agresywne zachowanie guza

Rokowanie

Guz Wilmsa jest uleczalnym nowotworem u większości dotkniętych nim dzieci. Od lat 80. XX wieku wskaźnik pięcioletniego przeżycia dla guzów Wilmsa o korzystnej histologii konsekwentnie przekracza 90%. Ogólny wskaźnik przeżycia wynosi około 85-90%, ale rokowanie dla poszczególnych dzieci jest mocno uzależnione od indywidualnego stopnia zaawansowania i leczenia.¹³²⁴²⁸

Wskaźniki 4-letniego całkowitego przeżycia dla guzów anaplastycznych wynoszą odpowiednio 83%, 83%, 65% i 33% dla stadiów I, II, III i IV, co pokazuje znacznie gorsze rokowanie dla zaawansowanych stadiów z niekorzystną histologią.³

Rokowanie dla pacjentów z nawrotem choroby jest gorsze niż dla tych z nowo zdiagnozowanym guzem Wilmsa, przy czym 40-80% pacjentów z nawrotem może przeżyć po terapii ratunkowej.³

Powikłania i skutki długoterminowe

Osoby, które przeżyły guz Wilmsa, mogą doświadczać problemów zdrowotnych lub późnych efektów leczenia w życiu dorosłym, takich jak:¹³¹⁴

Zmniejszona funkcja nerek – szczególnie w przypadkach obustronnego usunięcia części nerek
Choroby serca – jako odległe skutki chemioterapii (zwłaszcza doksorubicyny) lub radioterapii
Rozwój wtórnych nowotworów – zwiększone ryzyko wystąpienia innych nowotworów w późniejszym życiu
Problemy płucne – po radioterapii klatki piersiowej lub chemioterapii
Zaburzenia wzrostu i rozwoju – szczególnie w przypadku intensywnej terapii w młodym wieku

Z tego powodu konieczna jest stała, długoterminowa opieka medyczna nad pacjentami po leczeniu guza Wilmsa, aby monitorować nawroty nowotworu oraz długoterminowe skutki uboczne radioterapii i chemioterapii.¹³

Podsumowanie klinicznych objawów guza Wilmsa

Kategoria objawów	Objawy kliniczne	Częstość występowania
Objawy główne	Bezbolesna masa w jamie brzusznej Powiększenie brzucha Ból brzucha	80% Powszechne 30-40%
Objawy układu moczowego	Krwiomocz (makroskopowy) Krwiomocz (mikroskopowy) Nawracające infekcje dróg moczowych	15-20% 24% Rzadziej
Objawy układu krążenia	Nadciśnienie tętnicze Rozszerzone naczynia żylne na brzuchu	25% Rzadziej
Objawy ogólnoustrojowe	Gorączka Anemia Spadek masy ciała Utrata apetytu Zmęczenie	Poniżej 15% Zmienne Zmienne Zmienne Zmienne
Objawy zaawansowanej choroby	Duszność i kaszel Krwioplucie Ból w klatce piersiowej Silne bóle głowy Zaburzenia świadomości	Około 10% ma przerzuty przy diagnozie

Powyższa tabela przedstawia zestawienie objawów klinicznych guza Wilmsa na podstawie danych z literatury medycznej.²⁹³⁴

Wskazówki diagnostyczne

Guz Wilmsa często nie powoduje żadnych wczesnych objawów, co utrudnia wczesne rozpoznanie. Nawet dość duży guz może być bezbolesny. Dlatego ważna jest regularna ocena pediatryczna, szczególnie u dzieci z podwyższonym ryzykiem nowotworu (np. z zespołami genetycznymi predysponującymi do guza Wilmsa).¹⁷³⁰

Wiele z możliwych objawów guza Wilmsa jest częściej powodowanych przez inne schorzenia. Niemniej jednak, jeśli dziecko ma którykolwiek z wymienionych objawów, należy skonsultować się z lekarzem, aby ustalić przyczynę i rozpocząć leczenie, jeśli jest to konieczne.⁸

