How is Wilms tumor treated?
General comments about treatment
Overall, about 9 of 10 children with Wilms tumor are cured. A great deal of progress has been made in treating this disease with surgery, radiation therapy, and chemotherapy. Much of this progress in the United States has been because of the work of the National Wilms Tumor Study Group (now part of the Children’s Oncology Group), which runs clinical trials of new treatments for children with Wilms tumor. Today, most children with this cancer are treated in a clinical trial to try to improve on what doctors believe is the best treatment. The goal of these studies is to find ways to cure as many children as possible while limiting side effects by giving as little treatment as needed.
Because Wilms tumors are rare, few doctors outside of those in children’s cancer centers have much experience in treating them. Most doctors recommend a team approach that includes the child’s pediatrician as well as specialists at a child’s cancer center. For Wilms tumors, the doctors on this team often include:
- A pediatric surgeon or pediatric urologist (doctor who treats urinary system problems in children [and genital problems in boys])
- A pediatric oncologist (doctor who uses chemotherapy and other medicines to treat childhood cancers)
- A pediatric radiation oncologist (doctor who uses radiation therapy to treat cancer in children)
Many other specialists may be involved in your child’s care as well, including physician assistants, nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals. For more information, see our document Children Diagnosed With Cancer: Understanding the Health Care System.
After your child’s tumor is found and its stage and histology are determined, the cancer care team will discuss treatment options with you. It’s important to discuss all of the options as well as their possible side effects with your child’s doctors so you can make an informed decision. (For a list of some questions to ask, see the section “What should you ask your child’s doctor about Wilms tumor?”)
If time permits, it can often be helpful to get a second opinion if you have questions about the recommended plan (or if you just want to confirm that it’s the best option). This can provide you with more information and help you feel more confident about the treatment plan you choose.
The main types of treatment that can be used for Wilms tumor are:
Most children will get more than one type of treatment.
In the United States, surgery is the first treatment for most Wilms tumors. In Europe, doctors prefer to give a short course of chemotherapy before the surgery. There seems to be no difference in the results from these 2 approaches.
The first goal of treatment is to remove the primary (main) tumor even if the cancer has spread to distant parts of the body. Sometimes the tumor may be hard to remove. It may be very large, it may have spread into nearby blood vessels or other vital structures, or it may be in both kidneys. For these children, doctors might use chemotherapy, radiation therapy, or a combination of the 2 to try to shrink the tumor(s) before surgery.
If any cancer cells remain after surgery, radiation therapy or more surgery may be needed.
The next few sections describe the types of treatments used for Wilms tumors. This is followed by a description of the most common approaches used for these tumors based on the tumor stage (extent) and histology (appearance under a microscope).
Please see the “Additional resources for Wilms tumor” section for other, more specific materials on the different types of cancer treatments and their side effects.
Last Medical Review: 09/17/2013
Last Revised: 02/14/2014