Dr. Andrew Davidoff, chairman of surgery at St. Jude Children's, joins Dr. Rae Hanke to review the essentials of Wilms tumor in this videocast.
Type: video · posted 2020-05-02 Canonical: https://library.globalcastmd.com/watch/wilms-tumor-2533 ## Chapters - [0:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=0) Introduction and Epidemiology - [3:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=180) Clinical Presentation and Diagnostic Workup - [7:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=420) Staging System - [10:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=600) Management of Unilateral Wilms Tumor - [15:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=900) Management of Bilateral Wilms Tumor - [18:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1080) Intravascular Extension Management - [21:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1260) Metastatic Disease Management - [23:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1380) Key Takeaways and Conclusion ## Statements - "Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall" — Andrew Davidoff (epidemiological) [0:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=0) - "Approximately 75% of Wilms tumor cases occur in children younger than five years of age with a peak incidence at two to three years of age" — Andrew Davidoff (epidemiological) [0:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=30) - "Survival for patients with Wilms tumor when considered as a whole is currently greater than 90%" — Andrew Davidoff (epidemiological) [1:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=60) - "Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality" — Andrew Davidoff (epidemiological) [1:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=80) - "Children with Wilms tumor typically present with an asymptomatic abdominal mass" — Andrew Davidoff (clinical) [3:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=180) - "Associated signs and symptoms such as malaise, pain, microscopic or gross hematuria are found in only about 25% of children with Wilms tumor, as is hypertension" — Andrew Davidoff (clinical) [3:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=200) - "CT of the abdomen and pelvis is generally the definitive imaging study of choice for patients suspected of having a renal tumor based on ultrasound" — Andrew Davidoff (guideline) [4:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=250) - "Intravascular tumor extension occurs in about 6% of Wilms tumor cases" — Andrew Davidoff (epidemiological) [5:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=320) - "The most common site of metastatic spread of Wilms tumor is the lungs" — Andrew Davidoff (clinical) [6:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=380) - "Stage one Wilms tumors are localized tumors confined within the renal capsule" — Andrew Davidoff (guideline) [7:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=440) - "Stage two Wilms tumors penetrate the renal capsule but are resected with negative margins" — Andrew Davidoff (guideline) [7:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=460) - "Stage three criteria include biopsy or rupture (pre-operative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or administration of preoperative chemotherapy" — Andrew Davidoff (guideline) [8:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=480) - "Metastatic disease occurs in about 12% of Wilms tumor patients and is considered stage four" — Andrew Davidoff (epidemiological) [8:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=530) - "Patients with synchronous bilateral Wilms tumor are stage five" — Andrew Davidoff (guideline) [9:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=560) - "For unilateral tumors, up-front resection with regional lymph node sampling is currently the recommendation from the Children's Oncology Group" — Andrew Davidoff (guideline) [10:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=620) - "Most Wilms tumors are resectable at presentation because even large tumors rarely invade surrounding structures" — Andrew Davidoff (clinical) [11:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=680) - "Failure to perform up-front resection and instead administering neoadjuvant chemotherapy results in classification as stage three, mandating flank radiation and doxorubicin" — Andrew Davidoff (guideline) [11:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=710) - "Treatment of favorable histology stage one or two Wilms tumor is limited to vincristine and actinomycin D" — Andrew Davidoff (guideline) [12:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=760) - "For stage one tumors weighing less than 550 grams (tumor plus kidney) in patients less than 2 years of age, no adjuvant chemotherapy is given" — Andrew Davidoff (guideline) [13:05](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=785) - "Lymph node involvement is associated with increased incidence of tumor relapse and poorer prognosis" — Andrew Davidoff (clinical) [14:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=850) - "Lymph node sampling should be performed even in the absence of abnormal nodes on pre-operative imaging or gross inspection because these circumstances don't reliably predict lymph node negativity" — Andrew Davidoff (guideline) [14:35](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=875) - "Partial nephrectomy for patients with unilateral non-syndromic disease or laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial" — Andrew Davidoff (guideline) [15:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=920) - "About 5% of children with Wilms tumor present with synchronous bilateral disease or stage five disease" — Andrew Davidoff (epidemiological) [16:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=980) - "Patients with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs to shrink tumors and facilitate preservation of normal renal parenchyma" — Andrew Davidoff (guideline) [16:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1000) - "A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis" — Andrew Davidoff (guideline) [17:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1060) - "Biopsies of bilateral renal masses rarely detect anaplasia even when it exists in the tumor mass" — Andrew Davidoff (clinical) [18:15](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1095) - "A biopsy if performed in bilateral disease doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor" — Andrew Davidoff (guideline) [18:35](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1115) - "Bilateral nephron sparing surgery should be considered in all patients with bilateral Wilms tumor after either six or 12 weeks of neoadjuvant chemotherapy" — Andrew Davidoff (guideline) [19:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1140) - "Longer courses of pre-operative chemotherapy than 12 weeks are definitely discouraged in bilateral Wilms tumor" — Andrew Davidoff (guideline) [19:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1170) - "Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor" — Andrew Davidoff (clinical) [20:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1230) - "Primary resection of tumors with extension above the level of the hepatic veins or into the atrium is associated with higher operative morbidity" — Andrew Davidoff (clinical) [21:20](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1280) - "Neoadjuvant chemotherapy is generally used for intravascular tumor extension above the hepatic veins or into the atrium" — Andrew Davidoff (guideline) [21:50](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1310) - "Thrombus extending above the hepatic veins that persists after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove" — Andrew Davidoff (guideline) [22:10](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1330) - "About 12% of Wilms tumor patients have evidence of hematogenous metastasis at diagnosis with 80% being pulmonary metastasis" — Andrew Davidoff (epidemiological) [23:00](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1380) - "Stage four patients with radiographic disappearance of lung metastasis or tissue confirmation of no viable tumor at week six are considered rapid responders and continue three drug chemotherapy" — Andrew Davidoff (guideline) [23:40](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1420) - "Slow or incomplete responders to initial therapy are switched to more intensive chemotherapy and receive whole lung radiation" — Andrew Davidoff (guideline) [24:30](https://library.globalcastmd.com/watch/wilms-tumor-2533?t=1470) --- Not medical advice · citation policy: https://library.globalcastmd.com/ai