Wilms' tumor staging
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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
There are 5 stages of wilms' tumor based on both the results of the imaging studies and the surgical and pathologic findings at nephrectomy.
Staging
- Staging of wilms tumor is done based upon:
- Extent of tumor anatomically.
- It is not done on the basis of its genetics, histology or molecular markers.
- Extensive disease and worse prognosis is denoted by a higher stage.
- Patients suffering from a higher stage tumor get more aggressive treatment modalities.
- The staging systems that are currently used are:[1]
- National Wilms Tumor Study (NWTS) system.
- International Society of Pediatric Oncology (SIOP) system.
NWTS system
- This system is used throughout United States and Canada.
- It is based on the evaluations done during surgery before the administration of surgery.
- According to this system wilms tumor is divided into following stages.
- Stage 1
- Tumor is limited only to the kidney.
- When the tumor is resected the capsule is intact.
- Resected tumor shows no evidence of involvement of renal sinus vessel.
- Stage 2
- Tumor is extended beyond the kidney, but can be resected completely.
- Tumor margins go beyond the renal capsule.
- It extends into the renal capsule, soft tissues and blood vessels beyond the renal parenchyma.
- But all this is within the margins of the resected tumor.
- Stage 3
- Complete tumor cannot be resected.
- The remaining tumor is confined within the abdomen.
- After surgery, residual tumor remains, but is confined to the abdomen. This includes regional lymph node involvement, peritoneal surface involvement, incomplete resection of the tumor, tumor at or beyond the margin of the resection, tumor spillage, previous biopsy, or preoperative chemotherapy before removal of the tumor.
- Stage 1