Follow-up after treatment for Wilms tumour
Follow-up after treatment is an important part of cancer care. Follow-up for Wilms tumour cancer is often shared among doctors and other healthcare professionals, including audiologists, speech-language pathologists, dentists, nurses and psychologists. Your child’s healthcare team will work with you to decide on follow-up care to meet your child’s needs.
Some centres have “after-care” clinics that specialize in follow-up for survivors of childhood cancer. Long-term follow-up is important because there is a chance that cancer can come back, or recur, and late side effects from treatment can develop. People who have a childhood cancer are usually followed in after-care 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. Transition clinics help to prepare the survivor who is reaching early adulthood to successfully manage in the world of adult healthcare.
Don’t wait until the 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, or hematuria
- weight loss
The chance of Wilms tumour recurring is greatest within 2 years of diagnosis, so close follow-up is needed during this time. The risk of recurrence depends on the histology of the tumour. The most common sites of recurrence are the lungs, the area from where the primary tumour was removed (called the tumour bed) and the liver.
Schedule for follow-up visits
Follow-up after 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
A nephrogenic rest is a piece of embryonic tissue in the kidney that remains after the embryo develops. They can develop into Wilms tumours. If a child has nephrogenic rests in the kidney that was removed, follow-up visits are usually scheduled every 3 months. Children who are younger than 4 years when they are diagnosed have these follow-up visits for 6 years. Children who are older than 4 years at diagnosis have these follow-up visits for 4 years.
During follow-up visits
During a follow-up visit, your child’s healthcare team will usually asks questions about the side effects of treatment and how the child is coping. The doctor may do a complete physical examination, 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)
Follow-up generally involves a number of tests to check the effects of the cancer, the child’s response to treatment and the child’s progress. A child who is part of a clinical trial will be followed according to the guidelines in the protocol. Tests are often part of follow-up care. Your child may have:
- abdominal ultrasound or CT scan or MRI
- chest x-ray or CT scan
- blood tests
- heart function tests, such as echocardiogram (echo) or electrocardiogram (ECG)
Blood tests are done to check the levels of thyroid-stimulating hormone (TSH) and free thyroxine (T4) and monitor thyroid function in children who received radiation therapy to the chest. Heart function tests are done for children who received doxorubicin (Adriamycin).
If a recurrence is found during follow-up, the oncology team will assess the child with cancer to determine the best treatment options.
Find out more about these tests and procedures.
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.