One of the first investigations asked for in any child with a palpable mass in the abdomen is an ultrasonography. This is a simple, easily available non invasive investigation that helps in many ways. First, it tells us whether the lump is solid or cystic (full of fluid). A solid mass is likely to be a tumor, a cystic mass may be a cyst or collection of urine-hydronephrosis etc. The second important information given is the organ of origin - i.e where is the mass arising from the kidney, the liver, the adrenal, the intestine etc. Besides this, other vital information given is the dimensions of the mass the length, width and thickness; local spread of the tumor if solid, invasion of vital blood vessels in the abdomen and the presence of other tumor elsewhere in the abdomen that may not be palpable. Also the other solid organs in the abdomen can also be visualized.

The further investigations can be based on this preliminary investigation and will be specific for that organ or system. The investigations may be radiological or blood tests. The blood tests look at the function of the organ from which the tumor is arising; the radiological investigations like CT Scan are required to give more details of the mass to plan the type and timing of surgery and whether chemotherapy is to be given before the surgery. Joint consultation with a good medical oncologist and pediatrician to plan the entire approach makes a difference in the well being of the child and planning the line of therapy and its timing.

Follow up for multiple cycles of Chemo therapy is a must for long lasting results with the surgeon and oncologist to look for spread, recurrence. If there is a problem then a second surgery may be required . Complications in such cases may be inadequate removal of the mass, post operative bleeding, injury to adjacent non affected vital structures like vessels, other organs or tubular structures like the intestines or the ureter etc. Recurrence of the tumor, local and systemic spread of the tumor to places like lung, liver, brain, bone marrow are also possible.