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Treating Wilms tumour

Doctors plan your child’s treatment in one of the UK's children’s cancer centres. Your child has most of their treatment in this specialist centre, but some care might take place at a hospital closer to home.

Children's cancer centres have teams of specialists who know about Wilms tumours and the best way to treat them. Wilms tumour is curable in more than 9 out of 10 children (90%).

The main treatments include:

  • chemotherapy for almost all children
  • surgery for all children
  • radiotherapy for some children

In the UK and many other countries, children usually start treatment (chemotherapy) without a biopsy Open a glossary item if the tumour looks like a Wilms tumour on the CT or MRI scan. The tumour will then be taken out after a few weeks (usually 4 weeks). After the tumour is taken out and looked at, further treatment decisions are then made about your child's treatment.

Decisions about treatment

The specialist team plan treatment according to the type of Wilms tumour your child has. A pathologist Open a glossary item looks at the Wilms tumour cells under a microscope. This helps the team decide on the risk group for the tumour. This means if there is a low, medium or high risk of the cancer coming back after treatment.

They will also look at:

  • if your child has a tumour in one or both of their kidneys
  • whether there is any spread in the abdomen (tummy area) beyond the kidney (for example to the lymph nodes Open a glossary item)
  • whether the cancer has spread to distant organs such as the lungs
Don't be afraid to ask your doctor or specialist nurse any questions you have about the treatment. You might want to encourage your child to ask questions too if they are able. It helps to write down a list of questions you want to ask and to take a close friend or relative with you when you go to see them. They can make notes for you and will likely remember different things from the conversation.

Chemotherapy

The first treatment your child is likely to have for Wilms tumour is chemotherapy. This helps to shrink the tumour and make it smaller. The aim of this is to make surgery easier. 

Most children with Wilms tumour have these chemotherapy drugs:

  • vincristine
  • actinomycin D (also known as dactinomycin)

Your child might have another drug with vincristine and actinomycin D, for example doxorubicin. This may be because the tumour is classed as high risk or has spread to other parts of the body. Or, the initial treatment is not working as well as doctors hoped.

Some other chemotherapy drugs used for high risk Wilms tumours include:

  • cyclophosphamide
  • etoposide
  • carboplatin

Your child usually has 4 weeks of chemotherapy before surgery. Depending on the stage and risk group they might have between 4 and 34 weeks of chemotherapy treatment after surgery.

If your child is under 6 months of age, your child will usually have surgery first.

Surgery

After chemotherapy, all children have surgery to remove the affected kidney. This operation is called a nephrectomy.

The surgeon removes the whole kidney with the tissues around it including the adrenal gland and some lymph nodes in the area. The adrenal gland is attached to the kidney. Most children living with just one healthy kidney have few problems later on. The remaining kidney takes over the work of the kidney that has been removed.

The surgeon makes a cut, usually down the front or side of the tummy (abdomen). They then remove the kidney.

Most children are in hospital for less than a week. A nephrectomy is a big operation and it can be painful. Your child’s team will give them regular painkillers to help. Other problems are not common but can include:

  • bleeding
  • infection
  • a blockage in the bowel

Wilms tumour in both kidneys (bilateral)

Treatment for bilateral Wilms tumours usually involves surgery to both kidneys. Your child’s surgeon aims to remove as much of the tumour as possible. And leave as much healthy kidney tissue as they can.

Radiotherapy

Your child’s doctor may recommend they have radiotherapy after surgery. This might be because:

  • of how the tumour looks under a microscope once it has been removed – this can give doctors an idea if the tumour is likely to come back
  • of how far the tumour has spread outside the kidney
  • the tumour has spread to distant organs, like the lungs, and this hasn’t gone away quickly with chemotherapy

Treatment by stage

We also have more detailed information about the stages of Wilms tumour and treatment by stage.

Follow up

Most children with Wilms tumour are cured and their cancer does not come back.

