Nephroblastoma, or Wilms’ Tumor, is the most common solid abdominal tumor in childhood and usually appears as a painless abdominal mass in an otherwise well child. Frequently, the pediatrician on routine exam or the parents while playing with the child, will notice a large, firm mass below the rib cage on either the right or left side of the abdomen.
Initial evaluation includes CT scan of the abdomen and chest to evaluate the size of the tumor in the abdomen as well as any possibility of spread to the lungs, which is the most common site of distant spread. Most of these tumors can be initially resected, particularly if they are on one side only. An ultrasound of the abdomen is done pre-operatively to eliminate the possibility of the tumor extending into the vena cava, which returns blood to the heart. If ultrasound demonstrates tumor extending from the kidney into the vena cava, most physicians prefer to have pre-operative chemotherapy, thus shrinking the mass and decreasing the risk to the patient. If the mass involves only one kidney and does not have an extension into the inferior vena cava, the treatment of choice is to remove the kidney and the associated localized lymph nodes. In addition, the other kidney is looked at carefully, since 5–7% of these patients may have bilateral tumors. Generally with bilateral tumors, the tumors are biopsied and chemotherapy is instituted before partial resection or total resection of the kidney. Once the extent of the tumor and the histology of the tumor has been identified, the patient will undergo chemotherapy and/or radiation treatment as necessary. The results of this combination therapy have proven very effective and survival for Wilms’ Tumor has markedly increased during the past 10-15 years.
This information, although based on a thorough knowledge and careful review of current medical literature, is the opinion of doctors at The University of Texas Medical School and is presented to inform you about surgical conditions. It is not meant to contradict any information you may receive from your personal physician and should not be used to make decisions about surgical treatment. If you have any questions about the information above or your child's care, please contact our doctors.
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Pediatric General & Thoracic Surgery
6410 Fannin Street, Suite 950
Houston, Texas 77030
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