Wilms tumour is the most common kidney cancer in children under 15 and is usually found between the ages of 2 and 5; sometimes a parent notices a lump in the child's tummy or that the tummy has grown, and sometimes there is blood in the urine [1]. With surgery, chemotherapy and sometimes radiotherapy, about 9 in every 10 children are cured, even when the disease has spread [1, 3]. Neuroblastoma is a cancer of immature nerve cells that often starts in the adrenal gland and is usually seen before age 5 [4]; in the low- and intermediate-risk groups almost all children survive, and in the high-risk group about 6 in every 10 [4, 8].
Key points
- A lump in the tummy or a swollen tummy in a young child is one of the main signs of both tumours and should be shown to a doctor within 1 to 2 days [1, 4, 12].
- Wilms tumour is cured in about 9 in every 10 children, even when the disease has spread [3].
- Neuroblastoma varies a great deal: in some babies under 6 months it goes away on its own, while some older children need intensive treatment [4].
- Treatment of neuroblastoma depends on the risk group (low, intermediate or high); the group is set by the child's age, the spread of the tumour and its genetic features [4, 6].
- These children should be treated by a children's cancer specialist and an experienced team, following the full treatment plan [1, 4].
What is Wilms tumour?
Wilms tumour (nephroblastoma) is the most common kidney cancer in children under 15. Most affected children are 2 to 5 years old, and it is rare in older teenagers and adults [1].
Most affected children have no underlying condition, but about 1 in every 10 has a congenital syndrome [2]. These raise the risk [1]:
- Syndromes such as WAGR, Denys-Drash, Frasier and Beckwith-Wiedemann (overgrowth of the body or tongue, umbilical hernia)
- One side of the body being larger than the other (hemihypertrophy)
- Missing iris of the eye (aniridia) or abnormalities of the urinary and genital system, such as an undescended testicle
- A family history of Wilms tumour
Children at higher risk usually have an abdominal ultrasound every 3 months until they are at least 8 years old, so that a tumour is found early [1].
Wilms tumour symptoms in children
Sometimes Wilms tumour causes no symptoms, and a parent, for example while bathing the child, notices a lump in the tummy or that the tummy has grown; sometimes a doctor finds it at a routine check-up [1]. Other symptoms [1]:
- A lump, swelling or pain in the tummy
- Blood in the urine
- High blood pressure
- Fever with no known cause, loss of appetite or unexplained weight loss
- Cough, coughing up blood, trouble breathing or chest pain
These symptoms also have other causes; the only way to know is for a doctor to examine the child [1]. For the warning signs of other childhood cancers, see Warning signs of cancer in children.
Is Wilms tumour curable?
Yes. Wilms tumour is one of the most curable childhood cancers: about 9 in every 10 children are cured, even when the disease has spread [3]. Newly diagnosed Wilms tumour with a "favourable histology" (how the cells look under the microscope) can often be cured [1].
Treatment usually includes [1]:
- Surgery: removing the affected kidney (nephrectomy) together with the nearby lymph nodes; in some children only part of the kidney is removed.
- Chemotherapy into a vein
- Radiotherapy for some stages or for the "anaplastic" type (cells that look very abnormal under the microscope and divide quickly)
There are two common approaches worldwide: in North America surgery usually comes first, while in Europe chemotherapy is given first to shrink the tumour and surgery follows [2]. Both are considered standard approaches [2], and the care team chooses one.
The outcome depends on how the tumour cells look under the microscope, the stage, the child's age, genetic changes and lymph node involvement [1]. After treatment, regular follow-up for late effects, such as effects on the kidneys, heart, lungs, hormones and fertility, is needed [1].
What is neuroblastoma?
Neuroblastoma is a cancer that starts in immature nerve cells; often in the adrenal gland (on top of the kidney) and sometimes in the neck, chest or along the spine [4]. It is the most common solid tumour of childhood outside the brain [5].
