Neha Shiju, Mahlet Tekle, Mensah Abobi Macrina, Rutvi Mehta, Amrutha Bhat
Contents (Categories)
Discussion
Abstract
Introduction
Diagnosing Patients
Medical Professions Required
Treatments
Statistics (DATA)
Impacts
Conclusion
Bibliography/Citations (MLA Format)
Discussion
Wilms tumor is a rare kidney cancer which predominantly affects children. Wilms tumor is a very interesting type of cancer. There are many facts that make wilms tumor interesting to investigate. For instance, wilms tumor affects children of colour more than white children. It is also quite interesting to note that Wilms tumor usually occurs in just one kidney, however it is possible that it occurs in both. These facts make wilms tumor quite an interesting research topic. The intriguing nature of wilms tumor makes it fascinating to explore, hence it is the research topic that we chose.
Abstract
This investigation looks into Wilm’s tumor, focusing on the diagnosis, treatments, stastics and impact. It examines the effectiveness of treatment options such as chemotherapy, radiation therapy, surgery etc. Evaluating these treatments is crucial considering Wilms tumor primarily affects children. In order to ensure these children go on to live long and healthy lives, minimally invasive and harmful treatment methods are better. In order to thoroughly study the impact and procedure of these treatments, online sources were used. We ensured the credibility of the sources by using articles written by reliable individuals and/or instituitions.
It has been found through this research that Wilm’s tumor affects various impacts on the body. These impacts include kidney problems, bowel obstruction, heart problems, lung problems, bone and muscle problems, liver problems, reproductive system problems and the possibility of developing a second cancer.
In terms of treatment options, Wilm’s tumor can be treated using surgery (radical nephrectomy or partial nephrectomy), chemotherapy and radiation therapy.
Surgery involves the removal of the tumour. This surgery is called nephrectomy and there are two different types. There is radical nephrectomy and partial nephrectomy. If the cancer affects both kidneys, surgery involves removing as much cancer as possible from both. During surgery, the lymph nodes close to the kidney may be removed and examined for cancer cells and then the suitable type of surgery is chosen.
Chemotherapy uses strong medicines to kill cancer cells throughout the body. However, it was found that chemotherapy also has side-effects. Some ommon side effects include nausea, vomiting, loss of appetite, hair loss and higher risk of infections.
Radiation therapy involves the use of use strong radiation therapy for tumors that are stage III and above. In this therapy, a large machine points energy beams at the cancer. This therapy also has possible side effects, for instane, nausea, diarrhea, tiredness and sunburn-like skin irritation.
This study was conducted to examine the treatment options of Wilms tumor and understand how they work as well as what side-effects they propose. The battle against cancer requires global attention and a profound understanding of the disease itself. With that being said, the medical field is ever-expanding and gaining such insight is quite strenuous.
Introduction
Wilms tumor (nephroblastoma) is a cancer of the kidney which usually occurs in children. It was first named after and described by a German scientist by the name Max Wilms. It is the second most common intraabdominal cancer amongst children and the fifth most common pediatric malignancy overall. There are approximately eight cases per million children less than the age of fifteen per year in the US, with new cases totaling about 650 cases per year. Statistics show that about 75% of cases occur in children less than 5 years of age with peak incidences occurring at 2 to 3 years of age. Survival chances for patients which were less than 30% have now been improved to above 90%, making Wilms tumor of the real successes of modern-day medicine. This improvement is in fact attributed to the systematic way the approach to therapy has evolved. It is also important to note that surgery has always been a crucial component of Wilms tumor therapy; the addition and refinement of chemotherapy, and, in certain circumstances, radiation therapy, have also had a significant impact on achieving the improved survival rates.
Diagnosing Patients
Diagnosing Wilms tumor requires a comprehensive approach combining various medical techniques and tests. This process is crucial for early detection and effective treatment planning. The diagnostic journey typically involves several key steps, each providing valuable information to healthcare providers. Here's an overview of how medical professionals diagnose Wilms tumor:
Physical examination: The doctor may feel the child's abdomen for any lumps or swelling.
Imaging studies:
Ultrasound: Often the first test used to visualize the kidneys
CT scan or MRI: Provide detailed images of the tumor and surrounding tissues
Blood and urine tests: Check kidney function and overall health
Biopsy: A small sample of the tumor is taken and examined under a microscope
Genetic testing: May be done to identify specific gene mutations associated with Wilms tumor
Staging: Determines the extent of the cancer's spread
Histological examination: Analyzes the tumor's cellular structure after surgical removal
Medical Professions Required
Managing Wilms Tumor involves a multidisciplinary team of healthcare professionals. Each specialist plays a crucial role in the comprehensive care and treatment of the patient. Here is a list of the medical professions required in accordance with their roles, schooling and salary:-
• Pediatric Oncologist
- Role: Oversees the treatment plan, including chemotherapy and co-ordination with other specialists available.
