Wednesday, April 2, 2014

73 - Wilms' Tumor Staging

*Usually any tumor is staged before surgery, but Wilms' tumor is staged after surgery.

*Based on the stage of the tumor after surgery, the decision whether to give adjuvant chemotherapy or not is usually taken. (This is the typical practice in North America).

*In europe, oncologists first take a biopsy before surgery and confirm the tumor. Then before attempting surgery they try to shrink the tumor (the tumors are usually very large at presentation) by giving chemotherapy to the patient.

*In both the cases the tumor is staged only after surgery.

*It has to be noted that because the European oncologists use chemotherapy and markedly shrink the tumor before surgery, the postoperative staging is more of Stage I and Stage II variety in this case. The prognosis is excellent in both approaches and the overall relapse free survival is also almost the same with both approaches.

*So simply put the Pathologist decides the stage rather than the radiologist or the surgeon.


- StageI : The tumor is confined to the kidney with capsular or vascular invasion.

- Stage II : The tumor has extended beyond the renal capsule, infiltration of vessels. The cases where biopsy has been performed before surgery are grade II, as well as those cases where the tumor has ruptured intraoperatively.

- Stage III : Positive Lymph nodes in the abdomen or pelvis, peritoneal invasion, or residual tumor at surgical margins.

- Stage IV : Metastatic disease outside the abdomen or pelvis.

- Stage V : Bilateral tumors at original diagnosis.

* Below is a beautiful video (Contrast Enhanced CT Scan) of Wilms' tumor in the right kidney of a 13 month old patient.
- Note the large size and poor heterogenous enhancement of the tumor in a Pediatric patient that is typical of Wilms' tumor.

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