Complications
Normocytic normochromic anaemia may occur due to intratumoural haemorrhage or intra-abdominal bleeding.
Gross haematuria and iatrogenic blood loss may contribute to the anaemia and lead to iron deficiency.
May also result from chemotherapy-induced bone marrow suppression.
Managed with packed red blood cells.
Vincristine can cause decreased peristalsis and paralytic ileus; therefore, vincristine should be withheld until peristalsis is re-established after nephrectomy.
Stool softeners should be started early to prevent this complication.
Rarely associated with newly diagnosed Wilms' tumour (<10% incidence).[66]
Usually remits during or following therapy for tumour. Majority of patients have no bleeding or minimal bleeding and do not require treatment.
Vasopressin may be required in some patients.
Rarely, if bleeding is severe and coagulation studies are very abnormal, replacement therapy with von Willebrand's factor should be considered.
Due to chemotherapy and abdominal irradiation.
May result in sinusoidal obstructive syndrome or veno-occlusive disease.[150][151][152][153]
Most patients are able to resume chemotherapy (started at a lower dose) after resolution of severe hepatotoxicity without recurrence; outcomes are similar to those for patients without delays or dose reductions.[154]
Risk is low on DD-4A chemotherapy regimen (vincristine, dactinomycin, and doxorubicin).
However, patients at higher risk of infection (e.g., patients on chemotherapy regimen M [vincristine, dactinomycin, doxorubicin, cyclophosphamide, and etoposide] or relapsed patients) should receive trimethoprim/sulfamethoxazole prophylaxis, or if allergic to this antibiotic, pentamidine, dapsone, or atovaquone.
Anthracycline chemotherapy (e.g., doxorubicin) is associated with the risk of dose-dependent cardiotoxicity.[145]
Anthracycline-induced cardiomyopathy, arrhythmia, or congestive heart failure may occur, although the incidence is low.[130][146]
Serial echocardiograms should be obtained both during and after the completion of therapy.[81][147]
Rarely seen but may occur in patients with extensive bilateral disease or patients with Denys-Drash syndrome.[63][146][155] In one study, 14% of patients with bilateral Wilms' tumour developed end-stage renal failure following surgery and chemotherapy.[156]
[ 
]
Some patients may require dialysis or renal transplant.[142][157]
Risk of late kidney failure in survivors increases with age.[158]
Both irradiation and chemotherapy are associated with an increase in secondary malignancies.
Very rare, with the cumulative incidence being 1.6% at 15-year follow-up.[107][130][146][159]
One case-control study found that survivors of childhood cancer treated with abdominopelvic radiotherapy were three times more likely to develop colorectal cancer than those who did not receive this treatment (OR, 3.1 [95% CI, 1.4 to 6.6]).[160] Regular screening for colorectal cancer is recommended for these patients, starting at an earlier age than for the general population.[147][160]
Occurs in approximately 10% of patients undergoing surgery.[167]
Right-sided and larger tumours are at higher risk of this complication.
Associated with higher recurrence rates and requires more intensive therapy.
Haemorrhagic cystitis may occur very rarely with cyclophosphamide administration.
Prevented by adequate hydration and the use of mesna.
Emerging evidence suggests that doxorubicin and vincristine may induce mild lower urinary tract dysfunction, especially in female childhood cancer survivors.[166]
Use of this content is subject to our disclaimer