Wilms' tumor

The first step in treating your child is forming an accurate and complete diagnosis. Your child’s physician may recommend a number of different tests to determine the cause of her symptoms. In addition to a complete medical history and physical examination, your child’s doctor may order one or more of the following:

• Abdominal ultrasound: This imaging test can provide an outline of your child’s kidneys, the tumor, and determine if there are problems in the renal or other major veins in the abdomen. It can also determine if there are any lesions or tumors in the opposite kidney. This is usually the first test we recommend if a tumor is suspected.
   
• Chest or abdominal x-ray: An x-ray can help determine the size and location of the tumor and whether it has spread.
   
• Chest and abdominal computerized tomography (CT) scan: CT scans provide more detailed images than x-rays.
   
• Magnetic resonance imaging (MRI): MRI is used in some cases to look for tumor in blood vessels or other organs.
   
• Blood and urine tests: These can evaluate your child’s kidney and liver function and look for any other blood-related abnormalities.
   
• Biopsy: In some cases, a biopsy of the tumor helps your child’s doctor determine the tumor type.
   
• Surgical removal of the tumor and kidney (nephrectomy): surgery may be needed to make a definitive diagnosis. Surgical resection (removal of a tumor by surgery) is the goal of therapy.

How is Wilms’ tumor classified?

An important part of diagnosing Wilms’ tumor involves staging and classifying the disease, which will help your child’s doctor determine treatment options and prognosis. Staging is the process of determining whether the cancer has spread and, if so, how far.

Kidney tumors are typically categorized into five stages. Wilms’ tumor, the most common type of pediatric kidney tumor, is staged as follows by the Children’s Oncology Group (COG):

• Stage I: The tumor is limited to the kidney and can be completely removed surgically. About 40 percent of tumors are stage I.
   
• Stage II: The tumor extends beyond the kidney but can be completely removed surgically. This includes about 20 percent of tumors.
   
• Stage III: The tumor is cannot be completely removed surgically or is spilled at surgery, but disease is still limited to the abdomen. About 20 percent of tumors are stage three.
   
• Stage IV: The disease has spread from the abdomen through the bloodstream and may be found in the lung, liver, bone, or brain as well as distant lymph nodes. About 10 percent of cases are stage four.
   
• Stage V: The tumor is found on both kidneys at the time of diagnosis. This occurs in about 5 percent of cases.

Your child’s doctor can provide additional information on the classification of Wilms’ tumors.

After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then we will meet with you and your family to discuss the results and outline the best treatment options.