Male1: Sometimes a pediatrician gets a call and the mother gives a baby a bath, maybe about 18 months to two years old and they feel a mass in the belly and everybody is upset. And the pediatrician feels and he feels the and he says, you have got to see a surgeon right away. And if you are told that you are going to see a kid in the office that has a mass in the belly, what would go through your head?
Male2: Two or three year old, a year and a half old, taking a bath, routine exam and the pediatrician feels a mass on the belly on the side, the pediatric surgeon thinks of a cancer of the kidney. The cancer of the kidney that we see in children is called a Wilms tumor named after a 19th century--
Male1: That is pretty rare.
Male2: Yes, they are very rare. There is only about 500 in the United States per year. Whenever there is a mass in the belly, most often, the kidney, but it could be a benign disease. It is not necessarily cancer, it could be an obstruction with swollen kidney and a girl—an ovary can make a giant mass and that is often—that is really going to be cancer in a little baby. That will be a big cyst filled with fluid.
Male1: But getting back to Wilms tumor, if you saw it, you got rid of it, is the prognosis good or bad?
Male2: Prognosis is very good, but this one you need the pediatric oncologist. They are the real orchestra leaders here and the pediatrician gets your baby in touch with a pediatric cancer expert and they need the right imaging before any surgeon operates and they need the right staging and then the surgeon operates and removes that kidney completely through an abdominal operation and then they often need a little chemotherapy, occasionally a little radiation across the board survival, 90+%, one of the greatest success stories of modern cancer treatment. If you hear about all the misery, the lack of success, but in pediatrics, this kidney cancer called Wilms, it was about 15% survival early in the 20th century. It is now at 90+% survival between the chemotherapy and the radiation, the surgery, the safe anesthesia, all of these sorts of things combined, team effort that have really good outcome in most cases.
Male1: What about—could it be something coming out of the liver or something like that too?
Male2: Yes, there are less common even than that. A couple of cancers of the liver that can affect children and when they are very, very young interestingly, the outcome can be good—that is also a combination often of chemotherapy and surgery and you absolutely have to be in the hands of a children’s center that has--
Male1: So it is a team approach?
Male2: Oncology.
Male1: No question, you need a nurse specialist, you need a child life team, a social worker and a lot of different medical specialists.
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