ON THIS PAGE: You will learn about the different types of treatments doctors use to treat children with a Wilms tumor. Use the menu to see other pages.
In general, cancer in children is uncommon. This means it can be hard for doctors to plan treatments unless they know what has been most effective in other children. That is why more than 60% of children with cancer receive treatment as part of a clinical trial.
Treatment for Wilms tumors is a success story for improving the prognosis of children with cancer using clinical trials. Clinical trials are research studies that compare the standard of care with newer approaches to treatments that may be more effective. The “standard of care” is the best treatments known based on previous clinical trials. Clinical trials may test such approaches as a new drug, a new combination of existing treatments, or new doses of current therapies. The health and safety of all children who participate in clinical trials are closely monitored.
To take advantage of these newer treatments, children with cancer should receive treatment at a specialized cancer center. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research. A doctor who specializes in treating children with cancer is called a pediatric oncologist. If a pediatric cancer center is not nearby, general cancer centers sometimes have pediatric specialists who are able to be part of your child’s care.
How a Wilms tumor is treated
In many cases, a team of doctors works with a child and their family to provide care. This is called a multidisciplinary team. Pediatric cancer centers often have extra support services for children and their families, such as child life specialists, dietitians, physical and occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available.
The main treatments for a Wilms tumor are surgery, chemotherapy, and radiation therapy. Treatment options and recommendations depend on several factors, including:
The type, stage, and histology of the tumor
Possible side effects
The child and family’s preferences
The child’s overall health
Take time to learn about all of your child's treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your child's doctor and what you and your child can expect while they are receiving the treatment. These types of talks are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your child’s care. Shared decision-making is particularly important for Wilms tumor because there are different treatment options. Learn more about making treatment decisions.
The common types of treatments used for a Wilms tumor are described below. Your child's care plan also includes treatment for symptoms and side effects, an important part of cancer care.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery is a common treatment for all stages of a Wilms tumor. It is important that your child's surgeon has experience with removing Wilms tumors and, in some cases, experience with saving part of the kidney.
Surgery is usually performed by either a pediatric surgeon with experience in removing cancer in children or a pediatric urologist. A pediatric urologist is a doctor who specializes in treating urinary tract problems in children.
The types of surgery used to treat a Wilms tumor include:
Radical nephrectomy. A radical nephrectomy is the removal of the whole kidney and some surrounding tissue, as well as nearby lymph nodes. The surgical removal of the lymph nodes is called a lymph node dissection.
Partial nephrectomy. A partial nephrectomy is the removal of the tumor and some of the surrounding healthy tissue, leaving as much of the kidney as possible. A partial nephrectomy is performed when the other kidney is damaged, also contains a tumor, or has already been removed.
When 1 kidney is removed, the other kidney takes over the full job of filtering waste from the body. Dialysis may also be used if preserving 1 functioning kidney is not possible. Dialysis is when a machine does the filtering work of the kidneys.
Before surgery, talk with your child's health care team about the possible side effects from the specific surgery your child will have. Learn more about the basics of surgery.
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Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the tumor cells from growing, dividing, and making more cells. Chemotherapy for a Wilms tumor is given by a pediatric oncologist.
Chemotherapy may be given through the bloodstream to reach cancer cells throughout the body. When a drug is given this way, it is called systemic therapy. Chemotherapy for a Wilms tumor is usually given through an intravenous (IV) tube placed into a vein using a needle. Chemotherapy may also be given locally, which is when the medication is applied directly to the cancer or kept in a single part of the body.
A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. A person may receive 1 drug at a time or combinations of different drugs given at the same time. A Wilms tumor with a favorable histology is often treated with dactinomycin (Cosmegen) and vincristine (Vincasar PFS, Oncovin). In some cases, doxorubicin (Adriamycin) will also be added. Other drugs used to treat Wilms tumors include cyclophosphamide (Cytoxan, Neosar), etoposide (Toposar, VePesid), and irinotecan (Camptosar).
Chemotherapy can be given after surgery to eliminate any remaining cancer cells. When this is done, it is called adjuvant chemotherapy.
Sometimes, chemotherapy is given before surgery to shrink a tumor that is too large to remove or a tumor that is growing into blood vessels or other organs, making it too risky to remove. When this is done, it is called neoadjuvant chemotherapy.
The side effects of chemotherapy depend on the individual and the type of chemotherapy and dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away after treatment is finished.
Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, their purpose, and their potential side effects or interactions with other medications.
It is also important to let your child's doctor know if your child is taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your child’s prescriptions by using searchable drug databases.
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Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist.
The most common type of radiation treatment is called external-beam radiation therapy, which is radiation therapy given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
Radiation therapy may be used to treat a large tumor or a tumor that has spread to other parts of the body. It may also be used to shrink a tumor before surgery or to destroy cancer cells that remain after surgery. Radiation therapy is usually part of the treatment plan for children with a stage III or IV Wilms tumor with a favorable histology and for all children who have a tumor with an anaplastic histology (see Stages for more information).
Side effects from radiation therapy depend on which part of the body is treated. For example, side effects from radiation therapy to the abdomen can include fatigue, mild skin reactions like redness or peeling, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.
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Physical, emotional, and social effects of cancer
Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your child’s care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how your child feels during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. Your child may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Before treatment begins, talk with your child’s doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.
During treatment, your child’s health care team may ask you to answer questions about your child’s symptoms and side effects and to describe each problem. Be sure to tell the health care team if your child is experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.
Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website.
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Remission and the chance of recurrence
A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions are permanent, it is important to talk with your child’s doctor about the possibility of your child’s tumor returning. Understanding your child’s risk of recurrence and the treatment options may help you and your child feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.
If the tumor returns after the original treatment, it is called a recurrent Wilms tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
If a recurrence happens, a new cycle of testing will begin again to learn as much as possible about it. After this testing is done, your child’s doctor will talk with you about the treatment options. The treatment plan for a recurrent Wilms tumor depends on 4 factors:
Where the cancer has returned in the body
The type of treatment your child received for the original tumor
How long it has been since the original cancer was treated
Whether the new growth has a favorable or anaplastic histology
Often the treatment plan will include the treatments described above, such as surgery, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your child’s doctor may suggest clinical trials that are studying new ways to treat a recurrent Wilms tumor, including new medications. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.
When a Wilms tumor recurs, children and their families sometimes experience emotions such as disbelief or fear. Families are encouraged to talk with their child's health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.
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If treatment does not work
Although treatment is successful for many children with a Wilms tumor, sometimes it is not. If a child’s cancer cannot be cured or controlled, this is called advanced or terminal cancer. This diagnosis is stressful, and advanced cancer may be difficult to discuss. However, it is important to have open and honest conversations with your child’s health care team to express your family’s feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help.
Hospice care is designed to provide the best possible quality of life for people who are expected to live less than 6 months. Parents and guardians are encouraged to talk with the health care team about hospice options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Some children may be happier if they can attend school part-time or keep up other activities and social connections. Your child’s health care team can help you decide on an appropriate level of activity. Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced cancer care planning.
The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child.
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The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for children with a Wilms tumor. Use the menu to choose a different section to read in this guide.