Natychmiastowa pomoc medyczna i agresywna terapia są ważne dla najlepszego rokowania. Regularna, długoterminowa opieka jest niezbędna dla dziecka z rozpoznaniem guza Wilmsa, aby monitorować nawrót guza i długoterminowe skutki uboczne leczenia.¹³

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Materiały źródłowe

#1 Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/kidney/hp/wilms-treatment-pdq
Wilms tumor is the most frequent tumor of the kidney in infants and children. The incidence of Wilms tumor is 9.7 cases for every 1 million children younger than 15 years and 13.5 cases per 1 million infants. Approximately 650 cases of Wilms tumor are diagnosed in the United States each year. The male-to-female ratio in unilateral cases of Wilms tumor is 0.92 to 1.00, but in bilateral cases, there is a female excess (0.60). The mean age at diagnosis is 44 months in unilateral cases and 31 months in bilateral cases of Wilms tumor. About 10% of children with Wilms tumor have an associated congenital malformation syndrome. […] Wilms tumor typically develops in otherwise healthy children without any predisposition to developing cancer. However, approximately 10% of children with Wilms tumor have been reported to have a congenital anomaly. In patients with congenital anomalies and Wilms tumor, nephrogenic rests have been reported in 60% of cases. Children with Wilms tumor may have associated hemihypertrophy and urinary tract anomalies, including cryptorchidism and hypospadias. Children may have recognizable phenotypic syndromes such as overgrowth, aniridia, genetic malformations, and others. These syndromes have provided clues to the genetic basis of the disease. The phenotypic syndromes and other conditions have been grouped into overgrowth and non-overgrowth categories. Overgrowth syndromes and conditions are the result of excessive prenatal and postnatal somatic growth.
#2 Wilms tumor | Alex’s Lemonade Stand Foundation for Childhood Cancer
https://www.alexslemonade.org/childhood-cancer/guides/childhood-cancer/chapter-7-kidney-tumors/wilms-tumor
Approximately 550 to 600 children are diagnosed with Wilms tumor in North America every year. It is more common in children of European and African descent than in Asian children. Girls are slightly more at risk of developing Wilms tumor than boys. […] The average age at diagnosis is between 3 and 4 years when the disease is unilateral (affecting only one kidney), but it is generally diagnosed at a younger age when the disease is bilateral (affecting both kidneys). Seventy-five to 80 percent of children with Wilms tumor are diagnosed before the age of 5. Five percent of children with Wilms tumor have tumors in both kidneys at diagnosis. […] Once Wilms tumor has been diagnosed, more tests are done to determine whether the cancer has spread to other parts of the body. This process is called staging and it helps the doctor choose the best treatment for the child. Computerized tomography (CT) scans of the chest should be ordered because approximately 20 percent of children with Wilms tumor have lung metastases at diagnosis.
#3 Wilms Tumor: Practice Essentials, Background, Etiology
https://emedicine.medscape.com/article/989398-overview
Wilms tumor, or nephroblastoma, is the most common childhood abdominal malignancy. The median age at diagnosis of this kidney tumor is approximately 3.5 years. Clinical findings include the following: Asymptomatic abdominal mass (in 80% of children at presentation) […] Abdominal pain or hematuria (25%) […] Hypertension, gross hematuria, and fever (5-30%) […] Respiratory symptoms related to lung metastases (in patients with advanced disease; rare). Approximately 90% of all Wilms tumors have favorable histology; however, 3-7% of Wilms tumors are characterized by anaplastic changes. If these changes are present diffusely throughout the tumor, they are predictive of a poor outcome. Wilms tumors with anaplastic changes have unfavorable histology. Patients with synchronous bilateral tumors have a 70-80% survival rate, whereas those with metachronous tumors have a 45-50% survival rate. Patients with anaplastic Wilms tumor have a worse prognosis compared with favorable histology Wilms tumor; the 4-year overall survival rates are 83%, 83%, 65% and 33% for stages I, II, III, and IV, respectively. Children with a loss of heterozygosity at 1p and 16q have a worse prognosis than do children without this heterozygosity loss. The prognosis for patients who have a relapse is not as good as it is for those with a newly diagnosed Wilms tumor, with 40-80% of relapse patients expected to survive after salvage therapy.
