Andrew Davidoff

244 statements · 3 topics

Soft Tissue Sarcoma (lymph nodes) · guest expert Wilms Tumor · guest expert

Featured statements

▶ Ep 251 · 0:28

Approximately 75% of the cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age.

quote · Pediatric Oncology

▶ Ep 185 · 0:00

Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall.

quote · Pediatric Oncology

▶ Ep 7 · 14:10

the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis

quote · Wilms Tumor

▶ Ep 7 · 1:00

survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%

quote · Wilms Tumor

▶ Ep 4 · 1:20

children with Wilms' tumor typically present with an asymptomatic abdominal mass.

quote · Soft Tissue Sarcoma (lymph nodes)

▶ Ep 4 · 2:44

The most common site of metastatic spread of Wilms' tumor is the lungs

quote · Soft Tissue Sarcoma (lymph nodes)

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Andrew's statements about Pediatric Oncology 95 statements

Open the Pediatric Oncology collection →

Wilms Tumor

▶ Ep 185 · 0:00

quote Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall. ↗

▶ Ep 185 · 0:00

epidemiological Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall ↗

▶ Ep 185 · 0:30

epidemiological 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 ↗

▶ Ep 185 · 1:00

quote survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90% ↗

▶ Ep 185 · 1:00

epidemiological Survival for patients with Wilms tumor when considered as a whole is currently greater than 90% ↗

▶ Ep 185 · 1:20

epidemiological Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality ↗

▶ Ep 185 · 3:00

quote children with Wilms tumor typically present with an asymptomatic abdominal mass ↗

▶ Ep 185 · 3:00

clinical Children with Wilms tumor typically present with an asymptomatic abdominal mass ↗

▶ Ep 185 · 3:20

clinical 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 ↗

▶ Ep 185 · 4:10

guideline 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 ↗

▶ Ep 185 · 5:20

epidemiological Intravascular tumor extension occurs in about 6% of Wilms tumor cases ↗

▶ Ep 185 · 6:20

clinical The most common site of metastatic spread of Wilms tumor is the lungs ↗

▶ Ep 185 · 7:20

guideline Stage one Wilms tumors are localized tumors confined within the renal capsule ↗

▶ Ep 185 · 7:40

guideline Stage two Wilms tumors penetrate the renal capsule but are resected with negative margins ↗

▶ Ep 185 · 8:00

guideline 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 ↗

▶ Ep 185 · 8:50

epidemiological Metastatic disease occurs in about 12% of Wilms tumor patients and is considered stage four ↗

▶ Ep 185 · 9:20

guideline Patients with synchronous bilateral Wilms tumor are stage five ↗

▶ Ep 185 · 10:20

guideline For unilateral tumors, up-front resection with regional lymph node sampling is currently the recommendation from the Children's Oncology Group ↗

▶ Ep 185 · 11:20

clinical Most Wilms tumors are resectable at presentation because even large tumors rarely invade surrounding structures ↗

▶ Ep 185 · 11:30

quote most Wilms tumors are resectable at presentation ↗

▶ Ep 185 · 11:50

guideline Failure to perform up-front resection and instead administering neoadjuvant chemotherapy results in classification as stage three, mandating flank radiation and doxorubicin ↗

▶ Ep 185 · 12:40

guideline Treatment of favorable histology stage one or two Wilms tumor is limited to vincristine and actinomycin D ↗

▶ Ep 185 · 13:05

guideline 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 ↗

▶ Ep 185 · 14:10

quote the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis ↗

▶ Ep 185 · 14:10

clinical Lymph node involvement is associated with increased incidence of tumor relapse and poorer prognosis ↗

▶ Ep 185 · 14:35

guideline 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 ↗

▶ Ep 185 · 15:20

guideline 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 ↗

▶ Ep 185 · 16:20

epidemiological About 5% of children with Wilms tumor present with synchronous bilateral disease or stage five disease ↗

▶ Ep 185 · 16:40

guideline Patients with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs to shrink tumors and facilitate preservation of normal renal parenchyma ↗

▶ Ep 185 · 17:40

guideline A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis ↗

▶ Ep 185 · 18:15

clinical Biopsies of bilateral renal masses rarely detect anaplasia even when it exists in the tumor mass ↗

