Physiological Adaptation Q 57
A child is admitted to the hospital with a diagnosis of Wilms tumor, stage II. Which of the following statements most accurately describes this stage?
A. The tumor is less than 3 cm. in size and requires no chemotherapy.
B. The tumor did not extend beyond the kidney and was completely resected.
C. The tumor extended beyond the kidney but was completely resected.
D. The tumor has spread into the abdominal cavity and cannot be resected.
Correct Answer: C. The tumor extended beyond the kidney but was completely resected.
Stage II, the tumor extends beyond the kidney but is completely resected. Stage II would be a tumor that has grown outside the kidney to some degree, such as into surrounding fatty tissue. Usually, the tumor would be completely removable by surgery, and regional lymph nodes are negative. About 20% of all Wilms tumors are at this stage.
Option A: This is not included in the staging of Wilms tumor. Imaging is particularly important in surgical planning. Surgical risk factors include larger tumor size, contralateral tumor extension, and displacement of the great vessels which typically result in longer surgical times, increased blood loss, and higher complication rates.
Option B: This described stage I: the tumor is limited to the kidney and completely resected. Stage I indicates the tumor was completely contained within the kidney without any breaks or spillage outside the renal capsule and no vascular invasion. This stage accounts for 40% to 45% of all Wilms tumors.
Option D: This described stage IV, hematogenous metastasis has occurred with spread beyond the abdomen. Stage IV tumors are those that have spread through the vascular system to distant organs such as the lungs, liver, brain, or bones, or to distant lymph nodes. These account for about 10% of all Wilms tumors.