#4 Wilms Tumor Clinical Presentation: History and Physical Examination
https://emedicine.medscape.com/article/989398-clinical
The most common manifestation of Wilms tumor is an asymptomatic abdominal mass; an abdominal mass occurs in 80% of children at presentation. Abdominal pain or hematuria occurs in 25%. Urinary tract infection and varicocele are less common findings than these. Hypertension, gross hematuria, and fever are observed in 5-30% of patients. A few patients with hemorrhage into their tumor may present with hypotension, anemia, and fever. Rare patients with advanced disease may present with respiratory symptoms related to lung metastases. […] Examination often reveals a palpable abdominal mass. Pay special attention to features of those syndromes (WAGR syndrome and Beckwith-Wiedemann syndrome [BWS]) associated with Wilms tumor (ie, aniridia, genitourinary malformations, and signs of overgrowth).
#5 Wilms Tumor: Causes, Types, Symptoms, Diagnosis, and Treatment
https://www.webmd.com/cancer/what-is-wilms-tumor
Some children who have a Wilms tumor wont notice symptoms. Others may have: Belly pain […] Many Wilms tumors get very big before anyone notices them. Theyre sometimes the only sign of the disease. The average size is 1 pound. […] The outlook for most kids with a Wilms tumor is good. Up to 90% of children who have a tumor with favorable histology can be cured. If the tumor has unfavorable histology, the cure rate is lower.
#6 Wilms Tumor – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK442004/
Wilms tumor usually presents as an asymptomatic abdominal mass in the majority of children. The child’s caregiver may have discovered the mass while bathing the infant. Other features include: […] Abdominal pain is the most common initial presenting symptom (30% to 40%), followed by hypertension (25%) and hematuria (12% to 25%).
#7 Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/kidney/hp/wilms-treatment-pdq
Most Wilms tumor patients present asymptomatically with an abdominal mass noticed by a parent or pediatrician on a well-child visit. In children with known predisposing clinical syndromes, renal tumors can be found during routine screening. Clinical findings may include the following: A lump, swelling, or pain in the abdomen. Most children present with a nontender, large flank mass that is noted when they are bathed or dressed. If noted on physical examination, the mass does not move with respiration in contrast to splenomegaly. Abdominal pain is present in 40% of children. Blood in the urine. Gross hematuria occurs in about 18% of children with Wilms tumor at presentation, and microscopic hematuria is seen in 24% of patients. Hypertension. About 25% of children have hypertension at presentation, which is attributed to activation of the renin-angiotensin system.
#8 Symptoms of Wilms Tumors | American Cancer Society
https://www.cancer.org/cancer/types/wilms-tumor/detection-diagnosis-staging/signs-and-symptoms.html
Wilms tumors happen most often in young children. There are several possible symptoms of Wilms tumors, but these tumors often grow quite large before causing any symptoms. Children may look healthy and act and play normally. […] This is often the first sign of a Wilms tumor. Parents may notice swelling or hardness in the belly while bathing or dressing the child. The lump is usually on one side of the belly, but sometimes it might be large enough to be felt on both sides. Its usually not painful, but it might be in some children. […] Some children with Wilms tumor may also have: Fever, Nausea, Loss of appetite, Shortness of breath, Constipation, Blood in the urine. […] Wilms tumors can also sometimes cause high blood pressure. This doesn’t usually cause symptoms on its own, but in rare cases blood pressure can get high enough to cause problems such as headaches, bleeding inside the eye, or even a change in consciousness. […] Many of the possible signs and symptoms of Wilms tumors are more likely caused by something else. Still, if your child has any of these symptoms, check with their doctor so the cause can be found and treated, if needed.