- Schooling: MD, pediatrics residency (3 years), pediatric oncology fellowship (3
years).
- Salary: $200,000 - $400,000 annually
Pediatric Surgeon
- Role: Performs surgeries to remove the tumor and manage complications.
- Schooling: MD/DO, general surgery residency (5-7 years), pediatric surgery
fellowship (1-2 years)
- Salary:- $250,000 - $500,000 annually.
• Pathologist
- Role: Analyzes tissue samples to diagnose Wilms Tumor and determine its type and grade.
- Schooling: MD/DO, pathology residency (4years), also possibly a fellowship in pediatric pathology (1-2 years).
- Salary: $260,000 - $370,000 annually.
• Nurse Practitioner (Pediatric)
- Role:- Provides patient care, symptom management, and family education.
- Schooling: BSN, RN license, MSN with pediatric specialization.
- Salary: $51,000 – $130,000 annually.
• Oncology Social Worker
- Role: Offers psychological support, counselling, and assistance with
navigating the healthcare system.
Schooling: MSW, clinical social work license (LCSW).
- Salary: $60,000 - $80,000 annually
Treatments
Surgery
The main goal of surgery to treat Wilms' tumor is to remove as much of the main tumor as possible. The kidney, ureter and adrenal glands will be removed as well. This surgery is called nephrectomy. During surgery, the lymph nodes close to the kidney may be removed and examined for cancer cells. Nearby organs and the other kidney will be examined, and biopsies may be done.
Two types of nephrectomy are used to treat Wilms' tumor:
Radical nephrectomy
The most common surgery to treat Wilms' tumor. The entire kidney, along with surrounding tissue, is removed.
Partial nephrectomy (or kidney-sparing surgery)
When Wilms' tumors are in both kidneys, this surgery may be done to save as much healthy tissue as possible. The cancer and some of the surrounding healthy tissue are removed.
Removing all or part of both kidneys.
If the cancer affects both kidneys, surgery involves removing as much cancer as possible from both. Sometimes, this means removing both kidneys. The child would then need kidney dialysis or a kidney transplant.
Chemotherapy
Chemotherapy uses strong medicines to kill cancer cells throughout the body. Treatment for Wilms tumor usually involves using more than one medicine to kill cancer cells. The medicine is given through a vein.
Side effects of chemotherapy depend on the medicines used. Common side effects include nausea, vomiting, loss of appetite, hair loss and higher risk of infections.
If given before surgery, chemotherapy can shrink tumors and make them easier to remove. After surgery, it can kill cancer cells that are left in the body. Chemotherapy may also be an option for children whose cancers are too far along to be removed completely with surgery.
For children who have cancer in both kidneys, chemotherapy is given before surgery. This may make it more likely that one kidney might be saved.
Radiation Therapy
Doctors tend to use strong radiation therapy for tumors that are stage III and above. During radiation therapy, the child is placed on a table. A large machine moves around the child, pointing energy beams at the cancer. Some children will have radiation therapy after surgery to kill any cancer cells that are left & it also might be used to control cancer that has spread to other areas of the body. Possible side effects include nausea, diarrhea, tiredness and sunburn-like skin irritation. But it can also have short-term and long-term side effects, including tissue damage, so they’ll use as little as possible.
Statistics (Data)
Wilms tumor is the most common type of kidney cancer in children. Each year, about 500 to 600 new cases of Wilms tumor are diagnosed in the United States. This number has been fairly stable for many years. About 5% of all cancers in children are Wilms tumors.
Wilms tumors tend to occur in young children. The average age of children when they are diagnosed is about 3 to 4 years. These tumors become less common as children grow older. They're very rare in adults, although cases have been reported.
Wilms tumors are slightly more common in girls than in boys. The risk of Wilms tumor is slightly higher in Black children than in White children and is lowest among Asian American children.
Anaplastic WT cells apparently have increased resistance to therapy rather than increased aggressiveness. Focal anaplasia (FA) applies only to tumors with anaplasia confined to one or a few discrete loci within the primary tumor, with no anaplasia or marked nuclear atypia elsewhere. Eight children with metastases (the development of secondary malignant growth at a distance from a primary site of cancer.) at diagnosis and FA in the primary tumor were alive and free of relapse; 22 of 23 children with stage IV Diffuse Anaplasia (DA) WT died of tumor.
The average age of diagnosis of Wilms tumor in children depends upon whether one or both kidneys are affected:
If one kidney is affected (unilateral Wilms tumor), the age at diagnosis usually is 42-47 months
If both kidneys are affected (bilateral Wilms tumor), the age at diagnosis usually is 30-33 months
Impacts
Recovering from Wilms tumour and adjusting to life after treatment is different for each child.
