Symptoms of Wilms Tumor
Wilms tumor most commonly presents as an asymptomatic abdominal mass, but can also manifest with abdominal pain, hypertension, hematuria, and constitutional symptoms such as fever, night sweats, and weight loss. 1, 2, 3
Primary Clinical Presentations
Abdominal Mass
- The most frequent presenting sign is a palpable abdominal mass discovered incidentally by parents during bathing or dressing, or detected during routine physical examination 1, 3
- The mass is typically firm, smooth, and does not cross the midline 3
Abdominal Pain
- Abdominal pain as a chief complaint identifies a high-risk subgroup with significantly worse stage distribution and increased incidence of tumor rupture and anaplastic histology 2
- Patients presenting with abdominal pain tend to be older (mean age 5.5 years) and have higher stage disease at diagnosis 2
- These patients have a 14% incidence of anaplastic histology compared to those without pain 2
Hematuria
- Gross or microscopic hematuria occurs when the tumor involves the collecting system or renal pelvis 1, 4
- This symptom is less common than abdominal mass but clinically significant when present 1
Associated Systemic Symptoms
Hypertension
- Elevated blood pressure is a common finding, sometimes presenting as stage II hypertension even in the absence of other obvious symptoms 4
- Hypertension may be the only abnormality detected on initial physical examination 4
Constitutional Symptoms
- Fever, night sweats, fatigue, and weight loss can occur, though these are less specific 1
- These symptoms may indicate more advanced disease 1
Atypical Presentations
Wilms tumor can present with unusual symptoms unrelated to the primary renal mass, requiring high clinical suspicion 4
- Rare presentations include concerns mimicking unrelated conditions (such as foreign body sensation) with hypertension being the only detectable abnormality 4
Clinical Pitfalls and Caveats
- Do not dismiss abdominal pain as a benign symptom in children with suspected renal masses—this presentation warrants more extensive preoperative evaluation and consideration of neoadjuvant chemotherapy 2
- The absence of symptoms does not exclude Wilms tumor, as many cases are discovered incidentally 1, 3
- Hypertension in children should prompt evaluation for renal pathology, including Wilms tumor 4
- Constitutional symptoms, while nonspecific, should raise concern for malignancy when combined with other findings 1