Children's Cancer

Kidney (or renal) tumours affect cells in the kidneys.

Wilms tumour (also known as nephroblastoma) is the most common type of kidney tumour in children. They are more common in younger children, usually three to four-year-olds, than older children.

Other types of kidney tumours in children include:

• clear cell sarcoma of the kidney
• malignant rhabdoid tumour of the kidney
• mesoblastic nephroma
• renal cell carcinoma.

These types of kidney tumours are more common in teenagers and young adults than in young children.

Chance of a cure

One of your biggest concerns on learning that your child has cancer may be their chance of being cured.

Due to major advances in treatment, many children treated for cancer now survive into adulthood. Children diagnosed with cancer between 2004 and 2012 have a 5-year survival rate of 85%. In the 1980s, the 5-year survival rate for all cancers was about 73%.¹

Talk to your child’s doctor about your child’s diagnosis, treatment and long-term survival. Long-term survival is also called ‘outlook’ or ‘prognosis’. It on depends several things, including the:

• age of your child at diagnosis
• extent or stage of the cancer
• how the cancer cells look under a microscope (the shape, function and structure of the cells)
• how the cancer responds to treatment
• cancer or tumour biology, which includes
  • the patterns of the cancer cells
  • how different the cancer cells are from normal cells
  • how fast the cancer cells are growing.

To learn more about survival for kidney (renal) tumours in children, visit Australian Cancer Childhood Statistics Online

References

[1] https://cancerqld.blob.core.windows.net/content/docs/Childhood-Cancer-in-Australia-1983-2015.pdf

Clinical trials

It’s possible that your child may be able to be part of a clinical trial. Clinical trials are research investigations to test new treatments, interventions or tests, as a way to prevent, detect, treat, or manage various diseases or medical conditions. The patients involved in clinical trials are volunteers.¹

With regard to cancer, researchers run clinical trials to test new ways to:

• treat cancer
• find and diagnose cancer
• manage cancer symptoms and treatment side effects.

If a trial is available, taking part will be entirely the family’s decision

It’s possible, that your child may be able to be part of a clinical trial. However, taking part in one will be entirely up to you.

It’s important to note that any new treatments are strictly regulated and they must be approved before they can be used in a clinical trial. Your child’s doctor will explain everything about the trial and give you detailed written information. If you wish your child to be part of the trial, you will need to give permission.

Participating in a clinical trial may or may not directly benefit your child. But the results of clinical trials today help children with cancer in the future. If you’re interested in your child participating in a clinical trial, ask your child’s doctor if there are any suitable for your child.

You can find further information on our Clinical trials and research page.

References

[1] https://www.australianclinicaltrials.gov.au/what-clinical-trial

Diagnosis

When your child is diagnosed with cancer, it can feel overwhelming. This phase involves finding out if your child has cancer and determining the type of cancer they have. Children’s cancer can be difficult to diagnose, as many symptoms are similar to those caused by less serious conditions, or injuries. This means that your child may need several tests and medical appointments before you receive confirmation that your child has cancer.

If your doctor thinks your child has a kidney tumour, they may undergo several tests including:

• medical history and physical exam
• blood tests
• urine tests
• medical imaging, such as
  • X-ray
  • ultrasound
  • computed tomography (CT) scan
  • magnetic resonance imaging (MRI)
  • bone scan
• biopsy, with tests for genetic changes to help find out how best to treat your child.

Our section, How is cancer diagnosed? explains these tests in more detail.

Staging

Doctors use staging to describe how much the cancer has grown. Some of the tests for a kidney tumour will also help to stage the tumour. Staging is determined by:

• where the tumour is
• how big the tumour is
• if the tumour has spread to other parts of the body.

Your doctor will use this information to determine the best way to treat the disease. Staging will also give your doctor an idea of how well these treatments are likely to work (prognosis).

How doctors assess the stage or extent of disease varies. They often describe five stages for Wilms tumour:

• Stage I – doctors find a tumour in one kidney, with the outer layer of the kidney intact. The tumour has not spread, and surgery removed it fully.
• Stage II – the tumour has grown beyond the kidney into nearby tissue or blood vessels. The tumour has not reached the lymph nodes, and surgery removed it fully.
• Stage III – surgery has not fully removed the tumour, but it has not spread beyond the belly. There might be cancer cells around surgery site’s edges or elsewhere within the belly cavity. Another option is that the tumour may have invaded important tissues nearby (such as a major blood vessel). If this is the case, surgery could not remove it. The cancer might have spread to nearby lymph nodes.
• Stage IV – the cancer has spread to other organs that are far away from the kidneys. These could include the lungs, liver, brain, bone or distant lymph nodes.
• Stage V – tumours occur in both kidneys when doctors first diagnose Wilms tumour.

