Surgery
Surgery is a common treatment for Wilms' tumor. It is performed to remove tumors, provide tissue for a histology diagnosis and to perform staging of the disease.
Types of surgery include a simple nephrectomy, removal of the entire kidney and a partial nephrectomy, removal of the tumor and part of the surrounding kidney, preserving the rest of the organ. A partial nephrectomy is usually performed when the other kidney is damaged, also contains a tumor, or has already been removed. A radical nephrectomy takes out the whole kidney with some surrounding tissues and some area lymph nodes.
Chemotherapy
The oncologist may use chemotherapy drugs to kill the remaining cancerous cells. These drugs may be taken orally or injected into a vein or muscle. The drugs travel in the bloodstream and kill cancer cells throughout the body. Chemotherapy can also be used after the tumor is surgically removed to kill remaining cancer cells (adjuvant chemotherapy). The drugs used most often are dactinomycin D and vincristine, which are both given intravenously. For advanced stages, doctors may use doxorubicin, cisplatin and cyclophosphamide and/or etoposide.
The severity of side effects depends on the type of drug given and the length of time the child must take it. Because chemotherapy attacks rapidly dividing cells, including those in normal tissues such as the hair, lining of the mouth and intestines and bone marrow, patients may experience hair loss, mouth sores, nausea and vomiting.
Lowered resistance to infections due to low white blood cell counts or bruising and bleeding more easily due to lowered platelet counts are other side effects. Low red blood cell counts (anemia) may cause fatigue. Such conditions go away after chemotherapy is over.
Some patients develop another form of cancer years later as a result of chemotherapy. Clinical trials are studying whether patients can receive lower doses of drugs to avoid this problem.
Radiation
This form of treatment uses high-energy rays to damage or kill cancer cells. To treat Wilms' tumor, radiation usually comes from a machine outside the body (external beam radiation therapy). Side effects include tiredness, mild skin reactions, upset stomach and loose bowels.
Radiation may be used to treat larger tumors or metastases. It may also be used to reduce the size of the tumor before surgery, treat tumors with an unfavorable histology or kill cancer cells that remain after surgery.
Autologous bone marrow transplant
In this procedure, marrow is taken from the patient, treated with drugs to kill any cancer cells and frozen. The patient then receives high-dose chemotherapy, with or without radiation, to destroy cancer cells. The stored marrow is thawed and then injected to replace the marrow that was incidentally destroyed by the treatment.
Copyright © 2000 Oncology.com, Inc. All rights reserved.
