Master Wilms' Tumor (Nephroblastoma) with Picmonic for Physician Assistant

Wilms’ tumor, also called nephroblastoma, is a malignant tumor of the kidney(s) that occurs in children. Typically, the malignant mass occurs on the left kidney; however, it may also occur on the right side or bilaterally.

Parents of children with Wilms’ tumor may seek medical attention due to a noticeable swelling of the abdomen often found while bathing or dressing the child. The abdominal mass associated with this condition is usually unilateral and painless. This mass can be located in the upper abdominal quadrants, or in the flanks, and can be unilateral or bilateral.

Children with Wilms’ tumor may experience hematuria, or blood in the urine, depending on the extent of renal involvement.

Children may present with a fever of unknown origin before they are diagnosed with this disease.

Hypertension, due to excess renin production, may occur. For this reason, blood pressure should be closely monitored.

Surgery to remove all or some of the affected kidney(s) is called a nephrectomy. A bilateral nephrectomy is considered a last resort treatment option and is only performed if a kidney transplant is possible. Tissue removed during this procedure can can be biopsied to confirm the presence of Wilms’ tumor.

Chemotherapy can be used to shrink the tumor before surgery to allow for more conservative removal of the kidney(s). This treatment can also be used after surgery to destroy any remaining cancer cells.

Radiation therapy may also be used as a treatment modality after surgery has been performed. Postoperative radiation is often used for children with a large tumor, or with cancer that has metastasized.

Healthcare workers should never palpate the abdomen of a child with Wilms’ tumor, as this increases the risk of rupturing the encapsulated tumor, which could cause cancer cells to spread to other areas of the body. A preoperative tissue biopsy should also be avoided.

Wilms’ tumor will appear in children by the age of five with most diagnoses occurring between ages two and three.