If your child has been diagnosed with a Wilms’ tumor, you’ll naturally be eager to know how your child’s physician will treat the tumor. Your child’s physician will determine a specific course of treatment based on several factors, including:
- your child's age, overall health and medical history
- type, location, and size of the tumor
- extent of the disease
- your child's tolerance for specific medications, procedures or therapies
- how your child's doctors expects the disease to progress
There are a number of treatments we may recommend. Some of them help to treat the tumor, while others are intended to address complications of the disease or side effects of the treatment.
What are the treatments for Wilms' tumor?
Treatment will then depend on the extent of spread of your child’s tumor and its stage. Treatment for Wilms’ tumor is based on a comprehensive risk assessment that includes factors such as:
- your child’s age
- the size of the tumor
- microscopic characteristics of the tumor
- how far the tumor has spread
- genetic characteristics of the tumor
The first step in most treatments is surgery to remove the tumor.
The most common operation is a radical nephrectomy, which removes the whole kidney, the tissue around the kidney, the ureter and the adrenal gland (which sits on top of the kidney). This operation is performed if the tumor has occurred in only one of the kidneys. In some cases, low-stage Wilms’ tumors may be treated with surgery alone.
If your child has tumors in both kidneys or has a known predisposition to kidney cancer, your child’s physician make recommend a partial nephrectomy or kidney-sparing surgery which aims to remove the tumor while leaving healthy kidney tissue alone.
In rare cases—when the tumor is too big or has spread too far—your child’s doctor will recommend chemotherapy to try to shrink the tumor before surgery.
During surgery, a biopsy may need to be done in your child’s other kidney if a suspicious area is found on examination.
Surgery is followed by chemotherapy and sometimes radiation. The type of chemotherapy and the need for radiation are determined by tumor stage and type. The type of chemotherapy will be determined based on the tumor size, tumor type and the extent of spread of the tumor. Radiation therapy may be indicated for some tumors.
In very rare cases, a stem cell transplant, involving a transplant of your child’s own stem cells (autologous transplant) may be used. This allows your child’s physician to give high-intensity chemotherapy in difficult to treat cases of Wilms’ tumor. Stem cell transplantation and the treatment needed to manage its effects are complex and involve some risk. Your physician will give you more detailed information on what to expect.
How are side effects managed?
Side effects in the treatment of Wilms’ tumor can arise from surgery, radiation and chemotherapy.
- Procedures should be performed in specialized centers where experienced surgeons, working in the most technologically advanced settings, can provide the most appropriate kidney surgery.
- Radiation therapy often produces inflammation, which can temporarily exacerbate symptoms and dysfunction.
- Some of the chemotherapy agents are associated with fatigue, diarrhea, constipation and headache. These side effects can be effectively managed under most circumstances with standard medical approaches.
Our cancer treatment center has specialists who deliver complementary or alternative medicines. These treatments, which may help control pain and side effects of therapy include the following:
- therapeutic touch
- dietary recommendations
Talk to your child’s physician about whether complementary or alternative medicine might be a good option for your child.
You and your child’s care team will establish a schedule of regular follow-up care to monitor ongoing response to treatment and possible late effects of treatment, and to evaluate the health of the remaining kidney.
As with any cancer, prognosis and long-term survival can vary greatly from child to child. Prompt medical attention, aggressive therapy and continued follow-up are important for the best possible prognosis.
Factors that influence the outlook for a child with Wilms’ tumor include:
- extent of the disease
- the histology of the tumor (what is looks like under the microscope)
- genetic changes in the tumor
- age and overall health of the child at diagnosis
- size of the primary tumor
- response to therapy
- your child's tolerance of specific medications, procedures or therapies
With the appropriate therapy, which may include surgery, chemotherapy and/or radiation, the overall prognosis for children with Wilms’ tumor is excellent. More aggressive tumors or tumors that have spread significantly may be harder to treat.
The goal of treatment of Wilms’ tumor is both to cure the cancer and to minimize the long-term effects of therapy. Therefore, patients are carefully assessed so that they receive the appropriate amount of therapy with minimal side effects.