Wilms' tumor natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]
Overview
The complications of wilms' tumor include metastasis, high blood pressure, and kidney damage. Prognosis is generally good. The 5-year survival rate for Wilms tumor in children is around 90%, whereas older patients suffer worse outcome. The overall 5-year survival rate is approximately 63% for patients aged 10 to 16 years. Also, according to the different stage, anaplastic tumors have the relatively poorer outcome.
Natural History, Complications, and Prognosis
Natural History
Complications
- Common complications of wilms tumor include:
- Hypertension
- Anemia
- Weight loss
- Renal failure
- Metastasis to:[1]
- Lungs
- Liver
- Bone
- Brain
Prognosis
- Depending on various factors at the time of diagnosis, the prognosis may vary.[2]
- However, the prognosis can be tumor recurrence or death.
- These factors are:
- Histology of tumor
- Stage of the tumor
- Genetic and molecular markers
- Age of the patient
Histology of tumor
- 2 research groups have classified wilms tumor based on histology. These are:
- National Wilms Tumor Study / Children's Oncology Group (NWTS/COG) .
- International Society of Pediatric Oncology (SIOP).
- Prognosis is dependant on presence or absence of anaplasia.
- If anaplasia is positive then it signifies a poor prognosis in children.[3][4]
Stage of the tumor
- Staging of wilms tumor is done on the basis of:[5]
- Genetics
- Histology
- Molecular markers
- Stage I (43% of patients)
- Outcome: 98% 4-year survival; 85% 4-year survival if anaplastic
- Stage II (23% of patients)
- Outcome: 96% 4-year survival; 70% 4-year survival if anaplastic
- Stage III (23% of patients)
- Outcome: 95% 4-year survival; 56% 4-year survival if anaplastic
- Stage IV (10% of patients)
- Outcome: 90% 4-year survival; 17% 4-year survival if anaplastic
Genetic and molecular markers
- Multiple genetic and molecular markers can predict prognosis.[6] [7]
- These markers are:
- Loss of heterozygosity (LOH) at chromosomes:
- 1p
- 11p15
- 16q
- Gain in :
- 1q
- Loss of heterozygosity (LOH) at chromosomes:
- These markers are associated with increased risk of relapse and mortality.
Age of the patient
- Patient with age lass than 2 years have a better prognosis.[8]
- As the patient gets old the treatment related complication rate also increases.[9]
References
- ↑ Termuhlen AM, Tersak JM, Liu Q, Yasui Y, Stovall M, Weathers R, Deutsch M, Sklar CA, Oeffinger KC, Armstrong G, Robison LL, Green DM (December 2011). "Twenty-five year follow-up of childhood Wilms tumor: a report from the Childhood Cancer Survivor Study". Pediatr Blood Cancer. 57 (7): 1210–6. doi:10.1002/pbc.23090. PMC 4634648. PMID 21384541.
- ↑ Dome JS, Graf N, Geller JI, Fernandez CV, Mullen EA, Spreafico F, Van den Heuvel-Eibrink M, Pritchard-Jones K (September 2015). "Advances in Wilms Tumor Treatment and Biology: Progress Through International Collaboration". J. Clin. Oncol. 33 (27): 2999–3007. doi:10.1200/JCO.2015.62.1888. PMC 4567702. PMID 26304882.
- ↑ Zuppan CW, Beckwith JB, Luckey DW (October 1988). "Anaplasia in unilateral Wilms' tumor: a report from the National Wilms' Tumor Study Pathology Center". Hum. Pathol. 19 (10): 1199–209. PMID 2844645.
- ↑ D'Angio GJ, Evans A, Breslow N, Beckwith B, Bishop H, Farewell V, Goodwin W, Leape L, Palmer N, Sinks L, Sutow W, Tefft M, Wolff J (May 1981). "The treatment of Wilms' tumor: results of the Second National Wilms' Tumor Study". Cancer. 47 (9): 2302–11. PMID 6164480.
- ↑ Metzger ML, Dome JS (2005). "Current therapy for Wilms' tumor". Oncologist. 10 (10): 815–26. doi:10.1634/theoncologist.10-10-815. PMID 16314292.
- ↑ Perlman EJ, Grundy PE, Anderson JR, Jennings LJ, Green DM, Dome JS, Shamberger RC, Ruteshouser EC, Huff V (February 2011). "WT1 mutation and 11P15 loss of heterozygosity predict relapse in very low-risk wilms tumors treated with surgery alone: a children's oncology group study". J. Clin. Oncol. 29 (6): 698–703. doi:10.1200/JCO.2010.31.5192. PMC 3056654. PMID 21189373.
- ↑ D'Angio GJ (September 2008). "Pre- or postoperative therapy for Wilms' tumor?". J. Clin. Oncol. 26 (25): 4055–7. doi:10.1200/JCO.2008.16.5316. PMID 18757319.
- ↑ Breslow NE, Palmer NF, Hill LR, Buring J, D'Angio GJ (April 1978). "Wilms' tumor: prognostic factors for patients without metastases at diagnosis: results of the National Wilms' Tumor Study". Cancer. 41 (4): 1577–89. PMID 205340.
- ↑ Reinhard H, Aliani S, Ruebe C, Stöckle M, Leuschner I, Graf N (November 2004). "Wilms' tumor in adults: results of the Society of Pediatric Oncology (SIOP) 93-01/Society for Pediatric Oncology and Hematology (GPOH) Study". J. Clin. Oncol. 22 (22): 4500–6. doi:10.1200/JCO.2004.12.099. PMID 15542800.