Nashville Star Clare Bowen: Childhood Cancer Survivor

The actress reveals that she battled nephroblastoma at age four.

Clare Bowen is an Australian singer and actress who is known for her role as Scarlett O'Connor in the ABC musical-drama television series Nashville. She recently cut her signature long hair into a very short pixie cut.

In an emotional Facebook post, Bowen explained why:

"Wanna know why I cut it all off? When I was four years old, I asked my mother: 'Are there heaters in Heaven?' I had just been diagnosed with end stage nephroblastoma, after several visits to a GP who denied anything was wrong and dubbed my parents 'paranoid.' I'd overheard the doctors telling my family that the only hope of saving me was an experimental treatment that might kill me anyway. But without it I had maybe two weeks left."

Bowen went on to explain:

"Life in the White Palace (Granddad’s nickname for hospital) meant I got to grow up surrounded by children just like me. We were mostly bald, all tubed, taped, bandaged up and stitched back together. We were all missing parts, some obvious like eyes or legs, others more hidden, like lungs and kidneys…. We were all together, so no one's appearance came into question. No one got laughed at or teased. We were all we knew.

And then I got really lucky. I survived, my hair grew back and I got strong again. I look relatively normal on the outside, but on the inside, I am still the same stitched-back- together little creature, in a world where people are judged so harshly for the way they look. It has always been completely incomprehensible to me. How can people think there's time for that?"

What is Nephroblastoma?

Nephroblastoma is a form of childhood cancer located in the kidney.  It is also commonly known as Wilms tumor, named after Dr. Max Wilms (1867-1918), a German surgeon and pathologist who first described the tumor in 1899. 

In Wilms tumor, one or more tumors may be found in one or both kidneys. Wilms tumor may spread to the lungs, liver, bone, brain, or nearby lymph nodes.

According to the National Cancer Institute, about 500 new cases of Wilms tumors are diagnosed in the United States each year. It is the most common kind of kidney cancer in children. About five percent of all cancers in children are Wilms tumors.

Wilms tumors tend to occur in young children. The average age at diagnosis is about three years. It becomes less common as children grow older and is uncommon after age six. Wilms tumors are slightly more common among African-Americans and among girls. It is a very treatable cancer -- about 90 percent of patients are still cancer-free five years after treatment.

Wilms tumor may be part of a genetic syndrome that affects growth or development. A genetic syndrome is a set of signs and symptoms or conditions that occur together and is caused by certain changes in the genes. Certain conditions can also increase a child's risk of developing Wilms tumor. Some of these syndromes and conditions include: WAGR syndrome, Beckwith-Wiedemann syndrome, Denys-Drash syndrome, and aniridia (the iris, the colored part of the eye, is missing).

Signs of Wilms tumor and other childhood kidney tumors include:

  • A lump, swelling, or pain in the abdomen
  • Blood in the urine   
  • Fever for no known reason
  • High blood pressure (headache, feeling very tired, chest pain, or trouble seeing or breathing)
  • Hypercalcemia -- high calcium levels in the blood, which can lead to a loss of appetite, nausea and vomiting, weakness, or feeling very tired

Wilms tumor that has spread to the lungs or liver may cause the following signs and symptoms:

  • Cough
  • Blood in the sputum
  • Trouble breathing
  • Pain in the abdomen

The process used to find out if cancer has spread outside of the kidney to other parts of the body is called staging. Wilms tumors are staged during surgery and with imaging tests. The information gathered from the staging process determines the stage of the disease (I, II, III, or IV). It is important to know the stage in order to personalize treatment for individual patients.

In addition to the stages, Wilms tumors are described by their histology (how the cells look under a microscope).

The histology of the tumor affects the prognosis and the treatment of Wilms tumor. The histology may be favorable or "anaplastic" (unfavorable). Tumors with a favorable histology have a better prognosis and respond better to chemotherapy than anaplastic tumors. Tumor cells that are anaplastic divide quickly, and under a microscope do not look like the type of cells they came from. Anaplastic tumors are harder to treat with chemotherapy than other Wilms tumors at the same stage.

Certain genetic changes in the tumor cells are associated with a less favorable prognosis.  These changes involve the "short arm" of chromosome 1 (1p) and the "long arm" of chromosome 16 (16q) and specific laboratory tests can be done to detect these.

Treatment of nephroblastoma is one of the great success stories of modern medicine. Among "favorable" cases of the disease, overall survival rates top 90 percent, with  low risk of recurrence. However, 25 percent of patients have the "unfavorable" or high-risk variety and need to be treated differently and more aggressively.

Wilms tumors are removed by surgery. Treatments also may include radiation therapy or chemotherapy or a combination.

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