Treatment and diagnosis of Wilm's Tumoror

Wilm's tumor

1. RECENT ADVANCEMENTS (TREATMENT AND DIAGNOSIS) Roll no. SRHU20000362 – SRHU20000391 + Ex students

2. Evaluation of wilm’s tumor Investigations Abdominal ultrasound CT Scan Chest X-Ray Bone scan, skeletal survey Brain imaging (MRI, CT scan) FNAC Purpose Organ of origin, identify contralateral kidney, location of tumor thrombus in venacava . Localization of tumor and extent of spread. Pulmonary metastasis Bone metastasis(in clear cell sarcoma) Brain metastasis in a rhabdoid tumor and clear cell sarcoma Cytological confirmation of tumor prior to chemotherapy

3. Staging of wilm’s tumor (national wilm’s tumor study group( nwts )) Stage 1 Tumor confined to the kidney and completely resected. Renal capsule and sinus vessels not involved beyond 2mm. Regional lymph nodes dissected and negative. Stage 2 Tumor extends beyond the kidney but is completely resected with negative margins and lymph nodes. Atleast one of the following has occurred: Penetration of renal capsules. Invasion of renal sinus vessels. Stage 3 Residual tumor abdomen following surgery confined to abdomen. Lymph nodes (renal hilum, paraaortic chain, beyond) show tumor. Diffuse peritoneal contamination by tumor. Implants on peritoneal surface. Tumor extends beyond surgical margins(microscopy, gross examination) Tumor not completely resected because of infiltration of vital structures. Stage 4 Hematogenous metastasis, metastasis to distant lymph node. Stage 5 Bilateral renal involvement at the time of initial diagnosis

4. TREAtment of wilm’s tumor According to children’s oncology group (us): Recommends resection of the tumor. According to international society of pediatric oncology: Recommends preoperative chemotherapy without biopsy Advantages of chemotherapy: shrinks the tumor, decreasing the risk of spillage and rupture making surgery easier.

5. Treatment modalities as per nwts Stage Treatment Localized Stage 1, low grade None Stage 1, intermediate grade + anaplasia 18 weeks Dactinomycin/Vincristine Stage 2, no lymph node involvement 28 weeks Dactinomycin/Vincristine/Epirubicin Stage 2 + stage 3 28 weeks Dactinomycin/ vincristine/ epirubicin + radiotherapy of tumor bed. High grade 34 weeks Epirubicin/ Ifosfamide /Carboplatin + radiotherapy Metastatic Stage 4 Stage 5 As per local stage of tumor + treatment of metastasis. Nephron sparing surgery.

6. New regimens Discovery of effective chemotherapeutic agents and there incorporation into multimodality regimens has profoundly impacted the management of radiotherapy. Newer drugs : Topotecan, Irinotecan, Ixabepilone, Cixutumumab, Sorafenib, Aurora A kinase Inhibitor.

7. Thank you