Male1: Mother gives a bath to a little boy or a little girl and she feels a ball, and she feels a mass and it seems right near the liver. What would you be thinking about it, if it seems to something serious?
Male2: Well, the tumor that present in the belly especially in young children, we think about neuroblastoma and Wilms tumor as our most common--.
Male1: How would you show the difference if you can palpate it? Anyway you could know the difference in palpation?
Male2: If it appears arising from the liver and you feel just a very large liver especially in a little baby, that is more likely to be a neuroblastoma. Sometimes, as well, you can have other signs and symptoms of neuroblastoma especially in babies. They often look more wasted. Sometimes, they can have blue around their eyes. They can have abnormal eye movements and sometimes you can actually see neuroblastomas that arise from bone in other locations and they can involve some bones elsewhere. Male1: Does this cross the midline or one cuts across the midline?
Male2: Neuroblastoma will more likely cross the midline. It does not have too, but it has a tendency too. Wilms tumors on the other hand do not tend to arise from the liver, they will arise from the kidney. They can be on either on the right or the left side and they do not--well, I have seen one that they are large enough and then you are not quite sure what they are doing, but they tend to be on one side or the other. They tend not to have the same kind of wasting that kids have with neuroblastoma and are frequently diagnosed by a pediatrician on a routine examination. Often, the kids come in for a cold or something else, and the good pediatrician does not just say, "Well, you have got a cold. I am just going to look in your back and listen to your lungs." They throw in the abdomen for free and they feel this big mass and they say, "Well, your cold is not a big problem. Here is the issue."
Male1: You get a kid diagnosed with a Wilms tumor, what is the prognosis?
Male2: The prognosis on Wilms tumor is excellent. For the early stage Wilms tumor, there are those ones where it can be completely resected at first. You are talking cure rates in the mid-90s, even for advanced Wilms tumor, which means that you have spread either outside of the abdomen or you have spillage for stage 413, you have metastatic spreads, the lung is already on those with current protocols of chemotherapy, surgery and very low doses of radiation where leukemia cure rates that are in the 80% range.
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