Wilms tumor - diagnosis and therapy

How is the diagnosis made?

A blood test gives evidence of an inflammatory process at late stages. In addition, it may be possible to exclude another type of tumor (neuroblastoma).

By far the most important aids for the diagnosis are the imaging techniques, in particular the ultrasound and the magnetic resonance tomography. This can then determine the size and spread and recognize whether other organs are affected. As the tumor spreads to the lungs most often, an X-ray is also taken of it. The function of the kidneys is assessed by scintigraphy.

Further investigations are based on the tumor and the therapy. Since nephroblastoma can be diagnosed fairly reliably with these agents, a tissue sampling (fine needle biopsy), which carries the risk of tumor spreading in the abdomen, is only necessary in very few exceptional cases. Depending on whether the tumor is confined to one kidney, has grown into the surrounding tissue, has spread metastases, has infested both kidneys, and is surgically removable, it is assigned to one of five stages not only in treatment, but also in one also differ in the forecast.

Which therapy is there?

The treatment is a combination of chemotherapy (as tablets or injected into the vein or muscle), surgery and - in some cases - radiation. It depends on the type of tumor, its spread (staging) and the age of the child.

There are two principal treatment guidelines worldwide. They differ in that chemotherapy is performed first after surgery and in others before. In Germany, the second approach is common.

With pre-operative chemotherapy (preoperative), the tumor can be scaled down and thus slip into a group with better prognosis. In addition, the risk of a tumor tear with scattering of the cancer cells or bleeding during surgery is reduced. The duration of preoperative chemotherapy ranges from 4 to 40 weeks, depending on the tumor.

During surgery, either the affected kidney can be removed with or without surrounding tissue and lymph nodes, or, for example, if only one kidney is present, only the tumor can be skinned. Whether additional radiation or renewed chemotherapy is then required depends on the operative findings and how the removed tissue looks under the microscope.

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