Introduction
Wilms tumour (nephroblastoma) is a malignant embryonal tumour of renal tissue.
About 80% of children with Wilms tumour present before 5 years of age. It can present soon after delivery.
It may be associated with congenital anomalies such as hemihypertrophy and the absence of the iris (aniridia).
Wilms tumour has a very good prognosis with an over 80% chance of long-term cure.
Causes of Wilms tumour
- Sporadic gene mutation.
Symptoms of Wilms tumour
The symptoms of Wilms tumour include the following:
- Visible and or palpable abdominal mass
- Fever
- Blood in urine
Signs of Wilms tumour
The signs of nephroblastoma include the following:
- Abdominal mass (palpate with care to prevent dissemination or rupture)
- Haematuria (macroscopic or microscopic)
- Hypertension
- Associated congenital anomalies
Investigations
- Abdominal ultrasound scan
- Abdominal CT scan
- Chest X-ray
- Full Blood Count
- Blood Urea, electrolytes and creatinine
Treatment for Wilms tumour
Objectives
The treatment objectives of Wilms tumour are
- To obtain long term cure
- To provide adequate supportive and palliative care
Non-pharmacological treatment
- Nephrectomy
- Radiotherapy post-surgery for advanced cases
Pharmacological treatment
A. Pre-operative treatment
1st Line Treatment
Evidence Rating: [A]
Vincristine, IV,
And
Actinomycin D, IV,
And
Doxorubicin, IV, (if presence of metastases)
B. Post-operative treatment
Evidence Rating: [A]
- Vincristine, IV,
And
- Actinomycin D, IV,
And
- Doxorubicin, IV, (depending on stage and risk category)
Or
- Carboplatin, IV,
- Etoposide, IV,
- Doxorubicin, IV, Cyclophosphamide IV in combination (For high risk tumours)
C. For treatment of vomiting
Evidence Rating: [A]
Metoclopramide, IV or oral,
- 100-400 microgram/kg 8 hourly
Or
Granisetron, IV,
- 40 microgram/kg (max. 3 mg) stat.
May repeat 12 hourly if necessary
Granisetron, oral,
- 20 microgram/kg (max. 1 mg) within 1 hour before start of treatment
- Then 20 microgram/kg 12 hourly for up to 5 days
Or
Ondansetron, IV,
Adults
- 5 mg/m2 stat.
- Repeat 8 hourly if necessary
Children
- 12-18 years; 8 mg stat. (immediately before chemotherapy)
Or
Ondansetron, oral,
Adults: 8 mg 8 hourly, administered 30 minutes before the start of chemotherapy
Children:
- 12-18 years; 8 mg 8-12 hourly up to 5 days
- 1-12 years; 4 mg 8-12 hourly up to 5 days
D. For treatment of febrile neutropenia
Ceftriaxone, IV, 100 mg/kg daily
And
Gentamicin, IV, 5 mg/kg daily.
And
(if still febrile after 48 hours, add)
Cloxacillin, IV, 25-50 mg/kg 6 hourly
And
(if still febrile after 5 days, add)
Fluconazole, oral, 10 mg/kg daily
E. For treatment of anaemia and thrombocytopenia
Blood and blood product transfusions
(See ‘Bleeding disorders‘)
Referral Criteria
All patients should be referred to specialist centres for appropriate treatment.