#9 Wilms Tumor | Causes, Symptoms, Diagnosis & Treatment
https://www.cincinnatichildrens.org/health/w/wilms-tumor
Symptoms of Wilms tumor vary widely. Most children (60%) have a lump (tumor) in the abdomen (belly). Many children have no symptoms and Wilms tumor is found on routine exams. Some tumors can be very large, even bigger than the kidney itself. […] Cancer cells from the tumor may spread to other parts of the body. The most common site is the lungs. They can also move to the brain and the bones. Additionally, 5% to 10% of children with Wilms tumor have both kidneys affected at time of diagnosis. […] A wide range of other symptoms may occur. These include: Swelling in the belly, Pain in the belly, Blood in the urine (pee), Decreased appetite, Weakness or fatigue, Fever, High blood pressure, Veins that look large or swollen across the belly, Constipation.
#10 Wilms Tumor: Symptoms, Signs and Causes
https://www.hcgoncology.com/types-of-cancers/wilms-tumour-symptoms-and-causes/
A fever accompanying Wilms tumor, which is sometimes referred to as Wilms tumor fever, may signal an inflammatory response. Persistent or recurring fever among children should not be ignored. […] The development of hypertension, or high blood pressure, could also be one of Wilms tumor symptoms. Regular monitoring of blood pressure is essential, and doctors should promptly investigate any sustained elevation to ensure early detection and appropriate care. […] Anemia, a condition characterized by a deficiency of red blood cells, can be a consequence of Wilms tumor. The tumor’s impact on blood production and circulation may lead to reduced red blood cell levels. Further, anemia may cause symptoms such as fatigue, pallor, or weakness. […] Shortness of breath can be a symptom linked to Wilms tumor, particularly if the tumor affects lung function or if there are associated complications.
#11 8 year old son with a Wilms Tumour – Macmillan Online Community
https://community.macmillan.org.uk/cancer_types/kidney-cancer-forum/f/general/40116/8-year-old-son-with-a-wilms-tumour
My 8 year old son was diagnosed with a Wilms Tumour on the 20th June. From initially being admitted to hospital with a swollen tummy and temperature to where we are now. He has had a central line inserted. Started chemotherapy 3 weeks ago. Surgery to remove the tumour and kidney booked for 22nd July. The day after the 1st dose he was admitted to hospital with a high temperature. Blood tests showed no infection so was put down to the tumour. He is now on 3 lots of antibiotics as a precaution. My son just already seems so weak and ill. He isn’t eating or drinking. We are aware that the tumour can cause temperature spikes but they seem continuous. […] My son is also undergoing treatment for Wilms, he has undergone lots of chemo and also suffered from high temperature. After loads of tests and antibiotics, it turned out to be tumor related and the fever went after about 2 weeks (the tumor had shrunk).
#12 Wilms Tumor: Symptoms, Signs and Causes
https://www.hcgoncology.com/types-of-cancers/wilms-tumour-symptoms-and-causes/
Nausea is also one of the possible Wilms tumor symptoms, often associated with the tumor’s impact on kidney function or as a side effect of treatment. […] Consulting an oncologist is imperative if signs or symptoms associated with Wilms tumor, such as abdominal swelling, pain, hematuria, or unexplained fever are observed. Timely intervention enhances the chances of successful treatment.
#13 Wilms Tumor (Kidney Tumor) | Children’s Hospital of Philadelphia
https://www.chop.edu/conditions-diseases/wilms-tumor-kidney-tumor
