One of the most malignant neoplasms in the urological area is considered to beWilms tumor. It affects the parenchyma of the kidneys and is diagnosed mainly in early childhood.
It is otherwise called "nephroblastoma" or "adenosarcoma". It ranks fourth among all oncological pathologies of childhood.
The tumor is an embryonic neoplasm and is diagnosed mainly up to 5 years of age (often at 3 years). Oncopathology with the same frequency is detected both in boys and girls. In adulthood, nephroblastoma occurs in,% of cases of all types of kidney cancer.
Often, the cancer is asymptomatic at the initial stage, so it can only be detected with a medical examination. With the progression of the disease there are symptoms of intoxication syndrome, dysfunction of the cardiovascular system, urinary system and digestive tract.
What is the danger of this disease for the life of the patient?
When the tumor conglomerate spreads to neighboring tissues and organs, a pain syndrome arises, the intensity of which increases in parallel with the increase in tumor size. Painful sensations can be so pronounced that the introduction of narcotic painkillers is required.
In 30% of cases, the growth of a malignant focus on the renal parenchyma leads to the appearance of blood in the urine. In this case, the color of urine becomes more saturated with a reddish tinge. As a result, anemia increases in the blood (hemoglobin and erythrocytes decrease).
When there is necrotization and disintegration of tumor tissues, it is possible to attach a secondary infection. In urine tests, this is manifested by an elevated level of leukocytes and protein, and a temperature increase is clinically noted.
Another danger of this type of tumor is the risk of its reoccurrence after the treatment. Relapse is observed in 5-15% of cases, as a result of which the survival in the next 2 years is no more than 40%.
The most dangerous malignant tumors are tumors developing before, years, or at the age of 5 years.
The classification of Wilms tumor, as well as of other cancers, is based on the staging malignant process, taking into account its prevalence, the presence of metastases and the defeat of others structures.
- Stage 1 is characterized by the absence of growth of the tumor beyond the kidney, and the capsule and vessels are not affected.
- 2 - the neoplasm extends beyond the borders of the kidney, extending to the capsule or vessels. At this stage, complete removal of the body, which significantly increases life expectancy.
- 3 degree of cancer is characterized by the appearance of metastases in the regional lymph nodes and abdominal cavity.
- For stage 4, distant metastasis is typical with the formation of foci of elimination in the liver, lungs, bone structures and brain. There is a defeat of the tumor of both kidneys.
Causes and risk factors
It is proved thatWilms tumor in childrenis a consequence of genetic mutations, but it is not established which gene. In 1-2% of cases a family predisposition is recorded.
Especially often neoplasm develops against a backdrop of other developmental anomalies, for example:
- with defects of internal organs and an increase in the tongue;
- mental retardation, anomalies in the development of urogenital organs and the absence of the iris of the eye;
- in the presence of large moles, lengthening, thickening of the limbs and varicose veins of the lower extremities.
Clinical symptoms depend on the child's age, prevalence of the oncology and the presence of metastases in the lymph nodes and distant organs.
Tumor, reaching a large size, can be probed through the abdominal wall. In addition, there is an asymmetric shape of the abdomen. Lymph nodes to the touch become firm, enlarged, immobile and tightly welded to surrounding tissues.
Spreading on the intestine, developing intestinal obstruction, increasing intoxication and sharply worsens the general condition. When metastasizing to the lungs, there may be shortness of breath, shortness of breath and coughing.
When probed, the formation has a smooth surface. In stages 1-2, the tumor is mobile, but by 3-4 it can not be moved.
Microhematuria (blood in the urine) occurs in 30% of cases with germination in the renal parenchyma. When spreading to neighboring organs, painful sensations appear. More than half of the patients are diagnosed with high blood pressure.
Analyzes and examinations
At the initial stage of malignant disease, clinical symptoms may be absent. This is due to the fact that the tumor for a long time does not go beyond the kidneys and does not sprout into the capsule. However, the dimensions increase and squeeze the surrounding structures, provoking the appearance of pain.
Initially, an erased clinical picture is observed in the form of weakness, weight loss, deterioration of appetite and a rise in temperature to 37 degrees. Laboratory tests in the blood tests recorded an increase in ESR and anemia of moderate severity.
Laboratory diagnostics includes the performance of urine, blood tests and detection of oncomarkers. Instrumental methods involve ultrasound, CT of kidneys, urography, bone scintigraphy and sternal puncture.
The final diagnosis is established based on the results of a histological examination (biopsy).
How to cure Wilms' tumor?
Therapeutic tactics are determined in each case individually. The volume of the operation can be - removal of the kidney from one or two sides in combination with the surrounding fiber and affected lymph nodes.
Radiotherapy and chemotherapy can also be conducted. After the treatment, the ultrasound of the retroperitoneal space and the abdominal cavity should be performed regularly, as well as the chest X-ray.
Having diagnosedWilms tumor, the prognosis depends on the stage of oncoprocess. Thus, the survival rate after treatment at stage 1 is almost 90%, 2 - about 75%, 3 - about 40% and for 4 stages survival is not more than 17%..