Other chemistries, such as alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin, may be needed to assess liver function. Other blood tests including the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) may be used to measure response to treatment. Venous Access Device A venous access device (VAD), sometimes called a central venous catheter, is a temporary or long-term intravenous (IV) tube that can be used for the duration of your child’s therapy. It is placed in a large vein in the chest or the arm. These long, flexible catheters empty into or near the heart, allowing necessary treatments to be given within sec- onds. It can be used to administer medications, IV fluids, chemotherapy, blood products, and nutritional support and to draw blood for testing. It is inserted during surgery while your child is sedated or has been given general an- esthesia either before chemotherapy begins or within the first month of treatment. Not all children need a VAD. This will be determined by you and your child’s healthcare team. The VAD will be removed when it is no longer needed. There are different types of VADs, such as an implanted port inserted under the skin near the collarbone, a tun- neled central venous catheter (Broviac/Hickman) that has a tube, a lumen (either double or single) which comes out of your child’s chest, or a PICC line (a central line inserted through a vein in the arm). Your child’s healthcare team will discuss each type with you and help you choose the best device for your child’s treatment. The care for each of these types of catheters is slightly different. A port requires almost no care at home but a special needle (noncoring) will need to be inserted through the skin into the port each time it is used. Tubing can be attached to the needle if needed to give medication or IV fluids. An external central line requires routine dressing changes to prevent infection and to care for the skin around the tube. The external lines also are routinely flushed with a solution to keep them working properly. You will be taught how to care for the device at home. n HOW CAN WILMS TUMOR BE TREATED? Three types of therapy are commonly used to treat Wilms tumor: surgery, radiation, and chemotherapy. The type of therapy chosen depends upon the extent of the disease. Your child’s medical team will talk with you about the best treatment for your child. Surgery Surgery is the first-line treatment for all stages of Wilms tumor. Surgery can remove the bulk of the tumor and the affected kidney and is done at the time of diagnosis. In children whose tumor is too large, presurgery chemotherapy is given to shrink the tumor before removal. For children with Stage V Wilms tumor (both kidneys), the kidney with the largest tumor is removed. Chemotherapy Chemotherapy is medicine intended to kill tumor cells in the bloodstream or any tumor cells remaining elsewhere. Several chemotherapy medications are known to be effective in killing Wilms tumor cells, but no single chemotherapy medication can control this disease by itself. Most are given through a vein or CVC. Your child’s medical team will explain in detail the possible side effects of the specific chemotherapy medicines recommended for your child. Most children with Wilms tumor will get chemotherapy at some point during their treatment. Some children with very low risk might not need it.
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