Wilms Tumor Treatments

This information is an interpretation of various studies that have been published in medical journals. The information below represents various views of nurses and doctors who serve on the American Cancer Society’s Cancer Information Database Editorial Board. Keep in mind that the information provided in this article is not designed to be taken as medical advice or to replace the opinion and judgment of your personal cancer care team. It is simply designed to help you make informed decisions together with your doctor.

The general treatment options that will be discussed may not be what your doctor recommends, and there may be various reasons why. You should take the time to find out what specific treatments doctors recommend for you.

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The main treatment for Wilms tumors is surgical removal. But other treatments like radiation therapy, and chemotherapy may also be used.

Surgery for Wilms Tumors

The primary goal of surgery is complete tumor removal in one piece, which reduces the chance of the cancer spreading. The following techniques may be used:

Radical Nephrectomy

This is the most common surgical procedure for a Wilms tumor that is confined to one kidney (unilateral), as it offers the best chance of ensuring complete tumor removal. During this operation, the surgeon makes an incision, usually down the middle of the abdomen, and removes the entire affected kidney, the adrenal gland, the surrounding fatty tissue, and the ureter. It is possible to live and function normally with a single kidney, however, some lifestyle adjustments will be necessary.

Partial Nephrectomy (nephron-sparing surgery)

This involves removing only a portion of the affected kidney(s). This surgery may be performed on a small number of children who have Wilms tumors in both kidneys to preserve some normal kidney tissue. The surgeon may perform a radical nephrectomy on the kidney with the larger tumor. This is then followed by a partial nephrectomy on the other kidney, removing only the tumor and a margin of normal kidney tissue surrounding it. Another option is to perform partial nephrectomies on both kidneys. In some cases, both kidneys may need to be removed entirely. This requires the child to undergo dialysis several times a week until a donor kidney becomes available for transplantation.

Side effects and possible complications during and after kidney surgery:

  • Bleeding
  • Injuries to major blood vessels or other organs
  • Reactions to anesthesia
  • Internal bleeding
  • Blood clots
  • Infections
  • Problems with food moving through the intestines
  • Loss of kidney function and the need for regular dialysis
  • A need for a kidney donor
  • The need for immunosuppressants to prevent organ rejection after kidney transplant

Chemotherapy for Wilms Tumors

Chemotherapy uses potent drugs that target fast-growing and fast-dividing cells. These drugs are far-reaching and are called systemic because of their ability to treat cancer throughout the body. They do, however, attack hair and bone marrow cells as well. They are given in cycles with rest periods in between to prevent the patient from deteriorating. Chemo drugs are administered intravenously, or through a catheter that is surgically installed. Chemotherapy is usually done after surgery for Wilms tumor removal. The following drugs are commonly used:

  • Actinomycin D
  • Vincristine

For advanced Wilms tumors:

  • Doxorubicin (Adriamycin)
  • Cyclophosphamide
  • Etoposide
  • Irinotecan
  • Carboplatin

Potential Side Effects of Chemotherapy:

As mentioned above, chemo drugs are potent and non-selective, affecting hair cells, bone marrow cells, and other organs. Constant monitoring is essential so that doctors can adjust doses or use alternative drugs if any serious complications arise during treatment.

Short-term side effects:
  • Hair loss
  • Mouth sores
  • Appetite loss
  • Nausea and vomiting
  • Diarrhea or constipation
  • Blood problems
Specific side effects of certain drugs:
  • Vincristine: Nerve damage (peripheral neuropathy), causing tingling, numbness, weakness, or pain in hands and feet
  • Doxorubicin: Heart damage, risk increases with higher total doses
  • Cyclophosphamide: Bladder damage, causing blood in the urine (risk can be lowered by giving the drug with plenty of fluids and mesna)
Long-term side effects:
  • Doxorubicin (Adriamycin): Potential heart damage, closely monitored by doctors
  • Some chemo drugs: Increased risk of developing a second type of cancer (such as leukemia) years after Wilms tumor is cured
  • Some drugs: Potential effects on fertility (ability to have children) years later

Radiation Therapy for Wilms Tumors

Radiation therapy uses high-energy X-rays concentrated at the location of the tumor to shrink or kill cancer cells. External Beam Radiation Therapy (EBRT) focuses radiation from a machine outside the body, into predetermined angles that are aimed at the tumor via imaging tests. The following types of EBRT are used for Wilms tumor treatment:

3D-CRT

Three-dimensional conformal radiation therapy (3D-CRT) uses imaging tests, such as MRI, and specialized computers to create a precise map of the tumor's location. The radiation beams are then shaped and directed at the tumor from various angles. Each beam is relatively weak, reducing the likelihood of damaging normal body tissues, but the beams converge at the tumor site to deliver a higher dose of radiation.

IMRT

Intensity-modulated radiation therapy (IMRT) is an advanced form of 3D therapy that takes the process a step further. In addition to shaping the beams and aiming them at the tumor from multiple angles, IMRT allows for the adjustment of the intensity (strength) of the beams. This helps limit the radiation dose reaching nearby normal tissues, enabling doctors to deliver a higher dose specifically to the tumor. Many major hospitals and cancer centers now employ IMRT as part of their treatment options.

Potential side effects of radiation therapy:

Short-term effects:

  • Skin reactions in irradiated areas
  • Hair loss
  • Nausea or diarrhea
  • Fatigue

Long-term effects:

  • Kidney damage
  • Slowed growth of normal body tissues (less likely with advanced Radiation therapy)
  • Potential heart or lung problems later in life (if radiation is directed to the chest area)
  • In girls, abdominal radiation may damage the ovaries, potentially leading to abnormal menstrual cycles or fertility issues later in life if the doses are too high

If you or a loved one have suffered from a misdiagnosis or delayed diagnosis for your child's Wilms tumors or from negligence during their treatment that caused them more harm, contact us at 833-PORTER9, or e-mail us at info@porterlawteam.com to discuss the details of our experience representing other clients and the results we were able to obtain in the past for clients who are suffering as you are. In many ways, our results speak for themselves, and we will stand ready to help you and your family in your time of greatest need.

Last Updated on April 4, 2024 by Michael S. Porter
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