Complications of Wilms tumor

Wilms' tumor is a type of kidney cancer that usually affects children of the age of 3 or 4. The exact cause of Wilms' tumor is still unknown, but experts believe that it is innate.

Wilms' Tumor Symptoms

The symptoms of Wilms' tumor progress slowly, and the child may appear healthy. If the symptoms occur, they may include swelling in the abdomen, pain in the stomach, nausea, constipation, loss of appetite, fever, high blood pressure, and blood in the urine. If Wilms' tumor is detected and treated in time, the chances of full recovery are great.

Wilms' Tumor Diagnosis

To diagnose Wilms' tumor, the doctor may do a physical exam to perform urine and blood tests and MRI, CT scan, or X-ray imaging. After the thorough diagnostic measures, your doctor will establish the stage of cancer. There are 5 stages of Wilms' tumor which are determined according to the development of cancer and the fact whether it has affected other organs.

Wilms' Tumor Treatment

The most common treatments for Wilms' tumor are surgery, chemotherapy, and radiation. The term which refers to the removal of the kidney or kidney tissue is nephrectomy. Several types of surgical procedures may involve simple, partial, and radical nephrectomy.

In simple kidney nephrectomy, the entire kidney is removed, partial nephrectomy includes the kidney and the surrounding tissue, and radical nephrectomy includes the kidney, surrounding tissue, urethra, and adrenal gland. In the most severe cases, both kidneys will have to be removed and the child will have to go on dialysis until the transplantation.

Survival rates are excellent for children with Wilms tumor (WT), yet tumor and treatment-related complications may require pediatric intensive care unit (PICU) admission. We assessed the frequency, clinical characteristics, and outcome of children with WT requiring PICU admissions in a multicenter, retrospective study in the Netherlands.

Admission reasons of unplanned PICU admissions were described in relation to treatment phase. Unplanned PICU admissions were compared to a control group of no or planned PICU admissions, with regard to patient characteristics and short and long term outcomes.
In a multicenter cohort of 175 children with an underlying WT, 50 unplanned PICU admissions were registered in 33 patients.
Reasons for admission were diverse and varied per treatment phase. Younger age at diagnosis, intensive chemotherapy regimens, and bilateral tumor surgery were observed in children with unplanned PICU admission versus the other WT patients.
Three children required renal replacement therapy, two of which continued dialysis after PICU discharge (both with bilateral disease). Two children died during their PICU stay. During follow-up, hypertension and chronic kidney disease (18.2 vs. 4.2% and 15.2 vs. 0.7%) were more frequently observed in unplanned PICU admitted patients compared to the other patients. No significant differences in cardiac morbidity, relapse, or progression were observed.

In this multicenter study, with more than 15 years of inclusion, we observed that almost 20% of children with Wilms tumor required unplanned PICU admission, with young age and treatment intensity as potential risk factors. Hypertension and CKD stage 2 or higher was more frequently observed in unplanned PICU admitted patients, which justifies special attention for kidney function, development of proteinuria, and blood pressure monitoring during and after treatment of these children. Larger cohort studies are required to identify independent determinants of PICU admission and to clarify the role of events during PICU admission as a risk factor for hypertension and CKD as late morbidity in children with WT.

✓ Fact confirmed: Characteristics and Outcome of Children with Wilms Tumor Requiring Intensive Care Admission in First Line Therapy Anouk Steur, Paulien A. M. A. Raymakers-Janssen, Martin C. J. Kneyber, Sandra Dijkstra, Job B. M. van Woensel, Dick A. van Waardenburg, Cornelis P. van de Ven, Alida F. W. van der Steeg, Marc Wijnen, Marc R. Lilien, Ronald R. de Krijger, Harm van Tinteren, Annemieke S. Littooij, Geert O. Janssens, Annemarie M. L. Peek, Godelieve A. M. Tytgat, Annelies M. Mavinkurve-Groothuis, Martine van Grotel, Marry M. van den Heuvel-Eibrink and Roelie M. Wösten-van Asperen; 14 February 2022

Wilms' Tumor Complications

There are surgical complications that can appear during or after the surgery. These complications may include hemorrhage, infections, hernia, intestinal injury, small bowel obstruction, and vascular problems. Other complications that may appear later include renal failure, heart diseases, lung problems, liver damage, obstructed gonadal function and ovarian function, and problems with musculoskeletal function which can be a consequence of radiation and development of second cancer such as breast, thyroid, brain or bone cancer. If Wilms' tumor affected both kidneys, it may reflect on their function. Fortunately, Wilms' tumor is a rare condition, and so are the complications.

Conclusion

Having a small child with cancer may be devastating for the parents and family, so it is important to provide necessary support and care. You should be with your child during his/her stay in the hospital, try to explain what is happening, observe your child's behavior including sleep, appetite, temperature, and energy levels, and provide him/her with healthy food and plenty of fluids.