Until the 1960s, most children with Wilms' tumor died of the disease. Today, thanks to modern treatment advances, nine out of ten children with Wilm's tumor are cured. The three main types of treatment include surgery, chemotherapy, and radiation therapy. Before choosing a course of treatment or combination of treatments, a doctor will study the histology and all available test results to determine the extent that the tumor has spread, a process called staging.
Most often, surgery is the primary form of treatment for Wilms' tumor. There are three different surgical procedures that may be used. The first, a radical nephrectomy, involves the removal of the entire kidney and the tissues surrounding it (including the ureter, the adrenal gland, surrounding fatty tissues, and oftentimes, nearby lymph nodes), leaving the remaining kidney to continue filtering blood. The second method, a simple nephrectomy, involves the removal of the affected kidney; and the third, partial nephrectomy, is used in rare cases, such as when tumors are found in both kidneys, and involves the removal of the tumors and a section of the kidney surrounding the tumors.
Chemotherapy is often used in conjunction with/or after the primary surgical procedure has been completed. When used to treat Wilms' tumor, radiation therapy is also often combined with surgery and sometimes with surgery and chemotherapy.
In some cases of Wilms' tumor, the tumor is either too large or located too close to important internal body structures, such as organs and blood vessels. In these cases, chemotherapy and/or radiation therapy may be used to shrink the tumor down to a size that is more safely removed by surgery.
For children whose Wilms' tumor has returned, which is known as recurrent Wilms' tumor, treatment frequently requires surgery, radiation, and more chemotherapy -- if, when examined, the tumor is considered to have what is known as a favorable histology (the way in which the tumor's cells appear under microscopic inspection).
