Evaluation of prognostic factors in Wilms tumour.

Dharmendra, R P (2010) Evaluation of prognostic factors in Wilms tumour. Masters thesis, Coimbatore Medical College, Coimbatore.


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INTRODUCTION : Wilms tumour (WT) is the most common renal tumor of childhood typically affects children under the age of 6 years. The overall annual incidence of Wilms’ tumor is approximately 7.6 cases per million children under 15 years of age. Wilms’ tumor accounts for 6–7% of all childhood cancers. It is the subject of intense academic interest due to its occurrence in paediatric age group with significant mortality. This has been significantly reduced with relapse free survival rates due to ongoing scientific research and various cooperative protocols like National Wilms Tumour Study Group(NWTSG), Society for International Paediatric oncology group(SIOP), United Kingdom Children Cancer Study Group(UKCCSG). New treatment protocols with addition of chemotherapy and radiotherapy have contributed in improving the survival especially in the low risk Wilms tumour. Unfortunately patients with unfavourable histology, lung, liver metastasis, major tumour spillage and bilateral tumours have worst outcome. The present study is to analyse the various prognostic factors that determines the outcome of Wilms tumour and to analyse the prognostic significance of tumour staging and histopathology in Wilms tumour patients treated at our hospital. AIMS : 1. To assess the various prognostic factors that determines the outcome of Wilms tumour. 2. To analyze the prognostic value of histopathology in Wilms tumour. 3. To analyze the prognostic significance of tumour staging in Wilms tumour. 4. To identify the causes for early mortality in Wilms tumour. METHODS : All the patients with renal mass admitted in our department was evaluated thoroughly by clinical examination and the following investigations. Laboratory Studies : Complete blood count, Basic metabolic panel, including serum calcium levels, Coagulation abnormalities (to rule out acquired von Willebrand disease, which is coincident in up to 8% of individuals with Wilms tumor), Liver function tests, Renal function tests, Urinalysis and urine culture. Imaging Studies : Ultrasonography, CT scanning of the chest and abdomen, Chest radiography - As a baseline for pulmonary metastases, Magnetic resonance imaging. CONCLUSION : Stage I tumours had 100% survival rate. The mortality rate was higher in Stage III and Stage IV tumours (more than 75%). The unfavourable histology group had 80% mortality rate. Higher mortality rate was observed in less than 24 months age group. Resectabilty of the tumour at the time of initial diagnosis has significant prognostic value. Tumours spillage and lymph nodal involvement are associated with early mortality and recurrent tumour. Considering the constraints of the size of the study, it needs further follow-up to assess the long term prognostic variables.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Wilms tumour ; prognostic factors ; Evaluation.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 31 Jul 2017 04:22
Last Modified: 31 Jul 2017 04:22
URI: http://repository-tnmgrmu.ac.in/id/eprint/2366

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