Risk factors

A risk factor is anything that increases a person’s chance of getting a certain condition or disease. Researchers know about some risk factors that increase the chance of developing cancer. However, for most children with cancer, the cause is unknown.

What we do know is that if a child develops cancer, it’s not because of something they, or their parents did to cause it. No one is to blame if a child develops cancer.

Even if your child has a risk factor, it doesn’t mean they will develop cancer. Many children with a risk factor will never develop cancer. And others with cancer may have had no known risk factors. Even if a child with a risk factor develops cancer, the risk factor may not have had much to do with it.

Researchers don’t completely understand what causes kidney tumours. However, some things are linked to a higher chance of getting kidney tumours.

Family history

In a few children with Wilms tumour, one or more of their relatives also has Wilms tumour. These children are more likely to develop tumours in both kidneys.

Genetic conditions

Research links Wilms tumour with several genetic conditions. They include:

• WAGR syndrome
• Beckwith–Weidemann syndrome
• Denys–Drash syndrome
• hemihypertrophy syndrome.

If your child has one of these genetic conditions, they will need specific care. Your health care team will talk to you about which ongoing tests your child will need.

Childhood cancers that have links to genetic conditions may also affect the risk for other family members. You can ask your child’s treatment team if you or your family should get genetic counselling.

To learn more about genetic conditions, see the children’s cancer glossary or the Centre for Genetics Education.

Support and more information

A diagnosis of cancer in a child is difficult for your family. It’s normal for you and your family to feel overwhelmed, scared, anxious or angry.

If or others around you are having trouble coping, make sure you speak to your child’s treatment team. It’s very likely they have helped and supported many other families who have been through what you’re currently going through. Sometimes just letting other people know how you’re feeling helps you feel less alone. If you feel supported, then you will feel more able to support your child.

Most children’s hospitals will allocate a social worker to each family to provide support throughout treatment. If you need support, contact your hospital-based social worker to let them know how you’re feeling and to see what support can be made available to you and your family, including music therapists, play therapists or education support staff.

The following webpages and organisations also offer support and/or extra information for children with cancer and their families:

• Living with children’s cancer has information about physical, emotional and practical issues during and after diagnosis and treatment.
• Organisations that can provide support and information.
• Redkite is a national organisation that provides emotional support, financial assistance, information and resources to families who have a child with cancer. You can reach them through their support line 1800 733 548 (1800 REDKITE), which is open (9am-7pm AEST), email support@redkite.org.au or live chat on www.redkite.org.au
• Canteen provides a service called Canteen Connect, an online community for young people aged 12-25 dealing with their own or a close family member’s cancer, and Parent Connect, an online community with resources, information and peer support on parenting through cancer. Online counselling is available seven days a week, including evenings. Visit https://canteenconnect.org or call 1800 835 932.
• The Cancer Council in your state or territory can give you:
  • general information about cancer
  • information on resources and support groups in your area.
• You can call the Cancer Council Helpline from anywhere in Australia on 13 11 20.
• Any of the major children’s hospitals and networks in your state or territory can provide information about childhood cancer.

For more information about childhood kidney tumours, see:

• Wilms tumor, from the American Cancer Society
• Wilms tumor and other childhood kidney tumors treatment (PDQ®), from the National Cancer Institute (United States).
• Wilms tumor and other childhood kidney tumours, from Rare Cancers Australia.

Note that information from international organisations may not always apply to children in Australia.

Symptoms

Many conditions can cause the symptoms below, not just cancer. If your child has any of these symptoms and you are worried, talk to your child’s doctor. The earlier cancer is found, the better.

Wilms tumours can grow quite large without causing any symptoms.

Symptoms of Wilms tumour may include:

• lump or swelling in the belly
• fever
• nausea
• loss of appetite
• trouble breathing
• extreme tiredness
• blood in the urine
• high blood pressure.

Treatment

Your team of doctors, called a multidisciplinary team (MDT), will care for and treat your child, and will ensure that all your child’s needs are considered while they have cancer treatment. The section called The treatment team has further information about this.

Treatment for kidney tumours depends on:

• the age of your child
• the stage of the cancer
• other factors.

Doctors will suggest treatments based on your child’s situation. Treatment may involve one or more of the following:

• chemotherapy
• radiation therapy
• targeted therapy
• stem cell transplant
• other treatments.

Surgery

If your child has a Wilm’s tumour they will undergo surgery to have it removed. This is usually done by removing all or part of the affected kidney.  The timing and extent of the surgery will be decided between your child’s oncologist and a specialist surgeon and will be discussed with you when your child starts treatment.

Your child might also have surgery to insert a venous access device, which is a tube that allows chemotherapy to be delivered directly into a blood vessel.

See How is cancer treated – surgery for more detail about cancer surgery.