Wilms' Tumor Of The Kidney

Description

This is a congenital tumor usually found in children in the 2- to 5-year age group. This is among the most common tumors found in infancy. However, Wilms' tumor may occur in late childhood or even in an adult.

Symptoms

A mass usually noted in the abdomen or a painless swelling may be noted above the kidney region. This may cause asymmetry of the affected side. Other symptoms include hypertension, fever, hematuria, and later, malnutrition, asthenia, and anemia.

Treatment

The physician usually prefers immediate removal by surgery except in instances in which it is necessary to reduce the size of the tumor by preoperative radiation. The advantages of this are always carefully weighed against those of immediate surgical intervention. Since metastatic spread cannot always be detected, postoperative irradiation is almost universal. This is often combined with chemotherapy. The mortality rate is high.

Neuroblastoma

Description

These tumors arise from the sympathetic nervous system and frequently occur intracranically or in the adrenal medulla. They extend locally and often spread to multiple sites.

Symptoms

A variety of symptoms occurs, as one would expect, depending upon the part of the nervous system involved. Late symptoms include hemorrhage, adenopathy, bone pain, and often paresthesia.

Treatment

Surgery is usually attempted to determine the resectability of the tumor. If possible, the tumor is removed. This is usually followed by radiation and sometimes chemotherapy. The prognosis is good to guarded, depending upon the extensive-ness of the tumor and the structures involved.

Retinoblastoma

Description

This tumor occurs in the eye and may affect one or both sides. It is found in children 4 months to 4 years of age. It is one of the few tumors which is almost universally considered to be hereditary.

Symptoms

The symptoms can be detected even by an amateur since there is a change in the color of the pupil from black to white, green or red. This causes a peculiar "cat's eye" appearance. The child may stumble or hold his head to one side since his vision is impaired. Strabimus or a bulging eye may occur.

Treatment

When one eye is affected the treatment of choice is enucleation. When both eyes are involved the more affected eye is usually removed and the other treated by radiation. The outlook is grave. However, some patients do survive, even though blindness has occurred as a result of the treatment. Anyone who is treated for a retinoblastoma is almost always told of the possible hereditary nature of this tumor.

Bone Tumors

Description

These tumors are numerically important in adolescents and preadolescents. Their onset may be very insidious and pain may be lacking. For this reason bone tumors may be extremely difficult to diagnose. The two most common bone tumors are osteogenic sarcoma and Ewing's sarcoma. They occur frequently in the arm or leg regions.

Symptoms

As stated heretofore symptoms are often lacking. However certain symptoms sometimes occur: Ewing's sarcoma, pain, swelling, disability-Osteogenic sarcoma, again symptoms may be lacking, but pain and swelling do occasionally occur.

Treatment

Ewing's tumor is highly sensitive to radiation and if discovered early may be cured. Reaction to radiation may be a problem because of the extensive therapy which is needed. See page 61 for care during radiation therapy.

Osteogenic sarcoma is usually treated by surgical amputation if the tumor is diagnosed in a fairly early stage. Supplemental treatment consists of radiotherapy. The surgery may be radical in nature if the tumor is in the upper region of the arm or leg. Removal of part of the pelvis (hemipelvectomy) or part of the shoulder (interscapulo-thoracic resection) are not uncommon.