Follow-up after treatment for Wilms tumour

Follow-up after treatment is an important part of cancer care. Follow-up for Wilms tumour is often shared among the cancer specialists and your family doctor or pediatrician. Your child’s healthcare team will work with you to decide on follow-up care to meet your child’s needs.

Follow-up is important because there is a chance that cancer can come back (recur) and late side effects from treatment can develop. Initial follow-up focuses on assessing if the tumour has returned and ensuring that the child has recovered from the treatment. In the long term, follow-up looks for late effects of chemotherapy or radiation therapy. People who have a childhood cancer may be followed in aftercare programs for life. The Children’s Oncology Group (COG) provides long-term follow-up guidelines for childhood cancer survivors. Some centres across Canada have transition clinics set up to follow the survivors of childhood cancer. These clinics help prepare survivors who are reaching early adulthood to successfully manage their own healthcare.

Don’t wait until your child’s next scheduled appointment to report any new symptoms and symptoms that don’t go away. Tell the healthcare team if your child has:

  • a lump in the abdomen
  • swelling of the abdomen
  • pain in the abdomen
  • blood in the urine (called hematuria)
  • fever
  • weight loss

The chance that Wilms tumour will come back is greatest within the first 2 years after treatment ends, so your child will need close follow-up during this time. The risk of recurrence depends on the histology of the tumour and its initial stage. The most common sites of recurrence are the lungs, the liver and the area where the primary tumour was removed (called the tumour bed).

Schedule for follow-up visits

Follow-up visits for Wilms tumour are usually scheduled:

  • every 3 months for 2 years after diagnosis
  • then every 6 months for another 2 years
  • then once every 2 years

During follow-up visits

During a follow-up visit, your child’s healthcare team will usually ask questions about the side effects of treatment and how your child is coping.

Your child’s doctor may do a physical exam, including:

  • feeling the abdomen for signs of any local recurrence or a tumour in the liver
  • listening to the lungs for any signs of metastasis
  • feeling the thyroid for any growths (if the child had radiation therapy to the chest)

Tests are often part of follow-up care. Your child may have:

  • an abdominal ultrasound
  • a CT scan
  • an MRI
  • a chest x-ray
  • blood tests, such as thyroid-stimulating hormone (TSH) and free thyroxine (T4), to monitor thyroid function for children who have had radiation to the lungs
  • heart function tests, such as an echocardiogram (echo) or electrocardiogram (ECG), for children who have had doxorubicin (Adriamycin)
  • kidney tests, such as a urine test, blood work or a GFR (a radioactive dye test that determines how well the kidneys are working)
  • hearing tests for children who have had carboplatin (Paraplatin, Paraplatin AQ)

If the cancer has come back, you and the healthcare team will discuss a plan for your child’s treatment and care.

Questions to ask about follow-up

Find out more about the Children’s Oncology Group long-term follow-up guidelines. To make the decisions that are right for your child, ask the healthcare team questions about follow-up.

Expert review and references

  • American Cancer Society. About Wilms Tumour. 2016.
  • American Cancer Society. After Treatment - Living as a Wilms Tumour Survivor. 2016.
  • American Society of Clinical Oncology. Wilms Tumor - Childhood. 2016.
  • Wilms' tumour (kidney cancer in childhood). Cancer Research UK. CancerHelp UK. Cancer Research UK; 2012.
  • Fernandez CV, Geller JI, Ehrlich PF et al . Renal Tumors. Pizzo PA & Poplack DG (eds.). Principles and Practice of Pediatric Oncology. 7th ed. Philadelphia: Wolters Kluwer; 2016: 29:753-768.
  • Hendershot E . Renal tumours. Tomlinson, D. & Kline, N. E. Pediatric Oncology Nursing: Advanced Clinical Handbook. Germany: Springer; 2005: 2.7: 57-61.
  • Wilms tumor. Janes-Hodder, H. & Keene, N. Childhood Cancer - A Parent's Guide to Solid Tumor Cancers. 2nd ed. O'Reilly; 2002: 9:137-149.
  • Wilms' tumour in children. Macmillan Cancer Support. Macmillan Cancer Support. London, UK: Macmillan Cancer Support; 2011.
  • National Cancer Institute. Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQ®) Patient Version. 2017.
  • National Cancer Institute. Wilms Tumor and Other Childhood Kidney Tumors Treatment (PDQ®) Health Professional Version. 2017.
  • Wilms tumor in children. National Childhood Cancer Foundation & Children's Oncology Group. CureSearch. Bethesda, MD: 2011.
  • Paulino, A. C. et al . Wilms tumor. WebMD LLC; 2011.
  • Paulino, Arnold C. Medscape Reference: Wilms Tumor Treatment and Management. 2016: