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The following are treatment options for stage V Wilms tumour. The healthcare team will suggest treatments based on your child’s needs and work with you to develop a treatment plan. The goal of treatment is to remove as much tumour as possible, while keeping as much of the kidney as possible.
A diagnostic biopsy is not usually done for stage V Wilms tumour. Chemotherapy is given for about 6 weeks to shrink the tumours, and then surgery is done to remove as much of the tumours from both kidneys as possible, while leaving enough normal kidney tissue behind.
Treatment after surgery includes more chemotherapy and may include radiation therapy and further surgery to remove the tumours. Every effort is made to save as much normal kidney tissue as possible.
Surgery is an important part of treatment for stage V Wilms tumour. Surgery for stage V Wilms tumour is typically delayed for 6 weeks or more. The type of surgery done will depend on the extent of the tumours and how well chemotherapy works to shrink them. Surgery to remove part of a kidney is called partial nephrectomy. Surgery to remove all of a kidney is called radical nephrectomy.
The surgeon may remove all of the kidney that contains the most tumour and part of the other kidney. The surgeon may also remove part of both kidneys.
The surgeon may need to completely remove both kidneys, although this is uncommon. If both kidneys are removed, the child will need dialysis. A kidney transplant will be done when treatment is complete and a donor kidney becomes available. Most transplant centres will want to wait 1-2 years before doing a kidney transplant to ensure that the cancer is not going to come back, or recur.
Chemotherapy is usually given for 6 weeks before surgery to shrink the tumours before they are removed. Chemotherapy is also given after surgery. The type of chemotherapy and how long it is given again after surgery will depend on the extent and histology of the tumour tissue that remains after surgery.
Radiation therapy may be given to the abdomen after surgery.
Many children with Wilms tumour will be treated in a clinical trial that is tailored to the stage and type of tumour. The clinical trial protocol outlines the chemotherapy drugs and dosages that are used. Find out more about clinical trials.