Stage IV Wilms' Tumor
Treatment of both favorable and anaplastic stage IV
Wilms' tumors will probably consist of surgery to remove the kidney and some of the lymph nodes near the kidney, followed by radiation therapy to the abdomen, and chemotherapy. Patients whose cancer has spread to the lungs also usually receive radiation therapy to the lungs.
Stage V Wilms' Tumor
In cases of stage V Wilms' tumor, the doctor will probably do a biopsy of the cancer by taking out a piece of the cancer in both kidneys and removing some of the lymph nodes around the kidney to see whether they contain cancer. Following the biopsy, chemotherapy will likely be used to shrink the cancer. Doctors then typically perform a second surgery to remove as much of the cancer as possible, while leaving as much of the kidneys as possible. Surgery may be followed by more chemotherapy, radiation therapy, or both.
Sometimes the cancer is inoperable (meaning it cannot be removed during surgery) because it is too close to important organs or blood vessels or because it is too large to remove. In this case, the doctor may perform a biopsy only and then administer chemotherapy, with or without radiation therapy. Once the cancer has become smaller, doctors may use surgery to remove part or all of the tumor, followed by more chemotherapy and radiation therapy.
If the cancer comes back, treatment will depend on the treatment received before, how much time has passed since the first cancer was treated, the histology of the cancer, and where the cancer came back. Clinical trials are evaluating new treatments, such as new chemotherapy drugs and combinations, and very high doses of chemotherapy followed by bone marrow reinfusion.
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