Wilms tumor, or nephroblastoma, is the most common kidney cancer in children and usually appears between ages 2 and 5. Parents often notice a firm, painless swelling of the abdomen, and with modern treatment most children are cured.
Key symptoms
- Painless swelling or mass in the abdomen, often noticed during bathing
- Abdominal pain
- Blood in the urine
- Fever, poor appetite or weight loss
What you find on exam
- Firm, smooth flank mass that does not cross the midline
- Palpate gently and only as needed to avoid rupture
- High blood pressure
- Associated findings: aniridia, hemihypertrophy, genital anomalies
Tests
- Abdominal ultrasound first
- CT or MRI of the abdomen and CT of the chest for staging
- Urinalysis, blood count, kidney and liver tests
- Coagulation studies
Treatment basics
- Care at a pediatric cancer center
- Surgery (nephrectomy) first for most children in the US
- Chemotherapy such as vincristine and dactinomycin, based on stage
- Radiation for advanced stages
- Long-term follow-up of kidney function and late effects
Red flags
- Rapidly growing abdominal mass
- Sudden abdominal pain with pallor (possible rupture or bleeding)
- Very high blood pressure
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.