Wilms tumor is characterized by: […] Abdominal swelling, often toward one side […] Fever […] Abdominal pain […] Constipation […] High blood pressure (hypertension) […] Large swollen veins across the abdomen […] Blood in the urine (hematuria) […] Fatigue […] Loss of appetite […] Weight loss […] Frequent urinary tract infections. […] The overall cure rate for Wilms tumor is 85 percent. As with any cancer, however, prognosis and long-term survival can vary greatly from child to child. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with Wilms tumor because side effects of radiation and chemotherapy may occur as well as second malignancy. […] Regular follow-up care is essential for a child diagnosed with Wilms tumor to monitor for tumor recurrence and long-term side effects of radiation and chemotherapy.
#14 Wilms tumor: MedlinePlus GeneticsLock
https://medlineplus.gov/genetics/condition/wilms-tumor/
Wilms tumor is often first noticed because of abdominal swelling or a mass in the kidney that can be felt upon physical examination. Some affected children have abdominal pain, fever, a low number of red blood cells (anemia), blood in the urine (hematuria), or high blood pressure (hypertension). Additional signs of Wilms tumor can include loss of appetite, weight loss, nausea, vomiting, and tiredness (lethargy). […] With proper treatment, children with Wilms tumor have a 90 percent survival rate. However, the risk that the cancer will come back (recur) is between 15 and 50 percent, depending on traits of the original tumor. Tumors usually recur in the first 2 years following treatment and develop in the kidneys or other tissues, such as the lungs. Individuals who have had Wilms tumor may experience related health problems or late effects of their treatment in adulthood, such as decreased kidney function, heart disease, and development of additional cancers.
#15 Kidney Tumors in Children and Teens – Together by St. Judeâ¢
https://together.stjude.org/en-us/conditions/cancers/kidney-tumors.html
Common signs and symptoms of Wilms tumor include: […] Common signs and symptoms of kidney tumors include: […] Wilms tumor may affect one or both kidneys. Children with Wilms tumor are usually diagnosed around ages 2-3 if both kidneys are affected (bilateral) or ages 3-4 if one kidney is affected (unilateral). […] About 5-10% of patients have bilateral or multicentric (multiple tumors within the kidney) disease at diagnosis. […] Some children may be treated for constipation for a few months before they are diagnosed with Wilms tumor.
#16 CoxHealth | Wilms Tumor
https://www.coxhealth.com/condition/wilms-tumor/
Symptoms can be different for each child. They can include: A lump in the belly (abdomen) […] Blood in the urine […] Low red blood cell count (anemia) […] Fever […] High blood pressure (hypertension). Many of these symptoms may be caused by other health problems. It’s very important to see your child’s healthcare provider right away if you notice these symptoms. Only a healthcare provider can tell if your child has cancer. It may not cause any symptoms and may not be diagnosed until its large.
#17 Wilms Tumor and Other Childhood Kidney Tumors Treatment – NCI
https://www.cancer.gov/types/kidney/patient/wilms-treatment-pdq
Signs of Wilms tumor and other childhood kidney tumors include a lump in the abdomen and blood in the urine. […] Sometimes childhood kidney tumors do not cause signs and symptoms and the parent finds a mass in the abdomen by chance or the mass is found during a well-child health check-up. […] Wilms tumor that has spread to the lungs or liver may cause the following signs and symptoms: cough, blood in the sputum, trouble breathing, pain in the abdomen. […] The prognosis and treatment options for Wilms tumor depend on the following: how different the tumor cells are from normal kidney cells when looked at under a microscope, the stage of the cancer, the type of tumor, the age of the child, whether the tumor can be completely removed by surgery, whether there are certain changes in chromosomes or genes, whether the cancer has just been diagnosed or has recurred (come back). […] Sometimes Wilms tumor and other childhood kidney tumors come back after treatment. […] Childhood Wilms tumor may recur (come back) in the lungs, abdomen, liver, or other places in the body.
#18 Wilms Tumor – Children’s Health Issues – Merck Manual Consumer Version
https://www.merckmanuals.com/home/children-s-health-issues/childhood-cancers/wilms-tumor
