Wilms' Tumor and Other Childh... Health Article

Treatment Option Overview

How Wilms' tumor and other childhood kidney tumors are treated

There are treatments for patients with Wilms' tumor. Three kinds of treatment are used:

• Surgery (taking out the cancer in an operation)

• Chemotherapy (using drugs to kill cancer cells)

• Radiation therapy (using high-dosex-rays or other high-energy x-rays to kill cancer cells)

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

• Partial nephrectomy removes the cancer and part of the kidney around the cancer. This operation is usually used only in special cases, such as when the other kidney is damaged or has already been removed.

• Simple nephrectomy removes the whole kidney. The kidney on the other side of the body can take over filtering blood.

• Radical nephrectomy removes the whole kidney with the tissues around it. Some lymph nodes in the area may also be removed.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Chemotherapy given after an operation to remove the tumor is called adjuvant therapy.

When very high doses of chemotherapy are used to kill cancer cells, these high doses can destroy the blood-forming tissue in the bones (the bone marrow). 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 given back through a needle in a vein. This is called autologous bone marrowreinfusion.

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 (external radiation therapy). Radiation may be used before or after surgery and/or chemotherapy.

Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects. It is important that parents of children who are treated for cancer know about the possible late effects caused by certain treatments. After several years, some patients develop another form of cancer as a result of their treatment with chemotherapy and radiation. Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information. Clinical trials are ongoing to determine if lower doses of chemotherapy and radiation can be used.

Treatment of Wilms' tumor by stage

Treatments for Wilms' tumor depend on the stage of your child's disease, the histology (cell type), and your child's age and general health.

Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child take part in a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have unwanted side effects. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients. Clinical trials are ongoing in most parts of the country for most stages of Wilms' tumor. If you want more information, call the Cancer Information Service at 1-800-4- CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Stage I Wilms' Tumor

Treatment for stage I Wilms' tumor with either favorable or anaplastichistology will probably be surgery to remove the kidney and some of the lymph nodes near the kidney, followed by chemotherapy.

Stage II Wilms' Tumor

Treatment for stage II Wilms' tumor depends on the histology of the cancer.

If your child has a favorable histology tumor, treatment will probably be surgery to remove the kidney and some of the lymph nodes near the kidney, followed by chemotherapy.

If your child has an anaplastic histology tumor, treatment will probably be surgery to remove the kidney followed by radiation therapy plus chemotherapy.

Stage III Wilms' Tumor

Treatment of both favorable and anaplastic stage III Wilms' tumors will probably be surgery to remove the kidney and some of the lymph nodes near the kidney, followed by radiation therapy to the abdomen, and chemotherapy.

Stage IV Wilms' Tumor

Treatment of both favorable and anaplastic stage IV Wilms' tumors will probably be surgery to remove the kidney and some of the lymph nodes near the kidney, followed by radiation therapy to the abdomen, and chemotherapy. Patients whose cancer has spread to the lungs will also receive radiation therapy to the lungs.

Stage V Wilms' Tumor

Your child's doctor will probably do a biopsy of the cancer by taking out a piece of the cancer in both kidneys and removing some of the lymph nodes around the kidney to see whether they contain cancer. Following the biopsy, chemotherapy will be given to shrink the cancer. A second surgery will 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/or radiation therapy.