Wilms Tumor and Other Childhood Kidney Tumors

General Information | Treatment Options | Resources

 

Treatment
  • Overview
  • Standard Treatment
  • Clinical Trials
  • Treatment By Stage

There are different types of treatment for patients with Wilms tumor and other childhood kidney tumors.

Different types of treatment are available for children with Wilms and other childhood kidney tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children with Wilms tumor or other childhood kidney tumors should have their treatment planned by a team of doctors with expertise in treating cancer in children.

Your child's treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist may refer you to other doctors who have experience and expertise in treating children with Wilms tumor or other childhood kidney tumors and who specialize in certain areas of medicine. These may include the following specialists:

  • Pediatric surgeon or urologist.
  • Radiation oncologist.
  • Rehabilitation specialist.
  • Pediatric nurse specialist.
  • Social worker.

Late effects may be caused by cancer treatment.

Some cancers and cancer treatments cause side effects that continue or appear months or years after cancer treatment has ended. These are called late effects. Late effects of cancers and cancer treatment may include:

  • Physical problems.
  • Changes in mood, feelings, thinking, learning, or memory.
  • Second cancers (new types of cancer).

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some cancers and cancer treatments. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).

Clinical trials are ongoing to find out if lower doses of chemotherapy and radiation can be used.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

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.

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 increase the chances of a cure, is called adjuvant therapy. Sometimes, a second-look surgery is done to see if cancer remains after chemotherapy or 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.

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 spinal column, 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.

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.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

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.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.

Stage I Wilms Tumor

Treatment of stage I Wilms tumor with favorable histology may include the following:

  • Nephrectomy with lymph node removal followed by combination chemotherapy.
  • A clinical trial of nephrectomy with lymph node removal, followed by observation or new combinations of chemotherapy.

Treatment of stage I anaplastic Wilms tumor may include the following:

  • Nephrectomy with lymph node removal followed by combination chemotherapy.
  • A clinical trial of nephrectomy with lymph node removal, followed by combination chemotherapy and radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I Wilms tumor.

Stage II Wilms Tumor

Treatment of stage II Wilms tumor with favorable histology may include the following:

  • Nephrectomy with removal of lymph nodes, followed by combination chemotherapy.
  • A clinical trial of nephrectomy with removal of lymph nodes, followed by new combinations of chemotherapy.

Treatment of stage II anaplastic Wilms tumor may include the following:

  • Nephrectomy with removal of lymph nodes, followed by radiation therapy to the abdomen and combination chemotherapy.
  • A clinical trial of nephrectomy with removal of lymph nodes, followed by new combinations of chemotherapy and radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II Wilms tumor.

Stage III Wilms Tumor

Treatment of stage III Wilms tumor with favorable histology may include the following:

  • Nephrectomy with removal of lymph nodes, followed by radiation therapy to the abdomen and combination chemotherapy.
  • A clinical trial of nephrectomy with removal of lymph nodes, followed by radiation therapy to the abdomen and new combinations of chemotherapy.

Treatment of stage III anaplastic Wilms tumor may include the following:

  • Nephrectomy with removal of lymph nodes, followed by radiation therapy to the abdomen and combination chemotherapy.
  • A clinical trial of nephrectomy with removal of lymph nodes, followed by new combinations of chemotherapy and radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III Wilms tumor.

Stage IV Wilms Tumor

Treatment of stage IV Wilms tumor with favorable histology may include the following:

  • Nephrectomy with removal of lymph nodes, followed by radiation therapy to the abdomen and combination chemotherapy. If cancer has spread to the lungs, patients will also receive radiation therapy to the lungs.
  • A clinical trial of chemotherapy for cancer that has spread only to the lungs. If tumors remain after chemotherapy, radiation therapy may be given.
  • A clinical trial of chemotherapy and radiation therapy to places where cancer has spread.

Treatment of stage IV anaplastic Wilms tumor may include nephrectomy with removal of lymph nodes, followed by new combinations of chemotherapy and radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV Wilms tumor.

Stage V Wilms Tumor

Treatment of stage V Wilms tumor may be different for each patient. Treatment is usually chemotherapy to shrink the tumor, followed by surgery to remove as much of the cancer as possible. This may be followed by more chemotherapy and/or radiation therapy if cancer remains after surgery.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage V Wilms tumor.

Inoperable Tumors

Sometimes the tumor is inoperable (cannot be removed by surgery) because it is too close to important organs or blood vessels or because it is too large to remove. In this case, chemotherapy may be given to reduce the size of the tumor so it may be removed in surgery. If the tumor does not shrink enough after chemotherapy, radiation therapy may be given to shrink it further so that surgery may be done. This may be followed by more chemotherapy and/or more radiation therapy.

Clear Cell Sarcoma of the Kidney

There is no standard treatment for clear cell sarcoma of the kidney. Treatment is usually within a clinical trial and may include nephrectomy with lymph node removal, with or without radiation therapy to the abdomen, and new combinations of chemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with clear cell sarcoma of the kidney.

Rhabdoid Tumor of the Kidney

There is no standard treatment for rhabdoid tumor of the kidney. Treatment may be within a clinical trial and may include new combinations of chemotherapy and radiation therapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with rhabdoid tumor of the kidney.

Neuroepithelial Tumor of the Kidney

There is no standard treatment for neuroepithelial tumor of the kidney. Treatment is usually within a clinical trial. It may be treated in the same way that Ewing family of tumors or primitive neuroectodermal tumors are treated. See the PDQ summary on Ewing Family of Tumors Treatment for more information.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with peripheral primitive neuroectodermal tumor of the kidney.

Mesoblastic Nephroma

Treatment for mesoblastic nephroma is usually surgery with or without chemotherapy.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with congenital mesoblastic nephroma.

Renal Cell Cancer

Treatment of renal cell cancer is usually nephrectomy with removal of lymph nodes. If cancer has spread, treatment may include biologic therapy or surgery to remove the primary tumor. See the PDQ summary on Renal Cell Cancer Treatment for more information.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood renal cell carcinoma.

Diffuse Hyperplastic Perilobar Nephroblastomatosis

Treatment of diffuse hyperplastic perilobar nephroblastomatosis (DHPLN) may include nephrectomy with lymph node removal followed by combination chemotherapy. A partial nephrectomy may be done to keep as much kidney function as possible.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with diffuse hyperplastic perilobar nephroblastomatosis.

Recurrent Wilms Tumor and Other Childhood Kidney Tumors

Treatment of recurrent Wilms tumor may be within a clinical trial of combination chemotherapy, surgery, and radiation therapy, with or without stem cell transplant, using the child's own blood stem cells.

Treatment of recurrent clear cell sarcoma, rhabdoid tumor, and neuroepithelial tumor of the kidney is usually within a clinical trial.

Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent Wilms tumor and other childhood kidney tumors.

 

 

Cancer information from the NCI PDQ service