Children usually have a lump in the abdomen, and they may also have abdominal pain, fever, poor appetite, nausea, and vomiting. […] The most common symptom of Wilms tumor is a painless lump in the abdomen. The abdomen may enlarge, which parents may notice when children suddenly need a larger diaper size. […] Less often, children may have abdominal pain, fever, poor appetite, nausea, and vomiting. Blood appears in the urine of some children. […] Because the kidneys are involved in controlling blood pressure, Wilms tumor may cause high blood pressure (hypertension). […] This cancer can spread to other parts of the body, especially the lungs. If the lungs are involved, children may cough and be short of breath.
#19 Wilms’ tumor: Symptoms, treatment, and causes
https://www.medicalnewstoday.com/articles/188130
Wilms tumor, or nephroblastoma, is a rare type of kidney cancer. It usually affects children before the age of 6 years and is very rare in adults. […] A person might experience no symptoms during the early stages. Even a fairly large tumor may be painless. However, a doctor often finds these tumors before they start to metastasize, or spread to other parts of the body. […] If symptoms occur, they may include: swelling in the abdomen, blood in the urine and abnormal urine color, fever, poor appetite, high blood pressure, abdominal or chest pain, nausea, constipation, large and distended veins across the abdomen, malaise, or feeling unwell, vomiting, unexplained weight loss. […] If the tumor spreads to the lungs, it can cause coughing, blood in the sputum, and difficulty breathing.
#20 Wilms Tumour: Symptoms, Causes, Types and Treatments
https://www.acko.com/health-insurance/diseases/wilms-tumour/
The most common symptom of Wilms’ Tumour is swelling in the abdomen. This is usually painless, but it can be accompanied by a lump that the parent or carer can feel. It may also cause small amounts of bleeding in the abdominal area, which can irritate the kidney and cause pain. […] Children with Wilms Tumour may also experience the symptoms mentioned below. […] Vomiting or feeling of nausea […] Constipation […] Loss of appetite […] Fatigue and weakness […] Fever […] Discoloured urine […] Blood in urine […] High blood pressure […] Shortness of breath […] Chest pain […] Headaches.
#21 Wilms Tumor: Causes, Symptoms, Prognosis, Treatment
https://my.clevelandclinic.org/health/diseases/23259-wilms-tumor
Signs and symptoms of Wilms tumor include: A swollen spot or hard lump in your child’s abdomen (stomach area). The lump or swelling can be painful, but it’s usually not. […] Pain in their abdomen. […] Blood in their urine (hematuria). […] Fever. […] High blood pressure (hypertension). This in turn may cause your child to have nosebleeds, headaches and blood in their eye. […] The outlook for someone with Wilms tumor is generally good for almost all stages of Wilms tumor. Its best when your healthcare provider is able to remove the tumor entirely and no cancer is found elsewhere in your child’s body. There is a chance that Wilms tumor can come back (recur). […] Although Wilms tumor can be treated successfully by a combination of surgery and chemotherapy and/or radiation, it’s still cancer. It can still be fatal. […] About 90% of people diagnosed with Wilms tumor are still alive five years later. The rates may be higher or lower depending on the stage and other factors like tumor size and how the cancer cells appear under a microscope (histology).
#22 If Your Child Has a Wilms Tumor | American Cancer Society
https://www.cancer.org/cancer/types/wilms-tumor/if-your-child-has-wilms-tumor.html
Wilms tumors often grow quite large before causing any symptoms. The first symptom of a Wilms tumor is usually swelling or hardness in the belly. This might happen on one side or both. It’s usually not painful. […] Other symptoms of Wilms tumor might include: Fever, Nausea, Loss of appetite, Shortness of breath, Constipation, Blood in the urine. […] Wilms tumors can also sometimes cause high blood pressure. This might not cause symptoms on its own. But in rare situations a child’s blood pressure might get high enough to cause problems like headaches, bleeding inside the eye, or even a change in consciousness. […] If your child has a Wilms tumor, the doctor will want to find out some key pieces of information to help decide how to treat it. The most important information is: The stage (extent) of the Wilms tumor. This depends on whether the tumor is in one kidney or both, if it has grown outside the kidney, and if all of it can be removed with surgery.
