A 3-year-old girl is found to have a smooth, firm left renal mass on routine examination. CT shows an intrarenal mass distorting the collecting system, with the inferior vena cava patent. Biopsy confirms favourable-histology Wilms tumour. Which statement about its management is correct?
- A Radical nephrectomy with lymph node sampling, followed by chemotherapy according to stage ✓
- B The mass should be repeatedly palpated to monitor growth before surgery
- C Preoperative chemotherapy is mandatory in all cases before any surgery
- D Radiotherapy is the sole initial treatment for all stages
Correct answer: A. Radical nephrectomy with lymph node sampling, followed by chemotherapy according to stage
Explanation
Wilms tumour is treated primarily by radical nephrectomy with regional lymph node sampling for accurate staging, followed by adjuvant chemotherapy tailored to stage; favourable histology stage I to II disease has excellent survival with this approach. Vigorous repeated palpation is avoided because of the risk of capsular rupture and tumour spillage, which upstages disease. Preoperative chemotherapy is used selectively, for bilateral tumours or unresectable masses, not routinely. Radiotherapy is reserved for higher-stage or unfavourable histology disease.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.