Andrew Davidoff

149 statements · 2 topics

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

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Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall.
quote · Wilms Tumor
the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis
quote · Wilms Tumor
children with Wilms' tumor typically present with an asymptomatic abdominal mass.
quote · Soft Tissue Sarcoma (lymph nodes)
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 Soft Tissue Sarcoma (lymph nodes) 54 statements

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Topics in 10: Wilms Tumor

Statement Survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%. Open
Quotation Thankfully, survival for patients with Wilms' tumor, when considered as a whole, is currently greater than 90%. Open
Quotation The latter group comprises, thankfully, only about 10% of cases, but does contribute to over 50% of Wilms' tumor mortality. Open
Statement 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. Open
Statement Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality. Open
Statement Histology is a critical prognostic factor that profoundly impacts outcome in Wilms tumor, divided into favorable and unfavorable (anaplastic) histology. Open
Quotation 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. Open
Quotation children with Wilms' tumor typically present with an asymptomatic abdominal mass. Open
Statement 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. Open
Statement Children with Wilms tumor typically present with an asymptomatic abdominal mass. Open
Statement Intravascular tumor extension should be specifically investigated in preoperative evaluation as it may alter the timing and conduct of surgery. Open
Statement The workup of a child with an intra-abdominal mass suspected of being Wilms tumor usually begins with ultrasound. Open
Statement 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. Open
Statement 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. Open
Statement Intravascular tumor extension occurs in about 6% of Wilms tumor cases. Open
Statement If intracardiac extension of tumor thrombus is suspected, this can be assessed by echocardiography. Open
Quotation The most common site of metastatic spread of Wilms' tumor is the lungs Open
Statement The most common site of metastatic spread of Wilms tumor is the lungs. Open
Statement A chest CT should be included in the initial evaluation of a child suspected of having Wilms tumor. Open
Statement Metastatic disease, which occurs in about 12% of Wilms tumor patients, is considered stage 4. Open
Statement For stage 4 disease, the local stage should also be evaluated as this will determine whether abdominal radiation is indicated and to what field. Open
Statement Patients with synchronous bilateral Wilms tumor are stage 5, but local stage for each side should still be evaluated. Open
Statement 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. Open
Statement Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2. Open
Statement The Children's Oncology Group uses a surgical pathologic staging system in which localized Wilms tumors confined within the renal capsule are stage 1. Open
Statement Although Wilms tumors can grow to a large size, even large tumors rarely invade surrounding structures, so most Wilms tumors are resectable at presentation. Open
Statement A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy. Open
Statement Anaplastic histology is associated with a significantly worse outcome and is treated with more intensive chemotherapy. Open
Statement 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. Open
Statement 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. Open
Statement 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. Open
Statement Raising the age and weight limits for observation without adjuvant chemotherapy are currently being considered for study by COG. Open
Statement 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. Open
Statement Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D. Open
Statement 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. Open
Statement For unilateral tumors, upfront resection with regional lymph node sampling (generally radical nephrectomy) is currently the recommendation from the Children's Oncology Group. Open
Statement Longer courses of preoperative chemotherapy (beyond 12 weeks) are definitely discouraged in bilateral Wilms tumor. Open
Statement About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease. Open
Statement 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. Open
Statement 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. Open
Statement A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis. Open
Statement Studies have shown that biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass. Open
Statement A biopsy, if performed in bilateral disease, doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor. Open
Statement 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. Open
Statement It should be determined by preoperative imaging whether there is intravascular tumor extension, then its presence or absence confirmed intraoperatively. Open
Statement Thrombus that extends further into the vena cava can be withdrawn from the IVC after gaining proximal and distal control. Open
Statement Proximal control can generally be achieved if the superior extent of the thrombus is below the level of the hepatic veins. Open
Statement 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. Open
Statement 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. Open
Statement Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor. Open
Statement A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group. Open
Statement 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. Open
Statement About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases. Open
Statement 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. Open
Andrew's statements about Wilms Tumor 95 statements

