How is Wilms tumor staged?

Updated: Mar 04, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

Answer

Wilms tumors are usually staged by using the method suggested in the National Wilms Tumor Studies (NWTS), in which the tumors are classified for surgery into V stages, as described below. [23, 24, 25]

Stage I

The stage I tumor is confined to the kidney and is completely excised. The renal capsule is intact. No evidence of tumor at or beyond the resection margins is noted. The tumor is not ruptured, or it was sampled during biopsy (excluding fine-needle aspiration biopsy) before its surgical removal. The vessels of the renal sinus are free from disease.

Stage II

The stage II tumor extends beyond the kidney and is completely excised. The renal capsule or renal sinus may be invaded. The renal vascular pedicle may contain tumor. The tumor was previously sampled during biopsy (except for fine-needle aspiration biopsy), or the tumor spilled before or during surgery, but the spillage was confined to the renal fossa and does not involve the peritoneal surface. No evidence of tumor at or beyond the resection margins is noted.

Stage III

In stage III tumor, residual nonhematogenous tumor is present after surgery, and the tumor is confined to the abdomen. Any of the following situations may occur:

  • Lymph node findings in the abdomen or pelvis are positive.

  • The tumor penetrates the peritoneal surface, or implants are found on the peritoneal surface.

  • Tumor cells are found at the margin of surgical resection on microscopic examination.

  • Tumor spills beyond the flank before or during surgery.

Stage IV

In stage IV, there are hematogenous metastases—involving, for example, the lung, liver, bone, and brain—or lymph node metastases outside the abdominopelvic region.

Stage V

In stage V tumor, bilateral renal tumoral involvement is present.


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