Kidney problems
Children with Wilms tumour are usually very young when they are diagnosed and treated, so they have a risk of developing kidney problems as time goes on. These problems include proteinuria (too much protein in the urine) and hypertension (high blood pressure). Kidney failure can be a late effect for children who have Wilms tumour in both kidneys.
Kidney problems can develop 10 to 20 years after a nephrectomy, radiation therapy or chemotherapy to treat Wilms tumour. Depending on the dose, radiation therapy can cause kidney damage (called radiation nephritis).
Children with Denys-Drash syndrome have a higher risk for kidney problems after treatment for Wilms tumour. Children with WAGR syndrome also have a higher risk for kidney failure.
Children with only one kidney should avoid medicines that are harmful to the kidneys and wear protective equipment when they play contact sports.
Bowel obstruction
Children treated with abdominal surgery can develop scar tissue that increases the risk of bowel obstruction later in life. Symptoms of bowel obstruction include abdominal pain and vomiting.
Heart problems
Certain chemotherapy drugs used to treat Wilms tumour, such as doxorubicin (Adriamycin), can have late effects on the heart. These late effects include problems with heart muscle function, such as left ventricular dysfunction or cardiomyopathy. Chemotherapy for Wilms tumour can also lead to abnormal heart rhythms (arrhythmias). Depending on the dose used, up to one-quarter of children treated with doxorubicin for Wilms tumour develop some heart abnormality. People who have been treated with doxorubicin for Wilms tumour should avoid smoking because it damages the heart.
Lung problems
Pneumonitis is the most common lung problem caused by certain chemotherapy drugs, such as doxorubicin and dactinomycin. Pneumonitis is inflammation of the lungs. It can lead to pulmonary fibrosis, which is the formation of scar tissue in the lungs.
Bone and muscle problems
Children treated for Wilms tumour may grow and develop slower or less than other children. Radiation therapy to the abdomen can cause problems with the bones and muscles, or musculoskeletal problems. These problems may include a curved spine (called scoliosis) or underdeveloped or weak muscles.
Liver problems
Certain chemotherapy drugs, such as dactinomycin and vincristine (Oncovin), can cause liver problems. Radiation therapy to the abdomen can also damage the liver. The liver may become enlarged, which is called hepatomegaly. A severe but uncommon complication of treatment is a problem called sinusoidal obstruction syndrome or veno-occlusive disease of the liver. This problem usually occurs while the child is still undergoing treatment. If the liver damage increases, the liver may become hard (called fibrosis) and scarred (called cirrhosis).
Reproductive system problems
Some chemotherapy drugs used to treat Wilms tumour can affect the ovaries and testicles. These drugs can cause different reproductive system problems for children as they get older. These problems can include early or delayed puberty in both boys and girls. Sometimes children treated for Wilms tumour may be infertile when they are adults. Girls who receive radiation therapy to the whole abdomen may enter menopause early as women. There can also be negative effects on later pregnancies for women who received abdominal radiation as a child. The most common problem is premature delivery.
Second cancers
Wilms tumour survivors have a higher risk of developing a second cancer. This risk may be due to genetic conditions or to treatments, such as chemotherapy and radiation therapy.
The types of cancer that may develop after radiation therapy depend on the area treated. Radiation to the abdomen can increase the risk of colorectal and other gastrointestinal cancers. Radiation to the chest can increase the risk of lung, breast and thyroid cancers if these areas were in the field of radiation. Children who have had radiation therapy should be part of a long-term follow-up program that monitors them and teaches about the risk of second cancers.
Conclusion
In conclusion, Wilms tumor is a rare type of pediatric kidney cancer that predominantly manifests itself in children. It offers an extraordinary combination of opportunities and challenges to biomedical research and clinical practice. Nevertheless, major efforts have been made in the field of detecting and treating this condition, thus enhancing the survival rates significantly. The combination of radiation, chemotherapy, and surgery has altered treatment regimens and given hope to many young patients. Nevertheless, the complexity of Wilms tumor demands absolute attention to detail at all times. The necessity for ongoing monitoring and specialized follow-up care is underscored by the possible long-term effects, with the kidneys, heart, lungs, and reproductive system. This possibility of developing secondary tumors again reinforces the importance of patient education and long-term surveillance. However, while Wilms tumor has a much better prognosis now, the matter does not end with treatment. The medical community must remain committed to developing new treatment choices, minimizing side effects, and offering lifetime support to patients in order to ensure the best outcomes. We can further enhance outcomes and make sure that survivors not only survive longer but also have a higher quality of life via ongoing research and interdisciplinary teamwork. The fight against Wilms tumor is evidence of the effectiveness of medical advancements and the value of a constant dedication to patient care.
Bibilography
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