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    Winning the race against Wilms

    At the moment of diagnosis, Wilms tumor already has the lead in a life-or-death race. But kids with cancer in both kidneys are sprinting ahead and vanquishing their adversary, thanks to St. Jude.

    Some people compare it to a roller coaster ride. Others liken it to an interminable nightmare. But Tony McMorris describes his son’s journey through cancer treatment as an exhausting sprint with life-or-death odds. When doctors discovered softball-sized tumors on the kidneys of 1-year-old Brock McMorris, the race was on.

    “When cancer comes into your life, it’s like a track meet where you’re running a 100-yard dash and the fastest person in the world is running against you with a head start,” Tony says. “By the time you figure out what’s going on, the cancer’s already ahead of you, and it’s not waiting around.”

    Tony and Lisa McMorris learned in 2001 that Brock had a rare type of kidney cancer called Wilms tumor. In the United States, approximately 500 children are found to have Wilms tumor each year. But only 5 to 7 percent of those children will have tumors in both kidneys—that’s about 25 kids in a nation of more than 300 million people. Brock was one of those 25. He had five tumors on his right kidney and many more on his left.

    “I want to take him to the best place in the world,” Tony said.

    “I’ve got kids myself,” Brock’s pediatrician replied. “You say you want to go to the best place in the world? If it were my son, I’d take him to St. Jude Children’s Research Hospital in Memphis, Tennessee.”

    On your mark …

    Three days after the diagnosis, Tony, Lisa, Brock and his sister, Anna, arrived at St. Jude and met the team of medical professionals who would take care of Brock. “It was like a puzzle,” Tony recalls. “You had your oncologist, you had your radiologist and then you had your surgeon. For our surgeon, we were assigned to Dr. Davidoff.”

    Andrew Davidoff, MD, and his colleagues have extensive experience treating children with bilateral Wilms tumor, or cancer on both kidneys. In most hospitals, patients such as Brock would have one or both kidneys removed in an attempt to eradicate the cancer. But St. Jude has adopted a different—and extraordinarily successful—approach. Since 1999, every St. Jude patient with bilateral Wilms tumor exhibiting favorable histology (cell characteristics) has undergone bilateral nephron-sparing surgery. This procedure is designed to remove the malignant tumor, sparing healthy kidney tissue.

    If one kidney is removed and the cancer recurs in the other one, the possibility of losing renal (kidney) function is high. If both kidneys are removed, the child must endure dialysis and a possible kidney transplant. So the best scenario for the child is to retain as much healthy kidney tissue as possible.

    Get set…

    Surgeons traditionally hesitated to perform bilateral nephron-sparing surgery because the tumors appear to be inoperable on preoperative scans. Nephron-saving surgery is a more complex procedure than a complete nephrectomy, or kidney removal.

    “Sometimes things may look scary on preoperative scans, making surgeons think that there is nothing to save,” says Davidoff, division chief of St. Jude General Pediatric Surgery. “But in our experience, we have always been able to save normal kidney on both sides. We’ve learned not to make preconceived judgments based on imaging alone.”

    “The incidence of renal failure in kids with bilateral Wilms is significant,” Davidoff says. “We want to save these kids from renal failure by saving as much kidney, on both sides, as possible.” St. Jude accepts a high number of children with bilateral or surgically difficult cases. Several patients have come to the hospital in the past few years after being told elsewhere that they should have both kidneys removed. All of those children underwent successful nephron-sparing surgery at St. Jude.

    St. Jude patients with bilateral Wilms tumor generally receive chemotherapy followed by bilateral nephron-sparing surgery within 12 weeks of the initiation of therapy. This approach has allowed surgeons to preserve the renal function of children while winning the race against the cancer. Since St. Jude began using this process, all children who exhibited favorable histology Wilms tumor and underwent nephron-sparing surgery are still alive.

    Davidoff and his St. Jude colleagues recently authored an article about their experiences treating patients with bilateral Wilms tumor. The findings were published in the prestigious journal Cancer(April 1, 2008 issue). Editors of the journal deemed the study so important that they included an editorial highlighting its significance.

    The finish line

    Davidoff was able to remove all of the tumors on Brock’s kidneys, saving 30 percent of one kidney and half of the other. Nuclear medicine tests have indicated that the 7-year-old has normal kidney function. “If you take 100 normal kids off the street and give the test to them, Brock’s kidney function would be within the realm of their normal,” Tony marvels. “That’s simply amazing, considering what he’s had to live through.”

    When Brock’s physician told him that football might be too dangerous a sport for someone who has undergone kidney surgery, the boy inquired whether bull riding might be a good alternative. He finally agreed that fishing would be acceptable. Today, Brock is an avid fisherman who insists on baiting his hook every January 1 to usher in the New Year.

    In 2007, the wind was howling and the temperature was in the single digits when he and his dad headed to a lake near their home in Illinois. Tony gladly took his son on the traditional outing, breathing a prayer of thanks that their race against cancer has been successful.

    “Every time I look at Brock,” Tony says, “I see a boy who’s living because of God, because of that team of doctors and because of the research that’s happening at St. Jude.”

    Reprinted from Promise Spring 2008

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