Prognostic implications of hepatic adhesion, invasion, and metastases at diagnosis of Wilms' tumor

Article Abstract:

Wilms' tumor is a tumor of embryonic kidney cells; this tumor is common among young people, but occurs in older patients as well. One of the factors that affects the likely outcome of Wilms' tumor is the appearance of tumor cells under the microscope, and pathologists have identified a type of tissue structure now called ''favorable histology''. However, even among patients with favorable histology Wilms' tumor, there are important variations in outcome. Although the most common site for metastatic spread of Wilms' tumor is the lungs, the liver is also likely to be involved. However, in contrast with metastatic spread to the lungs, there are three ways in which the liver can be involved in cases of Wilms' tumor. Like the lung, the liver can be the site of metastatic cancer, in which colonies of cancer cells have become established in that organ. Secondly, the growing kidney cancer may extend to the point that the liver is invaded from the outside. The third possibility for liver involvement is that the kidney tumor may extend to the liver and become adherent to the fibrous tissue surrounding the liver, but not (yet) invade it. In a review of 1,762 patients with favorable histology Wilms' tumor, 191 patients had liver involvement. A study was conducted to determine the influence metastatic spread might have on overall survival. The analysis showed that when patients with liver involvement were compared with other patients with Wilms' tumor of equivalent stage, the liver involvement did not influence the outcome of the cancer. For patients with Stages I and II with tumor adherent to the liver, the three-year survival rate was 91 percent. Among patients without liver involvement the three-year survival was 92 and 90 percent for Stages I and II, respectively. These findings indicate that the general prognosis is good for patients with favorable histology Wilms' tumor. It is recommended, therefore, that a conservative approach be taken regarding the use of radiation therapy in the treatment of children with this type of tumor. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Prognosis, Liver cancer, Kidney cancer, Tumors, Embryonal, Embryonal tumors

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Late effects of treatment for Wilms' tumor: a report from the National Wilms' Tumor Study Group

Article Abstract:

Wilms' tumors are kidney tumors that arise from the embryonic mesoderm. Although unusual in adults, Wilms' tumors are second only to neuroblastoma as a common tumor among children under 10 years. Part of the function of the National Wilms' Tumor Study Group is to monitor the results of treatment so that the adverse affects of anticancer therapy in children may be wisely balanced against the need to prevent recurrence. Within the framework of the National Wilms' Tumor Study, a study was conducted of the long-term effects of treatment for Wilms' tumor in children. A total of 787 children were eligible for the study, of which physical examination data was available for 680. All 680 children were followed for at least five years; the average follow-up was almost 11 years. Scoliosis, or a lateral deviation of the spine, was nearly seven times more common among the patients with early-stage Wilms's tumor who were treated with radiation. Although the anticancer drug vincristine is known to have neurotoxic properties, patients who were treated with this drug did not show any excess of neuropsychological events when compared with others within the patient group. Only five second cancers occurred among the 680 patients; all five occurred among patients who had received radiotherapy. Benign tumors were far more common, and occurred approximately four times more frequently in those who had received radiation than those who did not. The use of the drug doxorubicin has raised some concern, since this agent is known to have adverse effects on the heart. Among the patients in this study, a higher rate of cardiovascular problems was observed among those who had received doxorubicin, but the difference was not quite statistically significant. The authors emphasize that given the long time necessary for the effects of heart muscle damage to become apparent, it is important to continue to follow-up the patients in this study to evaluate the long-term effects of doxorubicin treatment. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Cancer in children, Childhood cancer, Chemotherapy

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