▶ Ep 185 · 18:35

guideline A biopsy if performed in bilateral disease doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor ↗

▶ Ep 185 · 19:00

guideline Bilateral nephron sparing surgery should be considered in all patients with bilateral Wilms tumor after either six or 12 weeks of neoadjuvant chemotherapy ↗

▶ Ep 185 · 19:30

guideline Longer courses of pre-operative chemotherapy than 12 weeks are definitely discouraged in bilateral Wilms tumor ↗

▶ Ep 185 · 20:30

clinical Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor ↗

▶ Ep 185 · 21:20

clinical Primary resection of tumors with extension above the level of the hepatic veins or into the atrium is associated with higher operative morbidity ↗

▶ Ep 185 · 21:50

guideline Neoadjuvant chemotherapy is generally used for intravascular tumor extension above the hepatic veins or into the atrium ↗

▶ Ep 185 · 22:10

guideline Thrombus extending above the hepatic veins that persists after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove ↗

▶ Ep 185 · 23:00

epidemiological About 12% of Wilms tumor patients have evidence of hematogenous metastasis at diagnosis with 80% being pulmonary metastasis ↗

▶ Ep 185 · 23:40

guideline 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 ↗

▶ Ep 185 · 24:30

guideline Slow or incomplete responders to initial therapy are switched to more intensive chemotherapy and receive whole lung radiation ↗

Topics in 10: Wilms Tumor

▶ Ep 251 · 0:28

quote The latter group comprises, thankfully, only about 10% of cases, but does contribute to over 50% of Wilms' tumor mortality. ↗

▶ Ep 251 · 0:28

quote Thankfully, survival for patients with Wilms' tumor, when considered as a whole, is currently greater than 90%. ↗

▶ Ep 251 · 0:28

quote Approximately 75% of the cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age. ↗

▶ Ep 251 · 0:28

epidemiological Approximately 75% of Wilms tumor cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age. ↗

▶ Ep 251 · 0:28

epidemiological Survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%. ↗

▶ Ep 251 · 0:28

epidemiological Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality. ↗

▶ Ep 251 · 0:28

clinical Histology is a critical prognostic factor that profoundly impacts outcome in Wilms tumor, divided into favorable and unfavorable (anaplastic) histology. ↗

▶ Ep 251 · 1:20

clinical 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. ↗

▶ Ep 251 · 1:20

clinical Children with Wilms tumor typically present with an asymptomatic abdominal mass. ↗

▶ Ep 251 · 1:20

quote children with Wilms' tumor typically present with an asymptomatic abdominal mass. ↗

▶ Ep 251 · 1:46

guideline Intravascular tumor extension should be specifically investigated in preoperative evaluation as it may alter the timing and conduct of surgery. ↗

▶ Ep 251 · 1:46

guideline If intracardiac extension of tumor thrombus is suspected, this can be assessed by echocardiography. ↗

▶ Ep 251 · 1:46

epidemiological Intravascular tumor extension occurs in about 6% of Wilms tumor cases. ↗

▶ Ep 251 · 1:46

clinical CT will confirm the presence of a solid renal mass and afford the opportunity to visualize the contralateral kidney to confirm its presence and function and to exclude synchronous bilateral disease. ↗

▶ Ep 251 · 1:46

guideline 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. ↗

▶ Ep 251 · 1:46

guideline The workup of a child with an intra-abdominal mass suspected of being Wilms tumor usually begins with ultrasound. ↗

▶ Ep 251 · 2:44

clinical The most common site of metastatic spread of Wilms tumor is the lungs. ↗

▶ Ep 251 · 2:44

quote The most common site of metastatic spread of Wilms' tumor is the lungs ↗

▶ Ep 251 · 2:44

guideline A chest CT should be included in the initial evaluation of a child suspected of having Wilms tumor. ↗

▶ Ep 251 · 2:59

guideline Circumstances that make Wilms tumor stage 3 include biopsy or rupture (preoperative or intraoperative), positive resection margin or gross residual disease, lymph node involvement, or the administration of preoperative chemotherapy. ↗

▶ Ep 251 · 2:59

guideline Metastatic disease, which occurs in about 12% of Wilms tumor patients, is considered stage 4. ↗

