Wilms' tumour

Last reviewed: 28 Feb 2023
Last updated: 28 Dec 2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • upper abdominal/flank mass or swelling
More key diagnostic factors

Other diagnostic factors

  • abdominal distension
  • abdominal pain
  • pallor
  • hypoglycaemia in infancy
  • hypertension
  • lymphadenopathy
  • varicocele
  • hepatomegaly
  • cholestasis
  • fatigue
  • poor appetite or cachexia
  • fever
  • haematuria
  • shortness of breath
  • irritability
  • bone tenderness or pain
  • features of paraneoplastic syndrome
Other diagnostic factors

Risk factors

  • age 2 to 5 years
  • FHx
  • congenital urogenital anomalies
  • congenital syndromes
  • antenatal exposure to radiation or chemicals
  • paternal occupation
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • renal function
  • LFTs
  • urinalysis
  • serum total protein/albumin
  • coagulation studies
  • serum calcium level
  • abdominal ultrasound with Doppler
  • CXR
  • CT or MRI abdomen and pelvis with and without contrast
  • CT or MRI chest with and without contrast
  • biopsy
More 1st investigations to order

Investigations to consider

  • genetic testing
More investigations to consider

Emerging tests

  • loss of heterozygosity (LOH) studies

Treatment algorithm

ACUTE

NWTSG/COG criteria

SIOP/UKCCSG criteria

ONGOING

first tumour recurrence without multiple adverse prognostic factors

multiple adverse prognostic factors or multiple relapses

Contributors

Authors

Sandeep Batra, MD

Clinical Assistant Professor

Riley Hospital for Children

Department of Pediatrics

Indiana University School of Medicine

Indianapolis

IN

Disclosures

SB declares that he has no competing interests.

Peer reviewers

Nadine Deannie Lee, MD

Pediatric Hematologist-Oncologist

Hematology/Oncology

Riley Children's Hospital

Indiana University Health

Indianapolis

IN

Disclosures

NDL declares that she has no competing interests.

Norbert Graf, MD

Direktor

Klinik für Pädiatrische Onkologie und Hämatologie

Universitätsklinikum des Saarlandes

Homburg

Germany

Disclosures

NG declares that he has no competing interests.

Zelig Tochner, MD

Associate Professor

Radiation Oncology

Children's Hospital of Philadelphia

Philadelphia

PA

Disclosures

ZT declares that he has no competing interests.

  • Wilms' tumour images
  • Differentials

    • Neuroblastoma
    • Clear cell sarcoma of the kidney (CCSK)
    • Renal cell carcinoma
    More Differentials
  • Guidelines

    • SIOP PODC: clinical guidelines for the management of children with Wilms tumour in a low income setting
    More Guidelines
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