Earliest symptom of Wilm’s tumour: March 2004
**Core Concept**
Wilm's tumour, also known as nephroblastoma, is a type of kidney cancer that primarily affects children. It is a malignant tumour of the renal epithelium, most commonly presenting in children under the age of 5. The earliest symptoms of Wilm's tumour are often non-specific and can be mistaken for other common conditions.
**Why the Correct Answer is Right**
The earliest symptom of Wilm's tumour is typically a non-specific abdominal mass, which may be discovered during a routine physical examination. This is because the tumour can grow rapidly and cause a noticeable lump in the abdomen. The mass may be accompanied by other symptoms such as abdominal pain, nausea, vomiting, or a change in appetite. The non-specific nature of these symptoms can lead to delays in diagnosis.
**Why Each Wrong Option is Incorrect**
**Option A:** Abdominal pain is a common symptom of Wilm's tumour, but it is not the earliest symptom. Abdominal pain may occur as the tumour grows and presses on surrounding structures.
**Option B:** Hematuria is not typically an early symptom of Wilm's tumour. Hematuria may occur as the tumour grows and invades the urinary tract.
**Option C:** Fever is not a specific symptom of Wilm's tumour. Fever may occur as a result of a secondary infection or as a result of the tumour's growth.
**Option D:** Weight loss is not an early symptom of Wilm's tumour. Weight loss may occur as the tumour grows and the child becomes less active.
**Clinical Pearl / High-Yield Fact**
A palpable abdominal mass is the earliest and most common symptom of Wilm's tumour. A high index of suspicion is necessary to diagnose this condition promptly, as delays in diagnosis can lead to poor outcomes.
**Correct Answer:** A. A palpable abdominal mass