▶ Ep 251 · 2:59

guideline For stage 4 disease, the local stage should also be evaluated as this will determine whether abdominal radiation is indicated and to what field. ↗

▶ Ep 251 · 2:59

guideline Patients with synchronous bilateral Wilms tumor are stage 5, but local stage for each side should still be evaluated. ↗

▶ Ep 251 · 2:59

guideline The Children's Oncology Group uses a surgical pathologic staging system in which localized Wilms tumors confined within the renal capsule are stage 1. ↗

▶ Ep 251 · 2:59

guideline Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2. ↗

▶ Ep 251 · 4:06

clinical Careful lymph node sampling is a critical part of any operation for Wilms tumor because the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis. ↗

▶ Ep 251 · 4:06

guideline For unilateral tumors, upfront resection with regional lymph node sampling (generally radical nephrectomy) is currently the recommendation from the Children's Oncology Group. ↗

▶ Ep 251 · 4:06

clinical Although Wilms tumors can grow to a large size, even large tumors rarely invade surrounding structures, so most Wilms tumors are resectable at presentation. ↗

▶ Ep 251 · 4:06

guideline Failure to perform upfront resection but instead administering neoadjuvant chemotherapy in the COG results in classification of a tumor as stage 3, thus mandating the use of flank irradiation and doxorubicin, each associated with significant long-term toxicities. ↗

▶ Ep 251 · 4:06

guideline Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D. ↗

▶ Ep 251 · 4:06

guideline In rare circumstances when the tumor is stage 1, weighs less than 550 grams (tumor weight plus kidney), and the patient is less than 2 years of age, no adjuvant chemotherapy is given. ↗

▶ Ep 251 · 4:06

guideline Raising the age and weight limits for observation without adjuvant chemotherapy are currently being considered for study by COG. ↗

▶ Ep 251 · 4:06

guideline Lymph node sampling should be performed even in the absence of abnormal nodes on preoperative imaging or on gross inspection during operative exploration, since these circumstances don't reliably predict lymph node negativity. ↗

▶ Ep 251 · 4:06

guideline Partial nephrectomy for patients with unilateral, non-syndromic disease and laparoscopic nephrectomy are not currently standard of care and should generally only be performed in the context of a clinical trial. ↗

▶ Ep 251 · 4:06

clinical Anaplastic histology is associated with a significantly worse outcome and is treated with more intensive chemotherapy. ↗

▶ Ep 251 · 4:06

guideline A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy. ↗

▶ Ep 251 · 6:53

guideline A biopsy, if performed in bilateral disease, doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor. ↗

▶ Ep 251 · 6:53

guideline Patients with Wilms tumor arising in a solitary kidney or those with unilateral Wilms tumor at increased risk for developing metachronous tumor are also treated with neoadjuvant chemotherapy, though these patients usually don't receive doxorubicin. ↗

▶ Ep 251 · 6:53

guideline Children with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs (as used for stage 3 or 4 favorable histology) to shrink tumors prior to surgery and facilitate preservation of normal renal parenchyma, due to increased risk of renal failure. ↗

▶ Ep 251 · 6:53

epidemiological About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease. ↗

▶ Ep 251 · 6:53

clinical Studies have shown that biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass. ↗

▶ Ep 251 · 6:53

guideline A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis. ↗

▶ Ep 251 · 6:53

guideline Longer courses of preoperative chemotherapy (beyond 12 weeks) are definitely discouraged in bilateral Wilms tumor. ↗

▶ Ep 251 · 6:53

guideline Bilateral nephron-sparing surgery should be considered in all patients with bilateral Wilms tumor and should be performed after either 6 or 12 weeks of neoadjuvant chemotherapy. ↗

▶ Ep 251 · 8:42

clinical Thrombus that extends above the hepatic veins and persists to this extent after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove the full extent of disease. ↗

▶ Ep 251 · 8:42

clinical Proximal control can generally be achieved if the superior extent of the thrombus is below the level of the hepatic veins. ↗

▶ Ep 251 · 8:42

clinical Thrombus that extends further into the vena cava can be withdrawn from the IVC after gaining proximal and distal control. ↗