#23 Wilmsâ Tumor: Causes, Symptoms, and Diagnosis
https://www.healthline.com/health/wilms-tumor
Once diagnosed, more tests will be done to determine how advanced the disease is. […] Wilms tumor has five stages: Stage 1: The tumor is contained within one kidney and can be completely removed with surgery. About 40 to 45 percent of Wilms tumors are stage 1. Stage 2: The tumor has spread into the tissue and vessels around the kidney, but it can still be completely removed with surgery. About 20 percent of Wilms tumors are stage 2. Stage 3: The tumor can’t be completely removed with surgery, and some cancer remains in the abdomen. About 20 to 25 percent of Wilms tumors are stage 3. Stage 4: The cancer has spread to faraway organs, such as the lungs, liver, or brain. About 10 percent of Wilms tumors are stage 4. Stage 5: The tumor is in both kidneys at the time of diagnosis. About 5 percent of Wilms tumors are stage 5.
#23 Wilmsâ Tumor: Causes, Symptoms, and Diagnosis
https://www.healthline.com/health/wilms-tumor
About 90 percent of children with Wilms tumor survive, though the exact survival rate depends on the stage and histology of the tumor. The outlook for children with unfavorable histology is much worse than for children with favorable histology. […] There’s a long-term risk that cancer will come back. This happens in 15 to 50 percent of the cases, depending on the stage and histology of the original tumor. The prognosis tends to be worse for those whose cancer recurs.
#24 Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/kidney/hp/wilms-treatment-pdq
Wilms tumor is a curable disease in most affected children. Since the 1980s, the 5-year survival rate for Wilms tumor with favorable histology (FH) has been consistently greater than 90%. The prognosis for patients with Wilms tumor depends on the following: Histopathological features of the tumor (FH vs. anaplastic histology). Stage of disease at diagnosis. Molecular features of the tumor such as 1q gain and loss of heterozygosity of 1p and 16q. 1q gain, affecting 28% of Wilms tumors, is the most powerful predictor of outcome and is associated with an adverse outcome. […] Approximately 5% to 10% of individuals with Wilms tumor have bilateral or multicentric tumors. The prevalence of bilateral involvement is higher in individuals with genetic predisposition syndromes than in those without predisposition syndromes. For example, in 545 cases of bilateral Wilms tumors, bona fide germline pathogenic variants were found in 22% of patients. The most common predisposition variants are variants of WT1 and 11p15 loss of imprinting. Bilateral disease can be synchronous (both kidneys affected at the same time) or metachronous (one affected after the other) and occurs in 6.3% and 0.85% of patients with Wilms tumor, respectively. In general, perilobar nephrogenic rests are associated with synchronous bilateral Wilms tumor, whereas intralobar nephrogenic rests are more strongly associated with metachronous Wilms tumors.
#25 Syndromic Wilms tumor: a review of predisposing conditions, surveillance and treatment – Liu – Translational Andrology and Urology
https://tau.amegroups.org/article/view/39654/html
Wilms tumor (WT) is the most common renal malignancy in pediatric populations. Approximately 917% of all WTs are associated with a predisposing syndrome. In addition to an increased likelihood of developing malignancy, children are typically diagnosed with syndromic WT at an earlier age than those with non-syndromic WT, at 1 versus 34 years old, respectively. Despite this earlier presentation, in a study of 12 patients who presented with WT prior to diagnosis of Beckwith Wiedemann, 58% presented at stage 35 disease which is similar to that of sporadic WT. In general, bilateral WTs account for about 5% of all WT. As they are associated with germline mutations of WT1, bilateral tumors occur at higher rates than in non-syndromic WT. There is also a greater likelihood of developing metachronous bilateral tumors and having nephrogenic rests.
