Wilms' Tumor

“There are incalculable resources in the human spirit, once it has been set free.”- Hubert Humphrey It is an unimaginable anguish to have your child diagnosed with a life ending illness. Yet for many families this news is part of their living. Undoubtedly, the health care struggles are magnified for many especially during this COVID-19 pandemic. People oftentimes move in and out of our lives for a reason. Life is a journey fraught with many obstacles; some of which leaves us gutted. However, there is always hope and we should never surrender to the pain and suffering which exist. Earlier this year a parent shared with me that her 5 year old daughter was diagnosed with Wilms’ Tumor. At first I was clueless what is Wilms’ Tumor so I decided to do some research and turned to two trusted online sources. The Mayo Clinic defines Wilms' tumor as a rare kidney cancer that primarily affects children. Also known as nephroblastoma, it is the most common cancer of the kidneys in children. Wilms' tumour most often affects children ages 3 to 4 and becomes much less common after age 5. Interestingly, girls are more likely to be diagnosed with Wilms’tumor than boys. Wilms' tumor most often occurs in just one kidney, though it can sometimes be found in both kidneys at the same time. The mother of the affected five-year old recounts the family's journey from diagnosis to treatment. “As a homeschool mother of 6 young children, the diagnosis created a tremendous wave of confusion in our family. Fortunately for my daughter, I was able to camp out with her in the hospital at the University Hospital of the West Indies. Unfortunately, my daughter and I spent almost two months in the hospital away from home, my husband and the other children. The big C is not a diagnosis anyone wants to hear for themselves, worst of all for their infant child. There was nothing in her medical history that predisposed her to such a disease and the only noticeable sign was a lump on her left side and rapid weight loss. It was somewhat comforting however, to learn that the prognosis was overwhelmingly positive as the success rate of the medical treatment, and complete recovery rate for this particular cancer was significantly high. The treatment included a combination of approaches, namely chemotherapy and/or radiotherapy and surgery. Another comforting bit of information for us was that the tumor had not spread to any other organs and so the cancer was at an early to moderate stage of development; which meant that the treatment would be less aggressive. Despite that, we dreaded the often spoken about chemotherapy. While it was painful to see my little baby endure this, once we understood more about the treatment we were better able to manage the side effects and some of the hospital staff were very helpful, encouraging and supportive. This made the journey less excruciating for my daughter and for the rest of the family. There were some obviously difficult moments however. The COVID restrictions prevented anyone other than the parents from visiting the patient so my daughter’s siblings were only able to see her occasionally at the security post. This was the first time the family had been separated for an extended period and that was painful to endure. The side effects of the chemotherapy caused intense suffering to my little five years old. Some of the adverse effects include severe jaw pain, dehydration, fecal infection, diarrhea, unbearable stomach pain and alopecia. Having completed the first stage of her treatment, she is looking toward surgery now and that comes with its own challenges. Our faith in the Almighty, the loving support from family and friends are the things that keep us stable and give us hope. Encouragement and hope thrives also because of the many other children we met in hospital with similar and even worse conditions and the resilience and courage they and their parents and guardians show. There is strength within the human mind that can inadvertently take over when faced with tremendous hardship and pain. An unwavering belief in the Superior Being and the power of the community helps us realize and make use of this inner strength.”