▶ Ep 251 · 8:42

clinical Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor. ↗

▶ Ep 251 · 8:42

guideline It should be determined by preoperative imaging whether there is intravascular tumor extension, then its presence or absence confirmed intraoperatively. ↗

▶ Ep 251 · 8:42

guideline Primary resection of tumors with extension above the level of the hepatic veins or especially into the atrium is associated with higher operative morbidity, so neoadjuvant chemotherapy is generally used in these circumstances. ↗

▶ Ep 251 · 9:58

guideline A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group. ↗

▶ Ep 251 · 9:58

epidemiological About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases. ↗

▶ Ep 251 · 9:58

guideline Stage 4 patients treated with three-drug chemotherapy who have radiographic disappearance of their lung metastases or tissue confirmation that residual nodules don't contain viable tumor at week 6 imaging re-evaluation will be considered rapid responders, will continue on three-drug chemotherapy, but won't receive pulmonary irradiation. ↗

▶ Ep 251 · 10:47

guideline Patients who don't have complete resolution of pulmonary nodules at 6 weeks will be considered slow or incomplete responders, will be switched to more intensive chemotherapy regimen, and will receive whole lung irradiation. ↗

Andrew's statements about Soft Tissue Sarcoma (lymph nodes) 54 statements

Open the Soft Tissue Sarcoma (lymph nodes) collection →

Topics in 10: Wilms Tumor

▶ Ep 4 · 0:28

quote Approximately 75% of the cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age. ↗

▶ Ep 4 · 0:28

quote Thankfully, survival for patients with Wilms' tumor, when considered as a whole, is currently greater than 90%. ↗

▶ Ep 4 · 0:28

quote The latter group comprises, thankfully, only about 10% of cases, but does contribute to over 50% of Wilms' tumor mortality. ↗

▶ Ep 4 · 0:28

epidemiological Survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%. ↗

▶ Ep 4 · 0:28

epidemiological Approximately 75% of Wilms tumor cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age. ↗

▶ Ep 4 · 0:28

clinical Histology is a critical prognostic factor that profoundly impacts outcome in Wilms tumor, divided into favorable and unfavorable (anaplastic) histology. ↗

▶ Ep 4 · 0:28

epidemiological Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality. ↗

▶ Ep 4 · 1:20

clinical 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. ↗

▶ Ep 4 · 1:20

quote children with Wilms' tumor typically present with an asymptomatic abdominal mass. ↗

▶ Ep 4 · 1:20

clinical Children with Wilms tumor typically present with an asymptomatic abdominal mass. ↗

▶ Ep 4 · 1:46

guideline Intravascular tumor extension should be specifically investigated in preoperative evaluation as it may alter the timing and conduct of surgery. ↗

▶ Ep 4 · 1:46

guideline If intracardiac extension of tumor thrombus is suspected, this can be assessed by echocardiography. ↗

▶ Ep 4 · 1:46

guideline The workup of a child with an intra-abdominal mass suspected of being Wilms tumor usually begins with ultrasound. ↗

▶ Ep 4 · 1:46

epidemiological Intravascular tumor extension occurs in about 6% of Wilms tumor cases. ↗

▶ Ep 4 · 1:46

guideline 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. ↗

▶ Ep 4 · 2:44

clinical The most common site of metastatic spread of Wilms tumor is the lungs. ↗

▶ Ep 4 · 2:44

quote The most common site of metastatic spread of Wilms' tumor is the lungs ↗

▶ Ep 4 · 2:44

guideline A chest CT should be included in the initial evaluation of a child suspected of having Wilms tumor. ↗

▶ Ep 4 · 2:59

guideline The Children's Oncology Group uses a surgical pathologic staging system in which localized Wilms tumors confined within the renal capsule are stage 1. ↗

▶ Ep 4 · 2:59

guideline Patients with synchronous bilateral Wilms tumor are stage 5, but local stage for each side should still be evaluated. ↗

▶ Ep 4 · 2:59

guideline For stage 4 disease, the local stage should also be evaluated as this will determine whether abdominal radiation is indicated and to what field. ↗

▶ Ep 4 · 2:59

guideline Metastatic disease, which occurs in about 12% of Wilms tumor patients, is considered stage 4. ↗

