Wilms Tumor: Treatment, Cost and Side Effects

Wilms tumour is a type of cancer occurring in the kidneys. It is generally seen among children aged between 3 to 5 years and is much less common for children aged 5 years. It is named after the German doctor Dr. Max Wilms.

Wilms tumour affects one or both the kidneys. Most Wilms tumours are unilateral, which means that they affect only one kidney. However, 5% to 10% of children having Wilms tumours have more than one tumour in one kidney. On the other hand, about 5% of children have tumours in both the kidneys. This means they are bilateral. These tumours often become large and noticeable on proper diagnosis. When they are found, they appear quite large but have not spread to other organs (metastasized).

The cause of Wilms tumour is not known. However, sometimes the cancerous genes are passed down from parents to children. Also, they are generally found in children having certain syndrome or abnormalities like WAGR syndrome, Denys-Drash syndrome and Beckwith-Wiedemann syndrome. The risk of developing Wilms tumour is higher in African-American and lower among Asians. Moreover, there are two types of tumours based on histology (looked under the microscope). Favourable histology generally refers to having no anaplasia in the tumour. Children diagnosed with this type of tumour have very good survival rate and cure. Unfavourable histology refers to the presence of anaplasia (the cells nuclei which are the central part that contain the DNA appears to be large and distorted). Children having this type of tumour have low survival and cure rate.

The diagnosis for Wilms Tumour will generally include a blood test, urine test and USG (ultrasound sonogram) of the abdomen. Additional tests will include CT and MRI scan, Chest x-ray and biopsy of the tumour. Depending on these tests the cancer is divided into stages. There are five stages. The treatment of cancer depends on the stage of cancer. Other factors influencing the treatment of cancer include the child’s health, age, medical history and histology (favourable or unfavourable). Usually a combination of nephrectomy which is surgery, chemotherapy and radiation therapy is used.

Nephrectomy is usually simple, partial or radical. While in chemotherapy chemicals are used to destroy the cancer cells. The medication used is cytotoxic medicines. In radiation therapy, high-energy X-rays or particles are used to destroy cancer cells.

In stage 1 or 2, the cancer cells or tumours is contained within the kidney or have spread to the surrounding tissues or structures. The cancerous cells are removed by surgery, followed by chemotherapy. Usually the drug antinomycin D and vincristine are used to treat any left-over tissues or cancerous cells. If the tumour is very unfavourable, then radiation therapy is used to treat it. In stage 3 or 4, the tumour has spread beyond the kidney area and has spilled into the abdomen or has spread to other organs like lungs, liver, bones and brain. In this case, removing the tumour surgically may damage blood vessels. Therefore, chemotherapy is first given to shrink the tumour. A combination drugs antinomycin D, vincristine and doxorubicin are used. A surgery is performed after to remove the tumour followed by more radiation therapy and chemotherapy. In stage 5, cancer cells are found in both the kidneys (bilateral tumours). In such scenario, chemotherapy is given to shrink the tumour first followed by partial nephrectomy where the tumour and affected tissues are removed preserving as much as healthy tissues as possible. It will be followed by more chemo and radiation therapy.

Wilms tumour does not cause any symptoms in initial stage and also the symptoms can vary widely. However, children may experience symptoms like abdominal swelling, pain and a noon-tender abdominal mass may be felt. Other symptoms include hematuria (bloody urine), abnormal urine colour, and lack of appetite, hypertension (high blood pressure), nausea, constipation, malaise, vomiting and hemihypertrophy (enlargement of one side of the body). Go to a doctor if your child shows any of these symptoms.

Children having syndromes and abnormalities like WAGR syndrome, Deny's-Dash syndrome and Beckwith-Weidemann syndrome should consult a doctor to see whether he or she is eligible for Wilms tumour treatment.

As with other cancer treatments that involves chemotherapy and radiation therapy, there are side various side effects of these procedures. In chemotherapy which involves using cytotoxic medications to prevent cancer cells from dividing and growing, there are many side effects like hair loss, loss of appetite, low white blood cells, nausea and vomiting. This usually go way after chemotherapy is stopped. For radiation therapy where high-energy x-rays or particles are used to destroy cancer cells, side effects may include diarrhea, fatigue, nausea and skin irritation as areas hit by radiation may become red and sore.

Long-term and late complication and side effects may include reduced kidney function, heart or lung problems, slowed or delayed growth and development, changes in sexual development and increased risk of cancer recurrence. These symptoms usually appear in teenage or adulthood years.

Treatment for any type of cancer involves palliative care that will mean providing emotional, physical and mental support to the patient and their family. As Wilms tumour occurs among children, extra care and support should be given. After bringing your child home, monitor your child closely by observing his energy levels, body temperatures and sleeping patterns. Remember to give him or her prescribed medicine routinely and observe any side effects of the same. Plan a normal diet for your child and try to include more fruits, leafy vegetables and probiotics to help him regain strength and energy. If you are worried or confused about what to give him, then talk to your doctor about inclusion or exclusion of any specific food item. Check with the doctor before giving him any vaccinations as cancer treatment can affect the immune system. Also, talk to your child about his or her illness and try to encourage and support him in resuming school and normal day to day activities.

Recovery for any cancer treatment is long as it involves a combination of surgery, chemotherapy and radiation therapy being done. For Wilms tumour, it takes around 1 to 9 months to fully recover.

The pricing for Wilms tumour treatment includes surgery, chemotherapy and radiation therapy. Surgical cost can range from Rs.50,000 to Rs.1,00,000. Chemotherapy and radiation therapy starts from Rs.30,000 and go up to Rs.1,00,000.

Yes, the results are permanent but as with other cancers, Wilms tumour can also reoccur and needs further treatment.

Recent years have seen a rise in alternative medicine for cancer treatment that includes herbal remedies, massage therapy, relaxation therapy and acupuncture.