Treatment
Treatment for Wilms' tumor depends on the histology and stage of the disease, and may consist of surgery, chemotherapy, and possibly radiation therapy. Surgery to remove the tumor is usually the first treatment for Wilms' tumor. The doctor may give chemotherapy and/or radiation therapy to shrink the tumors before surgery (neoadjuvant therapy) or to destroy any remaining cancer cells after surgery (adjuvant therapy). Here are some procedures commonly used to treat kidney cancer:
Surgery
A nephrectomy, or surgery to remove all or part of the kidney, is the primary treatment for Wilms' tumors. The surgeon will try to remove the entire tumor at once to prevent cancer cells from spreading in the abdomen.
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Radical nephrectomy
Doctors usually recommend a radical nephrectomy for children with tumors in only one kidney. The surgeon removes the entire kidney, surrounding fatty tissue, the ureter, adrenal gland, and nearby lymph nodes. Most children can live well with one kidney.
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Partial nephrectomy
In this procedure, the surgeon removes only the cancerous section of the kidney and a margin of healthy tissue around it. If Wilms' tumor is present in both kidneys, the doctor will try to remove only the cancer and save as much healthy tissue as possible. The doctor may perform one radical and one partial nephrectomy, or two partial nephrectomies. If both kidneys are removed, the child will need dialysis or a kidney transplant.
Additional treatments
Chemotherapy
Chemotherapy is the use of drugs to target rapidly growing cells in an effort to destroy cancer cells. Chemotherapy is a standard treatment for Wilms’ tumor, and is almost always given to treat the disease. Chemotherapy may be given to shrink the tumor before surgery (neoadjuvant therapy) or to kill any cancer cells left after surgery (adjuvant therapy). The specific chemotherapy regimen depends on the histology and stage of the disease. The chemotherapy may be infused into a vein or administered through a venous access device.
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Radiation Therapy
Radiation therapy uses waves of high-energy rays to target and kill cancer cells. Radiation therapy is normally only used for more advanced cases of Wilms’ tumor. In these cases, it may be combined with chemotherapy and given to kill any cancer cells left after surgery. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Three-dimensional conformal radiation therapy (3D-CRT) uses CT images to map out or "simulate" the tumor and normal tissues so that a few X-ray beams can be shaped to conform to the tumor. Intensity-modulated radiotherapy (IMRT) may also be offered as a type of radiation therapy.
Clinical Trials
Clinical trials allow patients to try a new treatment before it is available to the general public. In some cases, this may be a new drug that has not been used in humans before, or it may be a drug or drug combination that is not currently used for that specific type of cancer. Early phase clinical trials are often used to test side effects of a drug or drug combination, while later phase clinical trials are used to see how effective a new treatment might be for a certain type of cancer. Clinical trials allow doctors and researchers to improve the treatment of cancers with possibly more effective therapies. A clinical trial may be a new, groundbreaking drug or it may have no effect. It is important to talk with your doctor about the pros and cons of clinical trials for your particular situation. Targeted therapy is being studied for the treatment of childhood kidney tumors that have recurred (come back).