It most often begins in infancy and is usually diagnosed between the first month of life and age 5; sometimes it is even seen before birth on a pregnancy ultrasound [4]. More than 1 in every 3 affected children is diagnosed in the first year of life, and 9 in every 10 are younger than 5 [5]. In many children the disease has already spread at diagnosis, for example to the bones, bone marrow, liver or skin [4].
Neuroblastoma behaves very differently from child to child: in some children up to 6 months old the tumour goes away without treatment, while in others it grows fast [4].
Neuroblastoma symptoms in children
Most symptoms come from the tumour pressing on nearby tissues or from spread to the bones. If your child has these symptoms, see a doctor [4]:
- A lump in the tummy, neck or chest
- Bone pain
- A swollen tummy with trouble breathing (in babies)
- Bulging eyes or dark circles around the eyes without a known cause
- Painless, bluish lumps under the skin (in babies)
- Weakness or paralysis of a part of the body, for example the legs
Less common symptoms: fever, tiredness, easy bruising or bleeding, high blood pressure, severe watery diarrhoea, a drooping eyelid with a smaller pupil on the same side, and jerky, uncontrolled movements of the muscles or eyes [4]. Uncontrolled eye and muscle movements are a rare sign, but about half of young children who have them turn out to have neuroblastoma [5].
Which tests are needed for the diagnosis?
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MIBG scan and bone marrow tests (in neuroblastoma)
An MIBG scan is used to find neuroblastoma tissue in the body, and a bone marrow biopsy checks whether the marrow is involved [4].
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Is neuroblastoma curable? Risk groups and treatment
Treatment of neuroblastoma depends on the "risk group". The risk group is set by the stage of the tumour (limited or spread), the child's age (younger or older than 18 months), how the tumour cells look under the microscope, genetic changes such as extra copies of the MYCN gene, and whether the tumour can be removed with surgery [4, 6, 7]. Low- and intermediate-risk neuroblastoma have a good chance of cure; the high-risk type is harder to cure [4].
| Risk group | Usual treatment | Outcome |
|---|---|---|
| Low risk | Surgery followed by monitoring; in babies under 6 months with a small adrenal tumour, sometimes monitoring alone; chemotherapy only for some children [4] | Almost all children were alive 5 years later [8] |
| Intermediate risk | Chemotherapy, often with surgery; sometimes surgery or monitoring alone in babies [4] | Almost all children were alive 5 years later [8, 9] |
| High risk | Three phases: chemotherapy and surgery; high-dose chemotherapy with a transplant of the child's own stem cells, and radiotherapy; then immunotherapy and the drug isotretinoin [4] | About 6 in every 10 children were alive 5 years later [8] |
These figures come from a large study of more than 4,800 children; your child's doctor knows their situation best.
Results in high-risk neuroblastoma have improved in recent decades: in large studies, adding immunotherapy with an anti-GD2 antibody (dinutuximab) [10] and giving two transplants in a row instead of one [11] kept more children free of relapse. After these treatments, another drug (eflornithine) is sometimes given as well [4]. For neuroblastoma that has come back, newer treatments, including CAR-T cell therapy, are being studied in clinical trials [4]. For more on transplants, see Blood stem cell transplant.
When should I contact my doctor?
These signs can also have causes other than cancer [1]. But show these to a doctor within 1 to 2 days [12]:
- A lump in the child's tummy, or a tummy that has grown for no clear reason [1, 12]
- Blood in the urine with no clear cause [12]
- Bone pain with no clear cause [4]
- Bulging eyes or bruising around the eyes without an injury, or jerky, uncontrolled eye movements [4]
- Bluish lumps under a baby's skin [4]
Sudden weakness or paralysis of the legs, trouble breathing, or heavy bleeding and bruising need emergency care: call your local emergency number [4]. If a child having chemotherapy gets a fever, see the guide Warning signs after chemotherapy.
Frequently asked questions
Is Wilms tumour hereditary?
Most of the time, no; but about 1 in every 10 affected children has a congenital syndrome [2], and a family history also raises the risk [1]. For these children, genetic counselling and regular abdominal ultrasound (every 3 months until at least age 8) are recommended [1]. In neuroblastoma too, certain gene changes (such as ALK or PHOX2B), some inherited syndromes and a strong family history raise the risk, and these children are checked for signs of neuroblastoma until age 10 [4]. Read more: Is cancer hereditary?
