There are two types of Wilms tumours. These are differentiated based on how the cells appear under a microscope. They are:

• Favourable histology: Most of the cases of Wilms tumour fall under this type. In this, there is hardly any difference between the cancer cells. Children suffering from this type have a higher chance of getting treatment.
• Unfavourable or anaplastic histology: In this type of Wilms tumour, the cells bear a largely varying appearance. Many of the cells appear distorted and huge. This is known as anaplasia. This type can be quite challenging to cure.

1. Diffuse Anaplasia: This is when the anaplasia has spread all over the tumour.
2. Focal Anaplasia: When only some parts of the tumour are affected by anaplasia, it is called focal anaplasia.

The primary reason behind cancer is when the cells in your body start growing uncontrollably.

If your child is suffering from Wilms tumour, it may be because the kidney cells were converted into cancer cells and did not develop the way they should have. This happens when a particular gene undergoes an unexpected change: the result of immature kidney tissues leading to tumour formation.

There are some risk factors, which can make your child susceptible to Wilms tumour, which are:

• Gender: Girls are at a higher risk of developing Wilms tumour than boys.
• Age: Most children diagnosed with Wilms tumour are between the age of 3-5 years.
• ● Congenital disabilities

1. Cryptorchidism: In this, the testicles are not formed properly.
2. Aniridia: The coloured section of the eye is partially or entirely missing.
3. Hypospadias: The opening of the penis is not on the tip but the underside.
4. Hemihypertrophy: An oversized leg or arm
5. Denys-Drash Syndrome: Children with this syndrome are highly prone to Wilms tumour. It is recommended that both the kidneys of such children are removed to avoid this health condition. Later, they can go for a donor-kidney transplant procedure.

Wilms tumour mostly affects children aged between 3-4 years. The symptoms of this ailment can be quite similar to other childhood disorders, so diagnosing it accurately can be tricky.

As parents, you need to be careful about the following symptoms associated with Wilms tumour:

• Constipation
• Nausea and vomiting
• Abdominal pain, swelling, and discomfort
• Weakness
• Fever
• A loss of appetite
• Discoloured urine or blood in the urine
• Elevated blood pressure, leading to chest pain, breathing difficulties, headache
• Constipation

Sometimes, a Wilms tumour can grow noticeably big before the appearance of any symptoms.

To check if your child has Wilms tumour, the following evaluation tests might be suggested by the doctor:

• Physical examination: A thorough medical assessment of your child is done to check for swellings around their abdominal region or any lump in their kidneys.
• Medical history: All details of your child’s medical history is evaluated to see if there is a history of cancer or urinary tract problems in your family.
• Imaging tests: CT (Computed Tomography) scan or MRI (Magnetic Resonance Imaging) scan of the child’s abdomen is done.
• Blood tests: These are done to find how well your child’s kidneys are functioning. These may also be used to check the red and white blood cell count and the body’s blood clotting functions.

If the presence of a tumour is detected, then further tests are done, which include:

• Bone scan: To test for damaged bones
• Advanced imaging tests: More scans to determine the spread of the disease
• Biopsy: A tissue sample is taken for biopsy

Based on the results received from the diagnostic tests, there are five different stages of Wilms tumour:

1. 1. Stage I: At this stage, only one kidney is damaged, but surgery can cure it.
   2. Stage II: Cancer has spread throughout the kidneys, but with surgery, it is curable.
   3. Stage III: At stage III, the area outside the child’s abdomen is affected, and it becomes difficult to treat it with surgery.
   4. Stage IV: Cancer has invaded other organs like the lungs, brain, bones, and lymph nodes outside the abdomen.
   5. Stage V: At stage V, both kidneys have tumours.

Wilms tumour treatment can include varied methods depending on the extent of the cancer.

• Surgery: If your child’s doctor finalises surgery as the treatment, then it may be one of the following ways:

1. Partial Nephrectomy: The surgeon will get rid of the tumour and some of the healthy tissues surrounding it.
2. Radical Nephrectomy: When the tumour has damaged the kidney badly, the surgeon will remove the damaged kidney, the adrenaline gland, the ureter, which is the tube carrying urine from the kidney, and some of the nearby tissues.
3. Removing both the kidneys: In some extreme cases, removal of both the kidneys becomes essential. After the surgery, your child will be on dialysis to filter the waste material from the blood. After this, at a suitable time, a kidney transplant is performed.

• Chemotherapy: In this method, certain medications are prescribed and administered to fight and destroy cancer cells. However, these medicines might also damage some healthy cells, due to which your child may repeatedly fall sick.
• Radiation Therapy: This treatment mode uses high energy rays or particles and is often chosen during the III, IV and V stages of Wilms tumour. Radiation therapy is given either before surgery to shrink the tumour or post-surgery to ensure the complete removal of the cancer cells.

When it comes to Wilms tumour, survival is often calculated using a 4-year benchmark. For kids suffering from stage I, II and III cancer with favourable histology, the chances of survival are as high as 95-100 per cent.

With timely diagnosis and treatment, the survival rate is over 90 per cent. Usually, the chances of recurrence are meagre.

Children undergoing chemotherapy may experience some side-effects like fatigue, hair loss, diarrhoea or constipation, mouth sores, infections, loss of appetite, etc. These can be managed with the help of powerful medications.

Additionally, children who have had Wilms tumour may face some health issues in their adulthood, like a heart condition, troubled kidney functions or the development of any other type of cancer. Other than this, the risk of relapse is generally there in the first two years post-treatment, but the percentage is extremely low.