Late effects of treatments for Wilms tumour

Recovering from Wilms tumour and adjusting to life after treatment is different for each child. Recovery can depend on the stage of the cancer, the type and dose of treatment, the child’s age at the time of treatment and many other factors. The end of cancer treatment may bring mixed emotions. Even though treatment has ended, there may be other issues to deal with, such as coping with long-term side effects.

Your child’s healthcare team will watch for late side effects and can help prepare you for what to expect. They can also suggest ways to help your child.

Children with Wilms tumour are usually very young when they are diagnosed and treated, so they have a risk of developing kidney problems as time goes on. These problems include proteinuria (too much protein in the urine) and hypertension (high blood pressure). Kidney failure can be a late effect for children who have Wilms tumour in both kidneys.

Kidney problems can develop 10 to 20 years after a nephrectomy, radiation therapy or chemotherapy to treat Wilms tumour. Depending on the dose, radiation therapy can cause kidney damage (called radiation nephritis).

Children with Denys-Drash syndrome have a higher risk for kidney problems after treatment for Wilms tumour. Children with WAGR syndrome also have a higher risk for kidney failure.

Children with only one kidney should avoid medicines that are harmful to the kidneys and wear protective equipment when they play contact sports.

Find out more about kidney problems.

Children treated with abdominal surgery can develop scar tissue that increases the risk of bowel obstruction later in life. Symptoms of bowel obstruction include abdominal pain and vomiting. It is important to see a doctor right away if these symptoms are severe.

Find out more about bowel obstruction.

Certain chemotherapy drugs used to treat Wilms tumour, such as doxorubicin (Adriamycin), can have late effects on the heart. These late effects include problems with heart muscle function, such as left ventricular dysfunction or cardiomyopathy. Chemotherapy for Wilms tumour can also lead to abnormal heart rhythms (arrhythmias). Depending on the dose used, up to one-quarter of children treated with doxorubicin for Wilms tumour develop some heart abnormality. People who have been treated with doxorubicin for Wilms tumour should avoid smoking because it damages the heart.

Girls have a greater risk of developing heart problems after chemotherapy with doxorubicin for Wilms tumour. Other risk factors for heart problems after treatment with doxorubicin include:

• receiving doxorubicin at a younger age
• receiving a larger total (cumulative) dose of doxorubicin
• radiation therapy to the chest
• radiation to the left side of the abdomen

Find out more about heart problems.

Lung problems can develop after treatment with certain chemotherapy drugs or radiation therapy to the chest. Radiation therapy to the chest can cause problems, such as radiation pneumonitis and pulmonary fibrosis.

Pneumonitis is the most common lung problem caused by certain chemotherapy drugs, such as doxorubicin and dactinomycin (Cosmegen, actinomycin-D). Pneumonitis is inflammation of the lungs. It can lead to pulmonary fibrosis, which is the formation of scar tissue in the lungs.

Find out more about lung problems.

Children treated for Wilms tumour may grow and develop slower or less than other children. Radiation therapy to the abdomen can cause problems with the bones and muscles, or musculoskeletal problems. These problems may include a curved spine (called scoliosis) or underdeveloped or weak muscles.

Find out more about bone and muscle problems.

Certain chemotherapy drugs, such as dactinomycin and vincristine (Oncovin), can cause liver problems. Radiation therapy to the abdomen can also damage the liver. The liver may become enlarged, which is called hepatomegaly. A severe but uncommon complication of treatment is a problem called sinusoidal obstruction syndrome or veno-occlusive disease of the liver. This problem usually occurs while the child is still undergoing treatment. If the liver damage increases, the liver may become hard (called fibrosis) and scarred (called cirrhosis).

Find out more about liver problems.

Some chemotherapy drugs used to treat Wilms tumour can affect the ovaries and testicles. These drugs can cause different reproductive system problems for children as they get older. These problems can include early or delayed puberty in both boys and girls. Sometimes children treated for Wilms tumour may be infertile when they are adults. Girls who receive radiation therapy to the whole abdomen may enter menopause early as women. There can also be negative effects on later pregnancies for women who received abdominal radiation as a child. The most common problem is premature delivery.

Find out more about male reproductive system problems and female reproductive system problems.

Wilms tumour survivors have a higher risk of developing a second cancer. This risk may be due to genetic conditions or to treatments, such as chemotherapy and radiation therapy.

The types of cancer that may develop after radiation therapy depend on the area treated. Radiation to the abdomen can increase the risk of colorectal and other gastrointestinal cancers. Radiation to the chest can increase the risk of lung, breast and thyroid cancers if these areas were in the field of radiation. Children who have had radiation therapy should be part of a long-term follow-up program that monitors them and teaches about the risk of second cancers.

Find out more about second cancers.

Find out more about watching for late effects of childhood cancer. To make the decisions that are right for your child, ask the healthcare team questions about supportive care after treatment.