Doctors plan your child’s treatment in one of the major 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:
Decisions about treatment
The specialist team plan treatment according to the type of Wilms’ tumour your child has. A pathologist (an expert who examines and identifies cells) 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)
- whether the cancer has spread to distant organs such as the lungs
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:
- actinomycin D
Your child might have another drug with vincristine and actinomycin D, for example, doxorubicin. This may be because the Wilms’ tumour has spread to distant organs. Or, the treatment is not working as well as doctors would have hoped.
They usually have 4 weeks of chemotherapy before surgery. And depending on the stage and risk group they might have between 4 and 34 weeks treatment after 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 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. Painkillers can help, your child’s team aim to keep them as pain free as possible. Other problems are not common but can include:
- a blockage in the bowel
Your child’s surgeon may remove the tumour using keyhole surgery. The surgeon makes a few small cuts in the skin over the kidney rather than one larger wound. They put a tube with a light and an eyepiece through one cut and instruments to remove the tumour through the other cuts.
Your child's surgeon will discuss with you which type of surgery is best for your child.
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.
Your child’s doctor may recommend they have radiotherapy after surgery. Around 2 out 10 children (around 20%) have radiotherapy as well as chemotherapy 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 Wilms’ tumour has spread to distant organs, like the lungs, and this hasn’t gone away with quickly with chemotherapy
Treatment by stage
We also have more detailed information about the stages of Wilms’ tumour and treatment by stage.
Most children with Wilms’ tumour are cured and their Wilms’ tumour does not come back.
Wilms’ tumour that comes back is called a relapse. This is 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
There are treatments available for children who have a Wilms tumour that has come back. Your child’s specialist team explain the different options and supports you through this difficult time.
Your child has regular follow up appointments. They continue for at least 5 years. 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
Long term side effects
Very few children have long term side effects from treatment, or from having one kidney.
Long term follow up clinics are available for those who are 5 years or more from the end of their cancer treatment. You child usually sees a specialist nurse. The specialist nurse can make referrals to other professionals when needed.
There is research taking place looking at different combinations of chemotherapy drugs for Wilms' tumour.
Because more children are getting better from their Wilms' tumour, doctors are also looking at the long term effects of chemotherapy and radiotherapy treatments.
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 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.