Every three months, the Cruz family — parents RJ and Emily and their two kids Elian, 10, and Avi, 4 — pile into the car and head out on something of a road trip. 

This isn’t some fun, family getaway, however. The family makes the 25-minute drive from their home in Waukesha to Children’s Wisconsin, specifically the MACC Fund Center for Cancer and Blood Disorders. It’s the family’s regular check-up day. 

The story begins back in 1998. RJ was 8 years old. One day, he was playing with his older brother, Gabe, on a playground and took a hard fall. A few weeks later, he noticed some blood in his urine. His parents assumed he must have injured himself on the playground and took him to Children’s Wisconsin. The reality was far worse. RJ was diagnosed with Wilm’s tumor.

“Wilm’s tumor is a rare form of cancer, but it is the most common kidney cancer we see in kids,” said Kerri Becktell, MD, a Pediatric Oncologist at the MACC Fund Center for Cancer and Blood Disorders at Children’s Wisconsin. “It’s most commonly seen in kids under the age of 10.”

Sadly, the Cruz family was all too familiar with Wilm’s tumor. Just eight years earlier, Gabe had been diagnosed as well. At the time, two siblings with this rare cancer was shocking. Articles were written about the boys in the local newspaper and they even appeared on the local TV news. 

“Doctors can’t explain why the Wilms tumor, which is usually more prevalent in girls and is not thought to be heredity, would strike both of the Cruz children,” one article wrote at the time. 

Thankfully, just like his older brother, RJ was successfully treated at Children’s Wisconsin. After a year of chemotherapy, he was cancer free. 

What makes a Wilm’s tumor so dangerous is it often presents without any symptoms. By the time it’s discovered, it’s often grown significantly and harder to treat. Both Gabe and RJ came to Children’s Wisconsin with unrelated injuries that led to the diagnosis. 

While RJ doesn’t remember much of his time at Children’s Wisconsin, he does recall how nice all the staff was to him and his family. 

History Repeats Itself

Fast forward 17 years. It’s December 2015. RJ and Emily have been married six years, and they welcomed their first baby into the world — Elian. For most of his early childhood — outside of a small procedure on his throat to help him feed better — Elian was a perfectly healthy boy. 

Then in September 2019, he developed a fever. 

“He was under the weather, and we really didn't think it was anything more than just a virus. So, we treated it as such,” said Emily. “But we got concerned when he started getting really lethargic.”

But things escalated quickly.

On a Friday, Elian fell asleep at dinner. He then started complaining of a stomachache. By the next day, his stomach had started to swell up. On that Monday, they went to his pediatrician and were immediately sent to the Children’s Wisconsin Emergency Department. 

Later that day they found the tumor. 

“I felt in my gut that it was Wilms' tumor,” said Emily. “Just like his dad.”

The Genetic Connection

Just a month before Elian was born, a paper was published in Nature Genetics that expanded the medical community’s understanding of Wilm’s tumor.  A hereditary risk of Wilms tumor was discovered.  

A team of researchers and scientists identified several new gene mutations that increase one’s risk for Wilms tumor. If a parent has one of the gene mutations, there is a 50% chance they’ll pass it onto their kids. 

“Roughly 10 percent of kids with Wilm’s tumor have a hereditary risk associated with them,” said Dr. Becktell. 

Quick and Coordinated Care

With the diagnosis confirmed — and a family history established — Dr. Becktell and her team jumped into action.

“It felt like a whirlwind of doctors and tests and a little bit of chaos,” said Emily. “They took care of us so quickly.”

Within a week, Elian was in surgery. And a week after that he started his radiation treatments.

“It was a comfort knowing that Children's Wisconsin did such a great job with me and I knew they would do whatever they can to help him,” said RJ. “But it was still scary.”

In all, Elian needed seven rounds of radiation and 16 chemotherapy treatments over 26 weeks. On April 23, 2020, Elian had his final treatment.

“Elian’s treatment went great, but when you have this genetic predisposition, you're at a higher risk of getting a second Wilms tumor,” said Dr. Becktell. “Because of that risk, I see Elian every three months to do an ultrasound of his kidneys.”

Elian will continue to be closely monitored until he is 12 years old and is no longer in the prime age range for Wilm’s tumors. Once he hits that age, his lifelong risk should be the same as the general population.

Getting Ahead of Diagnoses

The following year, in October 2021, Emily gave birth to a second son, Avi.

“I won’t lie,” said Emily, “from the moment I found out I was pregnant, we were pretty terrified.”

A couple years earlier, Dr. Becktell along with Amy Ott, MS, CGC, a Genetic Counselor with the MACC Fund Center for Cancer and Blood Disorders, opened a Cancer Predisposition Clinic. This first-of-its-kind program provides comprehensive care for children with higher risk of developing cancer.

“We are a medical home for patients who have any genetic change that increases their risk for developing tumors or cancer,” said Dr. Becktell. “The clinic is very busy. We've received more than 600 referrals since we opened. As more and more genetic testing is being incorporated into pediatric care, we are identifying more gene changes that need some surveillance.”

As soon as Avi was born, he was seen by Dr. Becktell and a genetic counselor.

“Emily was very interested in genetic testing,” said Dr. Becktell. “If we discovered he had the gene, we could start screening him and keep a close eye on him.”

When Avi was 2 months old, he was tested. He had the gene mutation.

“Just because you have the gene mutation, it’s not 100% you’ll develop Wilm’s tumor,” said Dr. Becktell. “It’s not a guarantee.”

With this information, Emily and RJ were proactive and monitored Avi’s health closely. Just like his big brother, Avi gets an ultrasound of his kidneys every three months. Dr. Becktell will follow him closely until he’s 12. The hope is if anything is ever discovered, it’ll be early enough and more easily treatable.

“I understand nothing about Wilms tumor,” said Emily. “But I know all of our family has been cared for and survived with Children’s Wisconsin.”

But, still, the possibility lingers. With every fever or cold or appointment, the thought of cancer rushes back.   

“It's not normal for a child to have to attend all these doctor's appointments,” said Emily. “Avi has one foot in that world and one foot out of it. But Elian has really helped him adjust to those appointments. He is such a good big brother.”

They go to all their appointments together, get their scans together one before the other.

“You don't wish on anyone, said Emily, “but it's nice they have each other.”

Surviving and Thriving

Today, both boys are doing great. Elian loves to play soccer and baseball. In 2025, as part of the MACC Fund Center’s Next Steps Survivorship Program, he participated in the Team Survivors triathlon for kids who successfully beat cancer.

And Avi remains cancer-free.

“He’s healthy and growing normal,” said Emily.

“Despite all of this,” said Dr. Becktell, “the boys are thriving.”