Wilms’ Tumor – Treatment Choices

Wilms’ Tumor is commonly treated using surgery, chemotherapy and radiation therapy that depends on the staging and overall condition of the child.

Surgery

Surgery is the most prevalent form of treatment for Wilms’ tumor wherein the doctor might remove the cancerous growth employing one of the below stated procedures.

• Partial Nephrectomy – This procedure is conducted for removal of the cancer and a section of the kidney that is situated around it.  It usually is done in just rare cases when there is damage done to the other kidney or has previously been taken out.
• Simple Nephrectomy – This procedure involves the complete removal of the kidney. The other kidney would then take on the role of purifying the blood.
• Radical Nephrectomy – In this procedure there is total removal of kidney, adjoining tissues and some of the lymph nodes.

Chemotherapy

Chemotherapy is the usage of drugs administered in either pill form or intravenously for annihilating cancer cells. Chemotherapy is also known as systemic treatment as the drugs on entry into the bloodstream, pass through the body and can stamp out cancer cells all through the body .When chemotherapy is offered as a post-operative procedure then it is known as adjuvant therapy.

In case elevated doses of chemotherapy are employed for killing the cancer cells, then the high doses could mar the blood-producing tissue present in the bones or bone marrow. If elevated doses of chemotherapy are required for treating the cancer, then the bone marrow might be extracted from the bones prior to therapy and kept in the freezer till its need arises. Subsequent to chemotherapy, the bone marrow is intravenously reinstated. This is known as autologous bone marrow reinfusion.

Radiation Therapy

Radiation therapy makes use of X-rays or other forms of high-power rays for annihilating cancer cells and shrinking the tumors. Radiation done for treating Wilms’ tumor generally is given through a machine located outside the body, also known as radiation therapy. Radiation might either be employed prior to or following surgery and chemotherapy.

Some patients tend to develop a second, altered form of the cancer after several years due to the outcome of being treated with chemotherapy and radiation. On-going clinical trials are intended at ascertaining whether chemotherapy and radiation could be employed in lower doses.

Stage-Wise Treatment

Treatment offered is dependent on the stage of the tumor, cell type or histology and the child’s overall health condition and age. A standardised treatment is adopted on the basis of its efficacy in several patients in earlier studies or investigational. The doctor might suggest that the child partake in a clinical trial – a research project that involves new investigational treatments. Several patients do not seem to be cured using standard therapy and there may be undue number of side effects experienced with some of the standard treatments. Due to these reasons, clinical trials are intended for testing novel, better treatment alternatives.

Stage I – In case the tumor bears a ‘favourable’ cell type or the child is having anaplastic Wilms’ tumor, then surgery for removal of cancer would be the probable line of treatment followed by chemotherapy. Surgery and subsequently radiation therapy and chemotherapy would be the probable line of treatment in case the child is having either clear cell sarcoma of the kidney or rhabdoid tumor.

Stage II – In case the tumor bears a ‘favourable’ cell type, the treatment would mostly involve surgery for removal of cancer, after which chemotherapy would be given. In case the child is having an ‘unfavourable’ cell type like anaplasia, clear cell sarcoma or rhabdoid tumor of the kidney, then the treatment might include surgery that would be followed by radiation therapy and chemotherapy.

Stage III – The treatment would possibly be surgery after which radiation therapy and chemotherapy would be given. At times, it is not possible to remove the cancer via surgery as it is located in close proximity to vital organs or blood vessels or due to its overbearingly large size. In such situations, only biopsy is conducted following which chemotherapy might be suggested that may or may not include radiation. Subsequent to the cancer being minimised by treatment, surgery would be conducted, that would be followed by further chemotherapy and radiation therapy sessions.

Stage IV – The line of treatment would generally be surgery that would be followed by radiation therapy and chemotherapy. In case there has been cancer metastasis or the cancer spreading to the lungs, then further chemotherapy sessions might be given.

Stage V – If cancer has metastasized to both the lungs, generally it is unfeasible to remove both the kidneys. A portion of the cancer from both the kidneys and adjacent lymph nodes might be removed for checking the presence of cancer. Subsequent to surgery, chemotherapy is conducted for shrinking the tumor. Following reduction of the cancer, a second operative procedure might be conducted for removing major parts of the cancer, while attempting to leave as much part of the kidneys as possible. Surgery might be followed by additional chemotherapy and radiation therapy.

Persistent – In case the cancer has relapsed in the child, the treatment offered would depend on the treatment previously offered, the amount of time transpired following the last treatment, the type of the cancer cells and the location of its re-emergence. Based on these factors, treatment would comprise of surgery, radiation therapy and chemotherapy.

Clinical trials, investigative projects that involve patients, aid in assessing novel treatments, like chemotherapy drugs, novel blends of treatments and bone marrow reinfusion.

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