Types of Wilms’ Tumors There are two kinds of Wilms’ tumors, divided by how the cells look under a microscope. Favorable histology. More than 9 out of 10 Wilms’ tumors fall into this group. It means there isn’t a lot of difference among the cancer cells. Children with this type have a good chance of being cured. Unfavorable or anaplastic histology. This type has a variety of deformed cancer cells. It can be much harder to cure. Symptoms Signs and symptoms of Wilms' tumor vary widely, and some children do not show any obvious signs. However, most children with Wilms' tumor experience one or more of these signs and symptoms: an abdominal mass you can feel, abdominal swelling, blood in urine and pain. The Mayo Clinic adds that other signs include, fever, nausea or vomiting or both, constipation, loss of appetite, high blood pressure and shortness of breath. Causes It is not clear what causes Wilms' tumor, but in rare cases, heredity may play a role. Cancer begins when cells develop errors in their DNA. The errors allow the cells to grow and divide uncontrollably and to go on living when other cells would die. The accumulating cells form a tumor. In Wilms' tumor, this process occurs in the kidney cells. In rare cases, the errors in DNA that lead to Wilms' tumor are passed from a parent to the child. In most cases, there is no known connection between parents and children that may lead to cancer. Factors that may increase the risk of Wilms' tumor include: African-American race. In the United States, African-American children have a slightly higher risk of developing Wilms' tumor than children of other races. Asian-American children appear to have a lower risk than children of other races. Family History of Wilms' Tumor. If someone in your child's family has had Wilms' tumor, then your child has an increased risk of developing the disease. Wilms' tumor occurs more frequently in children with certain abnormalities or syndromes present at birth, including: Aniridia. In aniridia (an-ih-RID-e-uh), the iris the colored portion of the eye forms only partially or not at all. Hemihypertrophy. Hemihypertrophy (hem-e-hi-PUR-truh-fee) means one side of the body or a part of the body is noticeably larger than the other side. Wilms' tumor can occur as part of rare syndromes, including: WAGR Syndrome. This syndrome includes Wilms' tumor, aniridia, genital and urinary system abnormalities, and intellectual disabilities. Denys-Drash Syndrome. This syndrome includes Wilms' tumor, kidney disease and male pseudohermaphroditism (soo-do-her-MAF-roe-dit-iz-um), in which a boy is born with testicles but may exhibit female characteristics. Beckwith-Wiedemann Syndrome. Children with this syndrome tend to be significantly larger than average (macrosomia). Other signs may include abdominal organs that jut out into the base of the umbilical cord, a large tongue (macroglossia), enlarged internal organs and ear abnormalities. There is also an increased risk of tumors, including a type of liver cancer called hepatoblastoma. Wilms Tumor Treatment The online source WebMD states that how a Wilms’ tumor is treated depends on how much the cancer has spread. It can include surgery, chemotherapy, and radiation therapy. If surgery is the preferred course then your doctor may do one of these procedures: Partial Nephrectomy which is the removal of the tumor and some healthy tissue around it. Radical Nephrectomy which is the removal of the affected kidney, the ureter (the tube that carries pee away from the kidney), the adrenal gland on top of the kidney, and nearby tissue. The third option is the removal of both kidneys. In some cases, the doctor will need to take out both kidneys. Your child would then need to have dialysis, using a machine to filter waste out of their blood. Once they are healthy enough, they might have a kidney transplant. Wilms Cancer Foundation The Wilms Cancer Foundation (WCF), is a charitable organization, that supports and represents the needs of children, families and healthcare organizations affected by the childhood kidney cancer nephroblastoma commonly known as ‘Wilms’. Through our programmes we aim to provide every child, family and healthcare organization with the support they need to tackle Wilms and save children's lives. The mission of the Wilms Cancer Foundation is as follows: to establish a national programme of awareness, education, advocacy, early detection and treatment in order to tackle the spread of childhood kidney cancer 'Wilms'. The Foundation also seek to support children, families and organizations as they tackle cancer, through initiatives such as our ‘Dream-Making’ program, in order to lighten the emotional and financial burden they face. Wilms’ Tumor Outlook The outlook for most kids with a Wilms’ tumor is good. Up to 90% of children who have a tumor with favorable histology can be cured. If the tumor has unfavorable histology, the cure rate is lower. Once cancer treatment ends, your child will have regular doctor visits to make sure they stay healthy. If there’s something you do not understand, make sure to ask your pediatrician. This will help you know how best to support your child during this challenging time. In the midst of disease and sickness which are constant in the world there is an urgent need to raise awareness of Wilms’ Tumour especially in Jamaica. Even with the deficiencies in our health care system we pause and must pay tribute to our hardworking healthcare workers who turn up and give of their best. We empathize with those parents who are journeying with their children who are diagnosed with Wilms’ Tumour. To the children who are suffering from this rare type of cancer we pray for your full and speedy recovery. Jesus said, “Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.” – St. Matthew 11:28-30 Wayne Campbell is an educator and social commentator with an interest in development policies as they affect culture and or gender issues. waykam@yahoo.com @WayneCamo © #WilmsTumour #Wilms #kidneycancer