For operable Wilms' tumour, nephrectomy is the initial treatment. The other kidney should always be inspected. In bilateral disease, the most severely affected kidney is removed and a partial nephrectomy performed on the other. In such cases, bilateral nephrectomy is a last resort as haemodialysis then becomes necessary.
Post-operative chemotherapy is used in stage 1 or 2 disease with favourable histology.
Chemotherapy is the mainstay of treatment in advanced disease. Nephrectomy can be performed at a later date if the tumour regression is adequate.
Postoperative radiotherapy is used in advanced cases with unfavourable histology.
In some cases a dose of chemotherapy is given before surgery to prevent iatrogenic seeding.
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