#26 Wilms tumor | Alex’s Lemonade Stand Foundation for Childhood Cancer
https://www.alexslemonade.org/childhood-cancer/guides/childhood-cancer/chapter-7-kidney-tumors/wilms-tumor
After treatment, there is a chance that the Wilms tumor will return (called a relapse or recurrence). The likelihood of relapse depends on the initial stage and histology, but the average relapse rate is only 10 percent. Tumor relapse most commonly occurs in the lungs, the original tumor site, or the liver. In 1 to 3 percent of children, a second tumor develops later in the remaining kidney most of these children were younger than 12 months old when they were originally diagnosed and/or their kidney tumor contained pockets of embryonal tissue called nephrogenic rests.
#27 If Your Child Has a Wilms Tumor | American Cancer Society
https://www.cancer.org/cancer/types/wilms-tumor/if-your-child-has-wilms-tumor.html
Doctors also use other information as they decide on treatment options and a child’s chances of getting better. This includes: The child’s age, If the tumor cells have certain gene changes, The size of the tumor. […] Doctors use all this information to put a child with a Wilms tumor into a risk group. Risk groups help doctors decide how best to treat a child.
#28 Wilms tumours factsheet | The Sydney Children’s Hospitals Network
https://www.schn.health.nsw.gov.au/wilms-tumours-factsheet
Wilms tumours are cancers that grow on one or both kidneys. […] Symptoms of a Wilms tumour will depend on how advanced the cancer is. […] They can include: a lump, swelling, and pain in the belly, abnormal or blood-coloured urine or wee, constipation – hard poo that is difficult to pass, loss of appetite, fever, high blood pressure, sweating at nighttime, nausea and vomiting. […] Children who have their Wilms tumour found and treated early have a cure rate of 85-90%, depending on the stage of their cancer. […] More advanced tumours can have a cure rate of around 70-80%, depending on their stage and whether they have spread to other body parts.
#29 Wilms Tumor: Symptoms, Causes, Stages, Diagnosis and Treatment – OncoDaily
https://oncodaily.com/oncolibrary/cancer-types/234450
Common symptoms of Wilms tumor include abdominal swelling or a palpable mass, which is often painless and typically discovered incidentally by parents or during routine pediatric check-ups. Other symptoms include blood in the urine (hematuria), fever, and loss of appetite, sometimes accompanied by fatigue or irritability. […] As reported by the Childrens Oncology Group and data cited in the Journal of Pediatric Hematology/Oncology, abdominal swelling is observed in approximately 80% of cases at diagnosis. Hematuria occurs in about 25%, while systemic symptoms like fever and appetite loss are seen in fewer than 15% of patients. These statistics emphasize the need for prompt evaluation of early signs to improve treatment outcomes. […] Early signs of Wilms tumor often include an asymptomatic abdominal mass, typically discovered incidentally during bathing or dressing, and elevated blood pressure (hypertension), caused by the tumors pressure on the kidneys or surrounding vessels. These subtle signs can complicate early detection, as they may not initially cause discomfort or prompt immediate medical evaluation.
#30 Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQÂ®) – NCI
https://www.cancer.gov/types/kidney/hp/wilms-treatment-pdq
The primary purpose of screening is to enable earlier detection of a small and localized tumor (stage I or II), improve prognosis, and use less intensive treatment (such as to facilitate nephron-sparing surgery). Children with a significant increased predisposition to develop Wilms tumor (e.g., most children with Beckwith-Wiedemann syndrome or other overgrowth syndromes, WAGR syndrome, Denys-Drash syndrome, sporadic aniridia, or isolated hemihypertrophy) are usually screened with ultrasonography every 3 months until they reach at least age 8 years.