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LETTER TO THE EDITOR Table of Contents   
Year : 2011  |  Volume : 8  |  Issue : 2  |  Page : 263-264
Late presentation of Wilms' tumour to a tertiary hospital


1 Department of General Surgery, Singapore General Hospital; Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
2 Department of Urology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania

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Date of Web Publication14-Oct-2011
 

How to cite this article:
Tan SS, Mteta KA. Late presentation of Wilms' tumour to a tertiary hospital. Afr J Paediatr Surg 2011;8:263-4

How to cite this URL:
Tan SS, Mteta KA. Late presentation of Wilms' tumour to a tertiary hospital. Afr J Paediatr Surg [serial online] 2011 [cited 2020 Oct 21];8:263-4. Available from: https://www.afrjpaedsurg.org/text.asp?2011/8/2/263/86086
Sir,

We read Wilde et al.'s article on the challenges of managing Wilms' tumour with much interest. [1] In particular, late presentation of patients to our institution currently poses a significant problem, and we wish to discuss its implications and contributing factors. The main reason for intraoperative spillage, in our experience, is the late presentation of advanced tumours. This can cause increased local recurrence of the tumour and diffuse contamination of the peritoneal cavity, leading inadvertently to a poorer overall prognosis in children with Wilms' tumour. [2]

One of the most pertinent factors influencing late presentation to our institution was the consultation of local village doctors for their opinion on the abdominal mass, serving as the primary contributor to the delay in coming to the hospital. In a 5-year-old boy who was eventually operated on, this also resulted in local practice of making incisions to the abdomen to 'drain' blood and toxins. [Figure 1] shows multiple scars of 2 to 3 cm in length on the patient's abdominal wall, a result of this practice which is said to ward off evil spirits.
Figure 1: Multiple scars on the abdomen of a child with Wilms' tumour caused by local village practices

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Apart from delaying presentation to tertiary centres, village doctors cutting into the abdomen could also introduce infection, cause peritonitis and result in malignant spread within the abdomen.

In addition, we realised that parents adopting a 'watchful waiting' strategy often put off a visit to the doctor until cachectic signs such as loss of weight and appetite had been observed. Last but not the least, a greater distance of the patient's home to the tertiary hospital contributed to a significant delay in eventual consultation at the tertiary institute.

Although the treatment of Wilms' tumour has significantly improved from the use of pre-operative chemotherapy and better surgical technique, its prognosis can enhanced further. We suggest reducing delay to presentation through promoting awareness and education of Wilms' tumour in local health centres and schools.

 
   References Top

1.Wilde JC, Lameris W, van Hasselt EH, Molyneux EM, Heij HA, Borgstein EG. Challenges and outcome of Wilms' tumour management in a resource-constrained setting. Afr J Paediatr Surg 2010;7:159-62.  Back to cited text no. 1
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2.Mteta KA, Mvungi M. Wilms' tumour clinical management in KCMC: A five year review. East Cent Afr J Surg 2005;10:1.  Back to cited text no. 2
    

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Correspondence Address:
Shaun S Tan
124 Seletar Terrace, Singapore 806981

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0189-6725.86086

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