Four types of standard treatment are used: WILMS TUMOR

Surgery

Radiation therapy

Chemotherapy

Biologic therapy

New types of treatment are being tested in clinical trials.

3

Watchful waiting

High-dose chemotherapy with stem cell transplant

Four types of standard treatment are used:

SURGERY
Wilms tumor and other childhood kidney tumors are usually treated with nephrectomy (surgery
to remove the whole kidney). Nearby lymph nodes may also be removed.
If cancer is found in both kidneys, surgery may include a partial nephrectomy (removal of the
cancer in the kidney and a small amount of normal tissue around it). Partial nephrectomy is done
to keep the kidney working.
In the United States, treatment for Wilms' tumor almost always begins with surgery to
remove or decrease the size of the kidney tumor. Except in patients who have tumors in both
kidneys, this surgery usually will require complete removal of the affected kidney. During
surgery, the surrounding lymph nodes, the area around the kidneys, and the entire abdomen will
also be examined. While the tumor can spread to these surrounding areas, it is less likely to do so
compare to other types of cancer. In cases where the tumor affects both kidneys, surgeons will
try to preserve the kidney with the smaller tumor by removing only a portion of the kidney, if
possible. Additional biopsies of these areas may be done to see if the cancer has spread. The next
treatment steps depend on whether/where the cancer has spread. Samples of the tumor are also
examined under a microscope to determine particular characteristics of the cells making up the
tumour.

Chemotherapy may be given before surgery to make the tumor smaller so less kidney tissue
needs to be removed and there are fewer problems after surgery. This is called neoadjuvant
chemotherapy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some
patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells
that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is
called adjuvant therapy. Sometimes, a second-look surgery is done to see if cancer remains after
chemotherapy or radiation therapy.
Information about the tumor cell type and the spread of the tumor is used to decide the best
kind of treatment for a particular patient. Treatment is usually a combination of surgery,
medications used to kill cancer cells (chemotherapy), and x rays or other high-energy rays used
to kill cancer cells (radiation therapy). These therapies are called adjuvant therapies, and this
type of combination therapy has been shown to substantially improve outcome in patients with
Wilms' tumor. It has long been known that Wilms' tumors respond to radiation therapy.

RADIATION THERAPY
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of
radiation to kill cancer cells or keep them from growing. There are two types of radiation
therapy. 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. The way the radiation therapy is given
depends on the type and stage of the cancer being treated and whether a biopsy was done before
surgery to remove the tumor.

CHEMOTHERAPY
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells,
either by killing the cells or by stopping them from dividing. When chemotherapy is taken by
mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer
cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into
the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect
cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends
on the type and stage of the cancer being treated.
Combination chemotherapy is treatment using two or more anticancer drugs. some types
of chemotherapy have been found to be effective in treating Wilms' tumor. These effective drugs
include dactinomycin, doxorubicin, vincristine, and cyclophosphamide. In rare cases, bone
marrow transplantation may be used.

BIOLOGIC THERAPY
Biologic therapy is a treatment that uses the patient's immune system to fight cancer.
Substances made by the body or made in a laboratory are used to boost, direct, or restore the
body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or
immunotherapy.

New types of treatment are being tested in clinical trials.

.

WATCHFUL WAITING
Watchful waiting is closely monitoring a patients condition without giving any treatment
until symptoms appear or change.

HIGH-DOSE CHEMOTHERAPY WITH STEM CELL

TRANSPLANT.
High-dose chemotherapy with stem cell transplant is a method of giving high doses of
chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells
(immature blood cells) are removed from the blood or bone marrow of the patient or a donor and
are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and
given back to the patient through an infusion. These re-infused stem cells grow into (and restore)
the body's blood cells.