▶ Ep 4 · 2:59

guideline Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2. ↗

▶ Ep 4 · 4:06

guideline Raising the age and weight limits for observation without adjuvant chemotherapy are currently being considered for study by COG. ↗

▶ Ep 4 · 4:06

guideline Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D. ↗

▶ Ep 4 · 4:06

clinical Although Wilms tumors can grow to a large size, even large tumors rarely invade surrounding structures, so most Wilms tumors are resectable at presentation. ↗

▶ Ep 4 · 4:06

guideline For unilateral tumors, upfront resection with regional lymph node sampling (generally radical nephrectomy) is currently the recommendation from the Children's Oncology Group. ↗

▶ Ep 4 · 4:06

guideline A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy. ↗

▶ Ep 4 · 4:06

clinical Anaplastic histology is associated with a significantly worse outcome and is treated with more intensive chemotherapy. ↗

▶ Ep 4 · 4:06

guideline In rare circumstances when the tumor is stage 1, weighs less than 550 grams (tumor weight plus kidney), and the patient is less than 2 years of age, no adjuvant chemotherapy is given. ↗

▶ Ep 4 · 6:53

epidemiological About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease. ↗

▶ Ep 4 · 6:53

guideline A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis. ↗

▶ Ep 4 · 6:53

clinical Studies have shown that biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass. ↗

▶ Ep 4 · 6:53

guideline A biopsy, if performed in bilateral disease, doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor. ↗

▶ Ep 4 · 6:53

guideline Bilateral nephron-sparing surgery should be considered in all patients with bilateral Wilms tumor and should be performed after either 6 or 12 weeks of neoadjuvant chemotherapy. ↗

▶ Ep 4 · 6:53

guideline Longer courses of preoperative chemotherapy (beyond 12 weeks) are definitely discouraged in bilateral Wilms tumor. ↗

▶ Ep 4 · 8:42

clinical Thrombus that extends further into the vena cava can be withdrawn from the IVC after gaining proximal and distal control. ↗

▶ Ep 4 · 8:42

clinical Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor. ↗

▶ Ep 4 · 8:42

guideline It should be determined by preoperative imaging whether there is intravascular tumor extension, then its presence or absence confirmed intraoperatively. ↗

▶ Ep 4 · 8:42

clinical Proximal control can generally be achieved if the superior extent of the thrombus is below the level of the hepatic veins. ↗

▶ Ep 4 · 9:58

epidemiological About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases. ↗

▶ Ep 4 · 9:58

guideline A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group. ↗

▶ Ep 4 · 10:47

Andrew's statements about Wilms Tumor 95 statements

Open the Wilms Tumor collection →

Wilms Tumor

▶ Ep 7 · 0:00

quote Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall. ↗

▶ Ep 7 · 0:00

epidemiological Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall ↗

▶ Ep 7 · 0:30

epidemiological 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 ↗

▶ Ep 7 · 1:00

epidemiological Survival for patients with Wilms tumor when considered as a whole is currently greater than 90% ↗

▶ Ep 7 · 1:00

quote survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90% ↗

▶ Ep 7 · 1:20

epidemiological Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality ↗

▶ Ep 7 · 3:00

clinical Children with Wilms tumor typically present with an asymptomatic abdominal mass ↗

▶ Ep 7 · 3:00

quote children with Wilms tumor typically present with an asymptomatic abdominal mass ↗

▶ Ep 7 · 3:20

clinical 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 ↗

▶ Ep 7 · 4:10

guideline 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 ↗

▶ Ep 7 · 5:20

epidemiological Intravascular tumor extension occurs in about 6% of Wilms tumor cases ↗

▶ Ep 7 · 6:20

clinical The most common site of metastatic spread of Wilms tumor is the lungs ↗

▶ Ep 7 · 7:20

guideline Stage one Wilms tumors are localized tumors confined within the renal capsule ↗

▶ Ep 7 · 7:40

guideline Stage two Wilms tumors penetrate the renal capsule but are resected with negative margins ↗

▶ Ep 7 · 8:00

▶ Ep 7 · 8:50

epidemiological Metastatic disease occurs in about 12% of Wilms tumor patients and is considered stage four ↗

▶ Ep 7 · 9:20

guideline Patients with synchronous bilateral Wilms tumor are stage five ↗

▶ Ep 7 · 10:20

guideline For unilateral tumors, up-front resection with regional lymph node sampling is currently the recommendation from the Children's Oncology Group ↗

