Victoria's Story Victoria's triumphant battle with Wilms' tumor |  |  |
|
|
Until the 1960s, most children with Wilms' tumor died of the disease. Today, thanks to modern treatment advances, nine out of ten children with Wilms' tumor are cured.
The three main types of treatment are surgery, chemotherapy, and radiation therapy. Before choosing a course of treatment or combination of treatments, a doctor examines the tumor cells under a microscope and considers all available test results to determine how widely 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 tube through which urine passes from the kidney to the bladder), the adrenal gland, surrounding fatty tissues, and oftentimes, nearby lymph nodes. The remaining kidney is left to continue filtering blood. The second method, a simple nephrectomy, involves the removal of the affected kidney only. The third method, a partial nephrectomy, is used in rare cases, such as when tumors are found in both kidneys. In this procedure the surgeon removes the tumors and a section of the kidney surrounding the tumors.
Chemotherapy is used either in conjunction with or after the primary surgical procedure has been completed. With more advanced stages of Wilms' tumor, radiation therapy is often combined 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, to be removed immediately. 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 with Wilms' tumor that has returned, which is known as recurrent Wilms' tumor, treatment frequently requires surgery, radiation, and more chemotherapy.
Treatment by Stage
- In Stage I tumors with favorable or unfavorable histology, the cancer is limited to the kidney and has been completely removed by surgery. This is followed by a course of chemotherapy. Approximately 40 percent of Wilms' tumors are classified as Stage I tumors.
- In Stage II tumors with favorable histology, the cancer has spread to the areas surrounding the kidney and has been completely removed by surgery. This is followed by a course of chemotherapy. Stage II tumors with unfavorable histology usually require surgery followed by both radiation therapy and chemotherapy. Approximately 23 percent of all Wilms' tumors are classified as Stage II tumors.
- In Stage III tumors with favorable or unfavorable histology, the cancer has spread to the areas surrounding the kidney, including blood vessels, lymph nodes, or other nearby organs, and could not be completely removed by surgery. In these cases the child requires radiation therapy and chemotherapy in addition to surgery. Sometimes Stage III tumors are either too large or too fragile, or are located too close to essential internal organs to be safely removed with surgery. In this case, chemotherapy is used to shrink the tumor to a small enough size that it can be surgically removed later. Approximately 23 percent of all Wilms' tumors are classified as Stage III tumors.
- In Stage IV tumors with favorable histology, the cancer has spread beyond the kidney's vicinity into such organs as the lungs, liver, bone, and brain. Stage IV tumors with favorable or unfavorable histology are treated with a combination of surgery, radiation therapy, and chemotherapy. Approximately 10 percent of all Wilms' tumors are classified as Stage IV tumors.
- Stage V tumors involve tumors found in both kidneys, in which case each kidney is staged separately. Approximately 5 percent of all Wilms' tumors are classified as Stage V tumors.