Your child has regular follow up appointments. This is generally every few months for the first 2 years. The follow up appointments then gradually get further apart. All children have at least 5 years follow up with their doctor. These appointments are to check:

  • how they are recovering
  • their development
  • if they are having any problems following treatment
  • if there are any signs of the Wilms tumour coming back

Children will also have regular tests such as x-rays and ultrasounds of the tummy during this time.

Long term side effects

Very few children have long term side effects from treatment, or from having one kidney. Some of the long term problems that can happen include:

  • changes to how the heart works due to having doxorubicin chemotherapy. Your child will have regular heart scans to check this.
  • your child’s kidney stops working properly. This may mean they need help to remove waste products from the blood (dialysis) or a new kidney (kidney transplant)
  • a very small risk of developing a second cancer later in life
  • a risk of being unable to have children when they are older if they have had a chemotherapy drug called cyclophosphamide
  • a risk of hearing problems due to the effects of having carboplatin chemotherapy

Long term follow up clinics are available for those who are 5 years or more when they finish treatment. Your child usually sees a specialist nurse. The specialist nurse can make referrals to other health professionals if needed.

Wilms tumour that has not gone away or has come back

Wilms tumour that does not go away is called refractory disease. Wilms tumour that comes back after treatment is called relapsed disease. It can be more difficult to control relapsed or refractory Wilms tumour but there are treatments available. 

Relapsed Wilms tumour are rare. If it does come back, it is most likely to happen in the first 2 years after treatment. Relapse is more common in children who:

  • had cancer cells in distant parts of the body when they were diagnosed
  • had cells that looked very abnormal under a microscope

Your child’s specialist team will explain the different options and support you through this difficult time. The different options will depend on a number of factors such as:

  • what treatment they have already had
  • where the cancer is
  • their general health
  • the stage and risk group of the cancer when they were first diagnosed

Research

Researchers are looking at improving the treatment for Wilms tumour, and to understand more about it. There is a large international study that’s collecting information from the time of diagnosis to how well the treatment has worked.

You can find out more about current research from your child’s healthcare team. 

Getting support and information

Parents have a lot to think about and are likely to be very worried about getting the best treatment for their child. Feeling frightened about your child having cancer is normal.

Talk to the doctors and nurses about any worries that you have. They want you to feel comfortable and confident with the treatment and care that your child is getting.

Cancer Research UK has an online forum called Cancer Chat. You may find it helpful to join the forum to talk to other people whose children or relatives have cancer.

You can also contact the Cancer Research UK information nurses on freephone 0808 800 4040. The lines are open from 9am until 5pm, Monday to Friday.
Last reviewed: 
15 Jan 2021
Next review due: 
15 Jan 2024
  • Pharmacotherapeutic management of Wilms tumour: an update
    R M Oostveen and K Pritchard-Jones
    Pediatric Drugs, 2019. Volume 21 Pages 1 to 13

  • Wilms Tumour "state of the art" update 2016
    S Irtan, P F Ehrlich and K Pritchard-Jones
    Seminars in Pediatric surgery, 2016. Volume 25, Issue 5, Pages 250 to 256

  • Risk Stratification for Wilms Tumour: Current Approach and Future Directions
    J S Dome and others
    American Society of Clinical Oncology (ASCO) Educational book, 2014. Number 34, Pages 215 to 223

  • Relapse of Wilms' tumour and detection methods: a retrospective analysis of the 2001 Renal Tumour Study Group–International Society of Paediatric Oncology Wilms' tumour protocol database
    J Brok and others
    The Lancet Oncology, 2018. Volume 19, Issue 8, Pages 1072 to 1081

  • The UMBRELLA SIOP-RTSG 2016 Wilms tumour pathology and molecular biology protocol
    G M Vujanic and others
    Nature Reviews Urology, 2018. Volume 15, Issue 11, Pages 693 to 701

  • The information on this page is based on literature searches and specialist checking. We used many references and there are too many to list here. Please contact patientinformation@cancer.org.uk with details of the particular issue you are interested in if you need additional references for this information.