▶ Ep 7 · 11:20

clinical Most Wilms tumors are resectable at presentation because even large tumors rarely invade surrounding structures ↗

▶ Ep 7 · 11:30

quote most Wilms tumors are resectable at presentation ↗

▶ Ep 7 · 11:50

guideline Failure to perform up-front resection and instead administering neoadjuvant chemotherapy results in classification as stage three, mandating flank radiation and doxorubicin ↗

▶ Ep 7 · 12:40

guideline Treatment of favorable histology stage one or two Wilms tumor is limited to vincristine and actinomycin D ↗

▶ Ep 7 · 13:05

guideline 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 ↗

▶ Ep 7 · 14:10

clinical Lymph node involvement is associated with increased incidence of tumor relapse and poorer prognosis ↗

▶ Ep 7 · 14:10

quote the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis ↗

▶ Ep 7 · 14:35

▶ Ep 7 · 15:20

▶ Ep 7 · 16:20

epidemiological About 5% of children with Wilms tumor present with synchronous bilateral disease or stage five disease ↗

▶ Ep 7 · 16:40

guideline Patients with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs to shrink tumors and facilitate preservation of normal renal parenchyma ↗

▶ Ep 7 · 17:40

guideline A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis ↗

▶ Ep 7 · 18:15

clinical Biopsies of bilateral renal masses rarely detect anaplasia even when it exists in the tumor mass ↗

▶ Ep 7 · 18:35

guideline A biopsy if performed in bilateral disease doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor ↗

▶ Ep 7 · 19:00

guideline Bilateral nephron sparing surgery should be considered in all patients with bilateral Wilms tumor after either six or 12 weeks of neoadjuvant chemotherapy ↗

▶ Ep 7 · 19:30

guideline Longer courses of pre-operative chemotherapy than 12 weeks are definitely discouraged in bilateral Wilms tumor ↗

▶ Ep 7 · 20:30

clinical Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor ↗

▶ Ep 7 · 21:20

clinical Primary resection of tumors with extension above the level of the hepatic veins or into the atrium is associated with higher operative morbidity ↗

▶ Ep 7 · 21:50

guideline Neoadjuvant chemotherapy is generally used for intravascular tumor extension above the hepatic veins or into the atrium ↗

▶ Ep 7 · 22:10

guideline Thrombus extending above the hepatic veins that persists after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove ↗

▶ Ep 7 · 23:00

epidemiological About 12% of Wilms tumor patients have evidence of hematogenous metastasis at diagnosis with 80% being pulmonary metastasis ↗

▶ Ep 7 · 23:40

▶ Ep 7 · 24:30

guideline Slow or incomplete responders to initial therapy are switched to more intensive chemotherapy and receive whole lung radiation ↗

Topics in 10: Wilms Tumor

▶ Ep 8 · 0:28

epidemiological Survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%. ↗

▶ Ep 8 · 0:28

quote Approximately 75% of the cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age. ↗

▶ Ep 8 · 0:28

quote Thankfully, survival for patients with Wilms' tumor, when considered as a whole, is currently greater than 90%. ↗

▶ Ep 8 · 0:28

epidemiological Approximately 75% of Wilms tumor cases occur in children younger than 5 years of age, with a peak incidence at 2 to 3 years of age. ↗

▶ Ep 8 · 0:28

epidemiological Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality. ↗

▶ Ep 8 · 0:28

quote The latter group comprises, thankfully, only about 10% of cases, but does contribute to over 50% of Wilms' tumor mortality. ↗

▶ Ep 8 · 0:28

clinical Histology is a critical prognostic factor that profoundly impacts outcome in Wilms tumor, divided into favorable and unfavorable (anaplastic) histology. ↗

▶ Ep 8 · 1:20

quote children with Wilms' tumor typically present with an asymptomatic abdominal mass. ↗

▶ Ep 8 · 1:20

clinical 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. ↗

▶ Ep 8 · 1:20

clinical Children with Wilms tumor typically present with an asymptomatic abdominal mass. ↗

▶ Ep 8 · 1:46

epidemiological Intravascular tumor extension occurs in about 6% of Wilms tumor cases. ↗