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Wilms Tumor

Quotation Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall. Open
Statement Wilms tumor is the second most common intra abdominal tumor in children and fifth most common tumor in children overall Open
Statement 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 Open
Statement Survival for patients with Wilms tumor when considered as a whole is currently greater than 90% Open
Quotation survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90% Open
Statement Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality Open
Quotation children with Wilms tumor typically present with an asymptomatic abdominal mass Open
Statement Children with Wilms tumor typically present with an asymptomatic abdominal mass Open
Statement 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 Open
Statement 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 Open
Statement Intravascular tumor extension occurs in about 6% of Wilms tumor cases Open
Statement The most common site of metastatic spread of Wilms tumor is the lungs Open
Statement Stage one Wilms tumors are localized tumors confined within the renal capsule Open
Statement Stage two Wilms tumors penetrate the renal capsule but are resected with negative margins Open
Statement 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 Open
Statement Metastatic disease occurs in about 12% of Wilms tumor patients and is considered stage four Open
Statement Patients with synchronous bilateral Wilms tumor are stage five Open
Statement For unilateral tumors, up-front resection with regional lymph node sampling is currently the recommendation from the Children's Oncology Group Open
Statement Most Wilms tumors are resectable at presentation because even large tumors rarely invade surrounding structures Open
Quotation most Wilms tumors are resectable at presentation Open
Statement Failure to perform up-front resection and instead administering neoadjuvant chemotherapy results in classification as stage three, mandating flank radiation and doxorubicin Open
Statement Treatment of favorable histology stage one or two Wilms tumor is limited to vincristine and actinomycin D Open
Statement 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 Open
Statement Lymph node involvement is associated with increased incidence of tumor relapse and poorer prognosis Open
Quotation the presence of nodal involvement is associated with an increased incidence of tumor relapse and a poorer prognosis Open
Statement 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 Open
Statement 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 Open
Statement About 5% of children with Wilms tumor present with synchronous bilateral disease or stage five disease Open
Statement Patients with bilateral Wilms tumor receive neoadjuvant chemotherapy with three drugs to shrink tumors and facilitate preservation of normal renal parenchyma Open
Statement A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis Open
Statement Biopsies of bilateral renal masses rarely detect anaplasia even when it exists in the tumor mass Open
Statement A biopsy if performed in bilateral disease doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor Open
Statement Bilateral nephron sparing surgery should be considered in all patients with bilateral Wilms tumor after either six or 12 weeks of neoadjuvant chemotherapy Open
Statement Longer courses of pre-operative chemotherapy than 12 weeks are definitely discouraged in bilateral Wilms tumor Open
Statement Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor Open
Statement Primary resection of tumors with extension above the level of the hepatic veins or into the atrium is associated with higher operative morbidity Open
Statement Neoadjuvant chemotherapy is generally used for intravascular tumor extension above the hepatic veins or into the atrium Open
Statement Thrombus extending above the hepatic veins that persists after neoadjuvant chemotherapy probably requires cardiopulmonary bypass to safely remove Open
Statement About 12% of Wilms tumor patients have evidence of hematogenous metastasis at diagnosis with 80% being pulmonary metastasis Open
Statement 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 Open
Statement Slow or incomplete responders to initial therapy are switched to more intensive chemotherapy and receive whole lung radiation Open

