Which assessment should be avoided if Wilms tumor is suspected?

• A. Palpation of the abdomen for the mass size
• B. Assessing the urine for the presence of hematuria
• C. Monitor the temperature for the presence of fever
• D. Monitor the blood pressure for the presence of hypertension

Answer: (A)

When Wilms tumor is suspected, avoid palpating the abdomen to feel for the mass because manipulating the tumor can rupture its capsule and seed cancer cells into the peritoneal cavity, potentially upstaging the disease and complicating treatment. The safer approach is imaging, starting with ultrasound to characterize the kidney mass without disturbing it. Monitoring blood pressure is helpful because Wilms tumor often causes hypertension due to renin secretion, and a urinalysis can reveal hematuria. Fever monitoring is not specific to this tumor but isn’t harmful to perform if clinically indicated.