▶ Ep 8 · 1:46

guideline If intracardiac extension of tumor thrombus is suspected, this can be assessed by echocardiography. ↗

▶ Ep 8 · 1:46

guideline Intravascular tumor extension should be specifically investigated in preoperative evaluation as it may alter the timing and conduct of surgery. ↗

▶ Ep 8 · 1:46

guideline 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. ↗

▶ Ep 8 · 1:46

guideline The workup of a child with an intra-abdominal mass suspected of being Wilms tumor usually begins with ultrasound. ↗

▶ Ep 8 · 2:44

quote The most common site of metastatic spread of Wilms' tumor is the lungs ↗

▶ Ep 8 · 2:44

guideline A chest CT should be included in the initial evaluation of a child suspected of having Wilms tumor. ↗

▶ Ep 8 · 2:44

clinical The most common site of metastatic spread of Wilms tumor is the lungs. ↗

▶ Ep 8 · 2:59

guideline Patients with synchronous bilateral Wilms tumor are stage 5, but local stage for each side should still be evaluated. ↗

▶ Ep 8 · 2:59

guideline For stage 4 disease, the local stage should also be evaluated as this will determine whether abdominal radiation is indicated and to what field. ↗

▶ Ep 8 · 2:59

guideline Metastatic disease, which occurs in about 12% of Wilms tumor patients, is considered stage 4. ↗

▶ Ep 8 · 2:59

guideline Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2. ↗

▶ Ep 8 · 2:59

guideline The Children's Oncology Group uses a surgical pathologic staging system in which localized Wilms tumors confined within the renal capsule are stage 1. ↗

▶ Ep 8 · 4:06

guideline A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy. ↗

▶ Ep 8 · 4:06

clinical Anaplastic histology is associated with a significantly worse outcome and is treated with more intensive chemotherapy. ↗

▶ Ep 8 · 4:06

guideline Raising the age and weight limits for observation without adjuvant chemotherapy are currently being considered for study by COG. ↗

▶ Ep 8 · 4:06

guideline In rare circumstances when the tumor is stage 1, weighs less than 550 grams (tumor weight plus kidney), and the patient is less than 2 years of age, no adjuvant chemotherapy is given. ↗

▶ Ep 8 · 4:06

guideline Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D. ↗

▶ Ep 8 · 4:06

clinical Although Wilms tumors can grow to a large size, even large tumors rarely invade surrounding structures, so most Wilms tumors are resectable at presentation. ↗

▶ Ep 8 · 4:06

guideline For unilateral tumors, upfront resection with regional lymph node sampling (generally radical nephrectomy) is currently the recommendation from the Children's Oncology Group. ↗

▶ Ep 8 · 6:53

guideline Bilateral nephron-sparing surgery should be considered in all patients with bilateral Wilms tumor and should be performed after either 6 or 12 weeks of neoadjuvant chemotherapy. ↗

▶ Ep 8 · 6:53

clinical Studies have shown that biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass. ↗

▶ Ep 8 · 6:53

guideline A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis. ↗

▶ Ep 8 · 6:53

epidemiological About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease. ↗

▶ Ep 8 · 6:53

guideline Longer courses of preoperative chemotherapy (beyond 12 weeks) are definitely discouraged in bilateral Wilms tumor. ↗

▶ Ep 8 · 6:53

guideline A biopsy, if performed in bilateral disease, doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor. ↗

▶ Ep 8 · 8:42

clinical Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor. ↗

▶ Ep 8 · 8:42

clinical Proximal control can generally be achieved if the superior extent of the thrombus is below the level of the hepatic veins. ↗

▶ Ep 8 · 8:42

clinical Thrombus that extends further into the vena cava can be withdrawn from the IVC after gaining proximal and distal control. ↗

▶ Ep 8 · 8:42

guideline It should be determined by preoperative imaging whether there is intravascular tumor extension, then its presence or absence confirmed intraoperatively. ↗

▶ Ep 8 · 8:42

▶ Ep 8 · 9:58

guideline A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group. ↗

▶ Ep 8 · 9:58

epidemiological About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases. ↗

▶ Ep 8 · 9:58

▶ Ep 8 · 10:47