Topics in 10: Wilms Tumor

Quotation 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. Open
Statement Survival for patients with Wilms tumor, when considered as a whole, is currently greater than 90%. Open
Statement Anaplastic histology comprises only about 10% of Wilms tumor cases but contributes to over 50% of Wilms tumor mortality. Open
Statement Histology is a critical prognostic factor that profoundly impacts outcome in Wilms tumor, divided into favorable and unfavorable (anaplastic) histology. Open
Statement 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. Open
Quotation The latter group comprises, thankfully, only about 10% of cases, but does contribute to over 50% of Wilms' tumor mortality. Open
Quotation Thankfully, survival for patients with Wilms' tumor, when considered as a whole, is currently greater than 90%. Open
Quotation children with Wilms' tumor typically present with an asymptomatic abdominal mass. Open
Statement Children with Wilms tumor typically present with an asymptomatic abdominal mass. Open
Statement 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. Open
Statement Intravascular tumor extension should be specifically investigated in preoperative evaluation as it may alter the timing and conduct of surgery. Open
Statement The workup of a child with an intra-abdominal mass suspected of being Wilms tumor usually begins with ultrasound. Open
Statement 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. Open
Statement 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. Open
Statement If intracardiac extension of tumor thrombus is suspected, this can be assessed by echocardiography. Open
Statement Intravascular tumor extension occurs in about 6% of Wilms tumor cases. Open
Statement The most common site of metastatic spread of Wilms tumor is the lungs. Open
Quotation The most common site of metastatic spread of Wilms' tumor is the lungs Open
Statement A chest CT should be included in the initial evaluation of a child suspected of having Wilms tumor. Open
Statement Patients with synchronous bilateral Wilms tumor are stage 5, but local stage for each side should still be evaluated. Open
Statement For stage 4 disease, the local stage should also be evaluated as this will determine whether abdominal radiation is indicated and to what field. Open
Statement Metastatic disease, which occurs in about 12% of Wilms tumor patients, is considered stage 4. Open
Statement 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. Open
Statement Wilms tumors that penetrate the renal capsule but are resected with negative margins are stage 2. Open
Statement The Children's Oncology Group uses a surgical pathologic staging system in which localized Wilms tumors confined within the renal capsule are stage 1. Open
Statement A distinction is made between focal and diffuse anaplasia when determining specific adjuvant therapy. Open
Statement Anaplastic histology is associated with a significantly worse outcome and is treated with more intensive chemotherapy. Open
Statement 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. Open
Statement 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. Open
Statement 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. Open
Statement Raising the age and weight limits for observation without adjuvant chemotherapy are currently being considered for study by COG. Open
Statement 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. Open
Statement Treatment of favorable histology Wilms tumor stage 1 or 2 is limited to vincristine and actinomycin D. Open
Statement 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. Open
Statement Although Wilms tumors can grow to a large size, even large tumors rarely invade surrounding structures, so most Wilms tumors are resectable at presentation. Open
Statement For unilateral tumors, upfront resection with regional lymph node sampling (generally radical nephrectomy) is currently the recommendation from the Children's Oncology Group. Open
Statement 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. Open
Statement Studies have shown that biopsies of bilateral renal masses rarely detect anaplasia even when it does exist in the tumor mass. Open
Statement A biopsy is not required in children with bilateral solid renal masses as bilateral Wilms tumor is the very likely diagnosis. Open
Statement 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. Open
Statement 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. Open
Statement About 5% of children with Wilms tumor will present with synchronous bilateral disease or stage 5 disease. Open
Statement Longer courses of preoperative chemotherapy (beyond 12 weeks) are definitely discouraged in bilateral Wilms tumor. Open
Statement A biopsy, if performed in bilateral disease, doesn't mandate subsequent radiation as it does in patients with unilateral Wilms tumor. Open
Statement It should be determined by preoperative imaging whether there is intravascular tumor extension, then its presence or absence confirmed intraoperatively. Open
Statement Tumor extension into the renal vein and proximal inferior vena cava can in most cases be removed en bloc with the kidney and tumor. Open
Statement Thrombus that extends further into the vena cava can be withdrawn from the IVC after gaining proximal and distal control. Open
Statement Proximal control can generally be achieved if the superior extent of the thrombus is below the level of the hepatic veins. Open
Statement 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. Open
Statement 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. Open
Statement About 12% of Wilms tumor patients will have evidence of hematogenous metastases at diagnosis with 80% of these being pulmonary metastases. Open
Statement A new response-based approach is being used for patients with stage 4 disease in the Children's Oncology Group. Open
Statement 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. Open
Statement 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. Open