How is Wilms tumor treated?

This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

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 conducts clinical trials of new treatments for most children with Wilms tumor. Today, most children with this cancer are treated in a clinical trial to try and 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 is necessary.

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 nurse practitioners, nurses, psychologists, social workers, rehabilitation specialists, and other health professionals.

After your child's Wilms tumor is found and its stage and histology are determined, your cancer care team will suggest a treatment plan. Take your time and think about all of your options.

You can often get a second opinion if you have questions about the recommended plan (or if you just want to confirm this is the best option). If you get one, it's important to get it fairly quickly because Wilms tumors are usually very large and tend to grow fast.

The main types of treatment that can be used for Wilms tumor are:

• Surgery
• Chemotherapy
• Radiation therapy

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.

If any cancer cells remain after the first operation, radiation therapy or more surgery may be needed. 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 shrink the tumor(s) before trying surgery.

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).