Treatment of nephroblastoma in Germany
Nephroblastoma is a kidney cancer in children. A tumor occurs in embryonic tissue and is dangerous for a child’s life. Nevertheless, it responds to treatment well, especially in case of early diagnosis. Nine out of ten kids suffering from nephroblastoma can be cured with the help of surgery, radiation therapy and chemotherapy in the developed countries.
Nephroblastoma – Diagnostics
The fact of nephroblastoma presence is determined by only instrumental diagnostics with the help of such techniques as:
- Ultrasound examination
- Computed tomography
- Chest X-ray (to detect metastases in the lungs)
In majority of cases a malformation detected in a child’s kidney is nephroblastoma. All other cancer types are rarely diagnosed at this age.
Visualization techniques also help to:
- Determine the degree of nephroblastoma spreading
- Plan surgical treatment and radiation therapy
- Assess the effectiveness of the provided treatment
Sometimes doctors need to distinguish nephroblastoma from neuroblastoma. Neuroblastoma is another embryonic tumor, which can occur in the adrenal gland tissues. Kidneys and adrenal glands are located close to each other and often it is hard to understand where exactly the tumor has started.
Levels of catecholamines and their metabolites in the urine are also a part of differential diagnostics. Increased level of dopamine, vanillylmandelic, and homovanillic acid is indicative of neuroblastoma.
Nonetheless, even without this symptom you cannot say exactly if it is a nephroblastoma. 10-15% of neuroblastoma cases are not characterized by the increase of these metabolites’ level in blood. Therefore, a mistake is possible in certain cases. The exact origin of a tumor is identified after the histological test of the tissue sample.
As a rule, biopsy is not performed separately. Tissue sample for histological test is taken during the surgery for the tumor removal. Modern German hospitals provide chance to do the test intraoperatively. This way, a doctor is able to adjust the surgery, if necessary.
Type of nephroblastoma is defined according to the histological test. If there are signs of anaplasia (different cell size, large cell nuclei) the tumor is considered unfavorable. If there is no anaplasia – the prognosis is better in this case, as these are favorable tumors diagnosed in about 90% of cases.
Best clinics for the nephroblastoma diagnostics in Germany:
University Hospital Duesseldorf
Pediatric Diagnostic Hospital M1 Munich
Charite University Hospital Berlin
Nephroblastoma – Treatment
Surgery is the treatment basis. Surgeons remove a kidney, ureter, lymph nodes and adipose tissue surrounding the organ.
Surgical treatment is more difficult in patients with bilateral nephroblastoma. In this case, one of three strategies is used:
- Resection (partial removal) of the left and right kidneys, if a tumor is small
- Removal of one kidney fragment, complete removal of another kidney (complete removal of the organ where the nephroblastoma is larger)
- Both kidneys removal
When removing two kidneys, patient needs a new organ transplant. Therefore, such an extreme measure is made only if it is really necessary and large tumors are present in both kidneys. A patient will have to undergo regular hemodialysis (blood purification with the help of “artificial kidney”) after removal of both kidneys while waiting for a new organ.
Chemotherapy is administered before or after the intervention. It is used almost always, except for presence of several favorable factors, namely:
Nephroblastoma is small (up to 500 g) and does not go beyond the kidney
Patient's age is under 2 years old
Radiation therapy is performed before the operation, but only if a tumor goes beyond kidney borders. Then, radiation helps to reduce the risk of tumor rupture during the surgery. If tumor has still ruptured, they must radiate the entire abdominal cavity.
Unfavourable histological types of nephroblastoma are treated with the help of all available techniques (surgery, chemotherapy, radiation therapy) regardless of child’s age and tumor size.
Nephroblastoma – Innovative treatment
The main research in the field of nephroblastoma treatment is aimed at finding effective medicines for the treatment of patients with histologically unfavorable types of the tumor. There are already few medicines, which show encouraging results. These are Irinotecan and Topotecan. The possibility of using chemotherapy shock doses in children with unfavorable histological type of nephroblastoma unresponsive to standard treatment is also being explored.
Intensive therapy damages the bone marrow, as it primarily affects quickly dividing cells. Therefore, such patients need stem cells transplantation in the future.
Best clinics for the nephroblastoma treatment in Germany:
University Hospital Ulm
Gamma Knife and Radiotherapy Center Krefeld
Charite University Hospital Berlin
Nephroblastoma – Rehabilitation
After treatment of complex oncological diseases most patients require rehabilitation. It includes the following aspects:
- Prevention of complications that may occur as a result of treatment. It can be pneumonia, lymphostasis, thromboembolic or infectious complications.
- Restoration of general health. The elimination of the consequences after surgeries and chemotherapy is carried out. The functions of internal organs are restored with the help of various medical and rehabilitation measures.
- Restoration of occupation. A person must not just stay alive. He must have physical and intellectual capabilities, which are sufficient for employment.
- Psychological support. First of all, it is required for patients, whose occupational performance was harmed because of the disease. Patients with deterioration of appearance also will benefit from psychological help.
- Restoration of appearance. If necessary, you can use surgical and other methods in Germany to restore appearance defects caused by cancer. For example, to carry out the reconstruction of the breast.
- Social and domestic rehabilitation. A person with reduced workability is trained to act in the society and perform everyday tasks in new conditions.
In German clinics, rehabilitation is carried out in a comprehensive manner. The patients are provided with qualitative care here. Doctors' monitoring and conservative treatment allow to avoid complications, which usually happen after treatment of oncological diseases. Psychotherapy, physiotherapy and physical therapy are actively used in Germany.
Specialists in different medical spheres take part in the rehabilitation process. These are massage therapists, speech therapists, specialists in physiotherapy exercises, physiotherapists. Social and occupational therapy is carried out, as well. If necessary, people are taught how to eat properly, take care of a colostomy or urostomy, etc.
In Germany, rehabilitation is carried out with the maximum level of comfort for the patient. A person feels the results quite quickly and it improves his motivation and promotes further recovery.
Author: Dr. Nadezhda Ivanisova
Here you can find the cost of treatment for this disease at the German University Hospitals. Leave a request and we will provide a free consultation with a doctor and will start organizing the whole treatment process.
The program includes the following:
- Issuing of an invitation for getting a visa for treatment as quick as possible
- Fixing an appointment at a time convenient for you
- Preliminary organization of a comprehensive examination and discussion of the forthcoming treatment plan
- Arranging transfer from the airport to the hospital and back to the airport
- Provision of interpreting services and services of a personal medical coordinator
- If necessary, assistance in the organization of further surgical treatment
- Provision of a medical insurance against treatment complications covering up to 200,000 euro
- Preparation and translation of medical records and recommendations from the hospital
- Assistance in the subsequent communication with your attending physician, including consultations on repeated X-ray images through the unique medical document management system E-doc