Wilms' Tumor
Treatment

Surgery, chemotherapy and radiation therapy are common treatments for Wilms' Tumor, depending on the stage of the cancer and the condition of your child.

Surgery

Surgery is a common treatment for Wilms' tumor. Your child's doctor may take out the cancer using one of the following:

• Partial Nephrectomy — This procedure removes the cancer and part of the kidney around the cancer. It typically is used only in special cases, such as when the other kidney is damaged or has already been removed.



• Simple Nephrectomy — This procedure removes an entire kidney. The other kidney can take over filtering blood.



• Radical Nephrectomy — Radical nephrectomy is performed to remove an entire kidney as well as tissues around it. Some lymph nodes also may be removed.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. It may be taken by pill or may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because drugs enter the bloodstream, travel through the body and can kill cancer cells throughout the body. Chemotherapy given after an operation, when there are no known remaining cancer cells, is called adjuvant therapy.

When very high doses of chemotherapy are used to kill cancer cells, these high doses can destroy the bone marrow, the blood-forming tissue in the bones. If very high doses of chemotherapy are needed to treat the cancer, bone marrow may be taken from the bones before therapy and frozen until it is needed. Following chemotherapy, the bone marrow is returned through a needle in a vein. This is called autologous bone marrow reinfusion.

Radiation Therapy

Radiation therapy uses X-rays or other high-energy rays to kill cancer cells and shrink tumors. Radiation for Wilms' tumor usually comes from a machine outside the body, also called external radiation therapy. Radiation may be used before or after surgery and chemotherapy.

After several years, some patients develop a second, different form of cancer as a result of treatment with chemotherapy and radiation. Clinical trials are underway to determine if lower doses of chemotherapy and radiation can be used.

Treatment by Stage

Treatment depends on the stage of the disease, cell type or histology and your child's age and general health. Treatment may be standard, based on its effectiveness in a number of patients in past studies, or experimental. Your doctor may propose that your child participate in a clinical trial, a research project involving experimental treatments. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new, better treatments.

Stage I

If the tumor has a "favorable" cell type or if your child has anaplastic Wilms' tumor, your child's treatment will probably involve surgery to remove the cancer followed by chemotherapy. If your child has either clear cell sarcoma of the kidney or rhabdoid tumor, treatment will probably involve surgery followed by radiation therapy and chemotherapy.

Stage II

If the tumor has a "favorable" cell type, your child's treatment will probably involve surgery to remove the cancer followed by chemotherapy. If your child has an "unfavorable" cell type such as anaplasia, clear cell sarcoma or rhabdoid tumor of the kidney, treatment may involve surgery followed by radiation therapy and chemotherapy.

Stage III

Treatment will probably involve surgery, followed by radiation therapy and chemotherapy. Sometimes, the cancer cannot be removed by surgery because it is too close to important organs or blood vessels or because it is too large. In these cases, the doctor may perform a biopsy only and then suggest chemotherapy with or without radiation. Once the cancer is reduced by treatment, surgery may be performed, followed by additional chemotherapy and radiation therapy.

Stage IV

Treatment will probably involve surgery, followed by radiation therapy and chemotherapy. If the cancer has metastasized or spread to the lungs, your child will receive additional chemotherapy.

Stage V

In this stage, both kidneys contain cancer. Usually, it isn't possible to remove both kidneys. Your child's doctor may remove a piece of the cancer from both kidneys and remove some of the surrounding lymph nodes to see if they contain cancer. Following surgery, chemotherapy is given to shrink the cancer. After the cancer is reduced, a second operation is performed to remove as much of the cancer as possible, while leaving as much of the kidneys as possible. Surgery may be followed by more chemotherapy and radiation therapy.

Recurrent

If your child's cancer recurs, treatment will depend on the treatment he or she received before, how much time has passed since the treatment, the cancer cell type and where the cancer emerges. Depending on these factors, treatment may involve surgery, radiation therapy and chemotherapy.

Clinical trials — research projects involving patients — help to evaluate new treatments, such as chemotherapy drugs, new combinations of treatments and bone marrow reinfusion.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.
Last updated July 14, 2010