What is the initial management for Wilms tumor?

• A. Nephrectomy followed by chemotherapy
• B. Chemotherapy first, then nephrectomy
• C. Radiation therapy alone
• D. Observation

Answer: (A)

Wilms tumor is managed most effectively by removing the tumor surgically first to obtain a definite histologic diagnosis and accurate staging. This nephrectomy establishes local control and guides further treatment. After the tumor is removed, systemic chemotherapy is given to eradicate any microscopic, undetectable spread and to reduce the risk of relapse. Radiation therapy is reserved for higher-stage disease, unfavorable histology, or residual tumor after surgery. While some centers use preoperative chemotherapy in specific situations (for example, very large tumors or bilateral disease to shrink tumor burden and spare renal tissue), the standard initial approach is nephrectomy followed by chemotherapy.