Can neuroblastoma go away on its own?
My child lives with one kidney: what follow-up is needed?
If the other kidney is also at risk of a tumour, an abdominal ultrasound is usually done every 3 months for up to 8 years [1]. Regular follow-up for late effects of treatment, such as effects on the kidneys, heart, lungs, hormones and fertility, is also needed [1]. Read more: After cancer treatment ends.
How is neuroblastoma different from Wilms tumour?
Where should treatment take place?
Treatment is planned and led by a children's cancer specialist together with a team experienced in childhood cancer, such as a paediatric surgeon [1, 4]. Complete the treatment fully and on time; see Is childhood cancer curable?
Classification, risk groups and treatment evidence (for doctors)
For physicians
Wilms tumour. Incidence 9.7 per 1 million children under 15; mean age at diagnosis 44 months in unilateral and 31 months in bilateral cases. About 10% have a congenital malformation syndrome; the risk of Wilms tumour is about 50% with WAGR syndrome (median age at diagnosis 22 months, bilateral disease in 37%) and about 90% with Denys-Drash syndrome. 5-year relative survival under age 20: 93%. Two standard approaches: COG uses immediate surgery for all unilateral tumours, and SIOP uses preoperative chemotherapy as the first step; in a resectable tumour, nephrectomy (North America) or chemotherapy (Europe) is performed instead of biopsy; biopsy is indicated when the mass is atypical on imaging for Wilms tumour and immediate nephrectomy is not planned [2]. Staging I to V (V: bilateral disease, each kidney staged separately) [1]. Surveillance of predisposed children: abdominal ultrasound every 3 months until at least age 8 [1].
Neuroblastoma. The most common extracranial solid tumour of childhood; 37% diagnosed in infancy and 90% under age 5, median age 17 months; about half of young children with opsoclonus-myoclonus syndrome have neuroblastoma [5]. INRG (8,800 children): the most significant factors were stage, age (cut-off 18 months), histological category, grade of differentiation, MYCN, 11q status and ploidy; 16 pretreatment groups with 5-year EFS over 85% (very low risk), over 75% to 85% (low risk), 50% to 75% (intermediate risk) and under 50% (high risk) [6]. INRGSS: L1 without and L2 with one or more image-defined risk factors (IDRF, 20 factors); M metastatic; MS metastases confined to the skin, liver and/or bone marrow under 18 months of age; 5-year EFS L2 vs L1: 78% vs 90% [7]. COG version 2 classifier (4,832 patients, INRGSS and segmental 1p and 11q aberrations): 5-year EFS and OS 90.7% and 97.9% in low risk, 85.1% and 95.8% in intermediate risk and 51.2% and 62.5% in high risk [8].
Treatment evidence. Intermediate risk without MYCN amplification with reduced chemotherapy doses and duration (479 patients; 4 or 8 cycles by biology): 3-year OS 96% (favourable biology 98%, unfavourable 93%) [9]. High risk: after response to induction and transplant, ch14.18 with GM-CSF and IL-2 plus isotretinoin vs isotretinoin alone, 2-year EFS 66% vs 46% and 2-year OS 86% vs 75%; grade 3–5 pain in 52%, capillary leak 23% and hypersensitivity reactions 25% [10]. Tandem autologous transplant (thiotepa/cyclophosphamide then dose-reduced carboplatin/etoposide/melphalan) vs single transplant (carboplatin/etoposide/melphalan): 3-year EFS 61.6% vs 48.4% (355 randomised patients) [11]. Current maintenance per PDQ: dinutuximab, GM-CSF and isotretinoin, possibly followed by eflornithine [4].
Referral. NICE NG12 (recommendations 1.12.1 and 1.12.3): consider very urgent referral (within 48 hours) for a child with a palpable abdominal mass or unexplained enlarged abdominal organ (neuroblastoma and Wilms tumour) and unexplained visible haematuria (Wilms tumour) [12].
References
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Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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