Last reviewed: 2 Jan 2023
Last updated: 28 Dec 2017
Summary
Definition
History and exam
Key diagnostic factors
- upper abdominal/flank mass or swelling
- FHx
- congenital urogenital anomalies
- congenital syndromes
More key diagnostic factors
Other diagnostic factors
- abdominal distension
- abdominal pain
- pallor
- hypoglycemia in infancy
- hypertension
- lymphadenopathy
- varicocele
- hepatomegaly
- cholestasis
- fatigue
- poor appetite or cachexia
- fever
- hematuria
- 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
- prenatal exposure to radiation or chemicals
- paternal occupation
More risk factors
Diagnostic investigations
1st investigations to order
- CBC
- renal function
- LFTs
- urinalysis
- serum total protein/albumin
- coagulation studies
- serum calcium level
- abdominal ultrasound with Doppler
- chest x-ray
- 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 tumor 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.
Differentials
- Neuroblastoma
- Clear cell sarcoma of the kidney (CCSK)
- Renal cell carcinoma
More DifferentialsGuidelines
- SIOP PODC: clinical guidelines for the management of children with Wilms tumour in a low income setting
More GuidelinesLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer