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ON THIS PAGE: You will read about your child’s medical care after treatment for Wilms tumor is finished and why this follow-up care is important. To see other pages in this guide, use the colored boxes on the right side of your screen, or click “Next” at the bottom.
After treatment for Wilms tumor ends, talk with your child’s doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your child’s recovery for the coming months and years. All children treated for cancer, including Wilms tumor, should have life-long, follow-up care.
Follow-up care for Wilms tumor includes regular visits to the doctor for physical examinations, blood and urine tests, and imaging tests (CT scans, ultrasounds, and x-rays). At first, these visits and tests will be more frequent (such as every three months). Eventually, the time between checkups will increase until five years after treatment when your child will be scheduled for a follow-up visit once a year.
The longer the time since treatment ended, the less likely the tumor will return. At this point, monitoring for late effects becomes an important part of follow-up visits. During follow-up visits, patients will have blood tests to make sure that there have not been any changes in the functioning of their kidney. This is especially important for patients who have one kidney or had a partial nephrectomy.
Based on the type of treatment your child received, the doctor will determine what examinations and tests are needed to check for long-term side effects (see below) and the possibility of secondary cancers. Your child’s doctor can recommend the necessary screening tests. Follow-up care should also address your child’s quality of life, including any developmental or emotional concerns. Learn more about childhood cancer survivorship.
You are encouraged to organize and keep a record of your child’s medical information. That way, as your child enters adulthood, he or she has a clear, written history of the diagnosis, the treatment given, and the doctor’s recommendations about the schedule for follow-up care. The doctor’s office can help you create this. This information will be valuable to doctors who care for your child during his or her lifetime. ASCO offers cancer treatment summary forms to help keep track of the treatment your child received and develop a survivorship care plan once treatment is completed.
Children who have had cancer can also enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating a balanced diet (including calcium and Vitamin D for healthy bones), and participating in regular physical activity. Patients and their families should discuss with their doctors whether there are any limitations to their activities or sports involvement. Also, children who have been treated for cancer need to protect their skin from the sun by using sunblock and watch any suspicious skin changes.
Talk with the doctor about developing a plan that is best for your child’s needs. Learn more about the next steps to take in survivorship.
Although many children with Wilms tumor are treated successfully, they still need to be monitored closely for possible long-term or late effects of the treatment.
Kidney failure. Because children treated for Wilms tumor usually have only one kidney, they have a slightly higher risk of kidney failure and will need to be monitored for the rest of their lives. They also need to keep well hydrated to help promote good kidney health. There are some medications such as codeine and ibuprofen that should only be taken in small amounts to avoid kidney damage.
Bowel obstruction. Depending on the type of surgery, Wilms tumor patients are at risk at any time during their life for developing a bowel obstruction from scar tissue that causes abdominal pain and vomiting.
Heart problems. Children who have received doxorubicin have a higher risk of developing heart abnormalities that can occur even years after treatment has ended. Children treated with doxorubicin who also had radiation therapy to their lungs have an even higher risk of developing heart problems. An echocardiogram may be used to monitor the effects of doxorubicin on the heart.
Skeletal abnormalities. If radiation therapy was given, depending on the location and dose, scoliosis (curvature of the spine) and underdevelopment of the soft tissue may occur.
Secondary cancer. Wilms tumor survivors have a small risk of developing another type of cancer within 15 years after Wilms tumor was first diagnosed. The most important risk factors are whether treatment included radiation therapy and doxorubicin.
Pregnancy concerns. Women who have had abdominal radiation therapy for Wilms tumor should be considered high risk during pregnancy and monitored closely by their doctor. Chemotherapy alone does not increase the risk of miscarriage; however, women who received radiation therapy aimed at the side of the body between the rib and hip (from the National Wilms Tumor Study records), depending on the dose, are more likely to have early labor, an unusual position of the baby’s head during birth, lower birth weight, and premature delivery (less than 36 weeks). Congenital (present at birth) abnormalities are also more common.
To continue reading this guide, choose “Next” (below, right) with a list of questions you may want to ask your child’s doctor. Or, use the colored boxes located on the right side of your screen to visit any section.