Wilms tumour, also called nephroblastoma, is a kidney cancer of young children, mostly under the age of 5. It usually affects one kidney, and in a small number of children both.
It is one of the childhood cancers that responds well to treatment, which combines surgery and chemotherapy and sometimes radiotherapy within an international protocol. How intensive treatment needs to be depends on stage and on what the tumour looks like under the microscope. Your child's own team is the right source for information about outlook.
Symptoms
- A painless swelling or firm lump in the abdomen, often noticed at bath time
- Abdominal pain
- Blood in the urine
- Fever without a clear cause
- High blood pressure
- Poor appetite, paleness or tiredness
Causes and risk factors
The tumour grows from immature kidney cells left over from development before birth. In most children there is no known reason and nothing could have prevented it. About 1 in 10 has an underlying syndrome or body feature that raises the risk, such as Beckwith-Wiedemann syndrome, WAGR syndrome, Denys-Drash syndrome, absence of the iris or overgrowth of one side of the body. Children with these conditions are offered regular kidney ultrasound in early childhood.
How it is diagnosed
- Abdominal ultrasound: The first test. It shows that the mass arises from the kidney and checks the main vein.
- CT or MRI of the abdomen: Defines the tumour, the other kidney and lymph nodes.
- Chest imaging: Looks for spread to the lungs.
- Blood and urine tests: Kidney function, blood count and urine markers that help rule out neuroblastoma.
- Histology: From the removed kidney, or from a needle biopsy in selected cases. It sets the risk group.
Treatment options
- Pre-operative chemotherapy: In the European SIOP approach, about 4 to 6 weeks of vincristine and actinomycin D shrink the tumour before surgery.
- Nephrectomy: Removal of the affected kidney with lymph node sampling by a paediatric surgeon or urologist. North American protocols usually operate first.
- Kidney-sparing surgery: Used when both kidneys are involved or in children with a predisposition syndrome.
- Post-operative chemotherapy: Its length and drugs depend on stage and histology.
- Radiotherapy: To the flank, abdomen or lungs for higher stages or unfavourable histology.
- Long-term follow-up: Monitoring of the remaining kidney, blood pressure, heart and growth.
When it is urgent
A child with a swollen abdomen and sudden pain, paleness or collapse, visible blood in the urine, or fever during chemotherapy must be seen at the nearest emergency department straight away. Do not press on or repeatedly examine the lump yourself, as the tumour can rupture.
Travelling to Türkiye for treatment
Treatment follows a fixed protocol over several months and works well when delivered by an experienced children's cancer unit, ideally close to home and family. Travel makes sense if your country lacks paediatric oncology or paediatric surgical expertise, for a pathology and imaging second opinion, or for complex surgery such as tumours in both kidneys. A child on chemotherapy can become unwell quickly, so plan to stay for the whole treatment block, not to commute between countries.
Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.
Frequently Asked Questions
Can a child live normally with one kidney?
Yes. The remaining kidney grows to take over the work. Blood pressure and urine are checked regularly through life.
Why is chemotherapy sometimes given before surgery?
It shrinks the tumour, makes rupture during the operation less likely and may reduce the treatment needed afterwards.
Is a biopsy always needed?
No. In the typical age group with typical imaging, many protocols start treatment without one.
Is it hereditary?
Rarely. Only about 1 to 2 percent of children have an affected relative. Genetic review is offered when there are syndrome features or tumours in both kidneys.