By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

SURGERY, CHEMOTHERAPY CURE MOST CASES OF WILMS TUMOR

Question: A few years ago, my 1-year-old son was diagnosed with Wilms tumor. The doctors said it was stage 1. The kidney with the tumor was removed, and this was followed by chemotherapy. He is now 5 years old and seems to be doing fine. I’m worried, however, that the cancer might return. After my daughter was born, she was checked for Wilms tumor and they said she was fine. I would like to know more about this disorder. Thanks.

Answer: Wilms tumor is a type of cancer that usually strikes children. The condition is named for Carl Max Wilhelm Wilms, a 19th-century German surgeon who recognized that the cancer develops from immature kidney cells. Wilms tumor may arise in either kidney. Rarely, it affects both kidneys. About 500 new cases are diagnosed in the United States each year.

Wilms tumor is usually found during a well-child examination as a lump -- what we physicians call a mass -- deep inside the abdomen. This cancer grows from the kidney and, therefore, is located deep below the stomach, intestines and other abdominal contents. Only in unusual cases does the growth become large enough to be noticed without specifically feeling for it. Children with this type of tumor often have no complaints to suggest there is a problem. Rarely, some do complain of low-back pain or generally not feeling well.

A child who is found to have an abdominal mass must undergo several tests to determine the specific cause of it. An MRI, CT scan, kidney X-rays and biopsy are often used. Wilms tumor has a characteristic appearance on these tests, and the tissue sample obtained from the biopsy shows a type of cancer called “nephroblastoma.”

Having a child stricken with cancer is every parent’s nightmare. Wilms tumor treatment is one of the brighter spots in that dark realm of cancer fears. About 90 percent of those diagnosed when the tumor is in one kidney (90 percent of cases) and has not spread outside that kidney are cured by surgery and chemotherapy. Even those whose cancer has spread into neighboring tissues have an 80 percent cure rate. Treatment is more complicated and less successful when tumors occur simultaneously in both kidneys or when the diagnosis is made after the cancer is too widely spread for surgical removal.

You have several things to be thankful for in your son’s case. The fact that his cancer was stage one is very good news. This means the chances of a recurrence are very remote. It is also good news that he is doing well now, several years after the cancer was diagnosed and treated. Your daughter’s test results are reassuring as well. I’m sure what they tested for was a defect on chromosome 11, which is present in about 20 percent of the cases of Wilms tumor. Since the test was negative, this means that your daughter, thankfully, does not have this abnormality, which means she is at very low risk of Wilms.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.