Wilms' tumor history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Overview

The common symptoms of wilms' tumor include swelling, abdominal pain, fever, hypertension, and hypercalcemia.

History and Symptoms

History

• Patients with wilms tumor may have a positive history of:
  • Asymptomatic abdominal mass
    • This occurs in 80% of children.
    • Urinary tract infection
    • Varicocele

Common Symptoms

• Common symptoms of wilms tumor include:
  • Abdominal pain
  • Hematuria

Less Common Symptoms

• The most common manifestation of Wilms tumor is an asymptomatic abdominal mass; an abdominal mass occurs in 80% of children at presentation. Abdominal pain or hematuria occurs in 25%. Urinary tract infection and varicocele are less common findings than these. Hypertension, gross hematuria, and fever are observed in 5-30% of patients. A few patients with hemorrhage into their tumor may present with hypotension, anemia, and fever. Rare patients with advanced disease may present with respiratory symptoms related to lung metastases.

The following symptoms may be caused by Wilms or other childhood kidney tumors:

• A lump, swelling, or abdominal pain. Most children present with an asymptomatic mass that is noted when they are bathed or dressed. Abdominal pain is present in 40% of children.
• Fever: Fever is occasionally noted.
• Blood in the urine. Although gross hematuria occurs in about 25% of children with Wilms tumor, most children with gross hematuria do not have Wilms tumor.
• Hypertension: About 25% of children have hypertension at presentation, which is caused by excessive renin excretion and responds to angiotensin-converting enzyme (ACE) inhibitors or surgical removal of the tumor.
• Hypercalcemia: Symptomatic hypercalcemia can sometimes be seen at presentation of rhabdoid tumors.

Children with Wilms tumors or other renal malignancies may also come to medical attention as a result of the following:

• Vascular obstruction or metastasis, including pulmonary symptoms due to lung metastasis.
• Abdominal pain due to liver metastasis, prominent abdominal wall vessels, or varicocele due to inferior vena cava obstruction.
• Pulmonary embolus (rare).