Over the past half century, survival rates for children with cancer have risen dramatically. More than 80% of these patients will survive at least five years beyond their diagnosis—whereas in 1950, the rate was around 10%. This increase is the result of major advances in cancer treatments, including pediatric cancer surgery.
In both children and adults, cancer begins when abnormal cells in the body start to grow uncontrollably. Certain types of cancer are more likely to develop in children, including leukemias, lymphomas, tumors derived from immature cells (blastomas), soft-tissue sarcomas and brain (or central nervous system) tumors.
For each patient, the treatment plan hinges on the type of cancer and where it’s located in the body. One of the most common options for pediatric patients (0 to 18 years old) with malignant tumors is surgery.
“Most tumors in children can be completely resected either at the time of diagnosis or after several cycles of chemotherapy,” says Emily Christison-Lagay, MD, a Yale Medicine pediatric surgeon, specializing in patients with cancer. “At Yale, we have a large number of subspecialty surgeons who are able to perform even the most complex procedures. These involve specialists of the brain, thyroid, heart, lung, liver, kidney, adrenals, intestines, bladder, muscles and bones.”
When is cancer surgery performed in children?
Like adults, children may undergo surgery to have tumors removed. The type of surgical treatment offered to pediatric cancer patients depends upon the diagnosis, as well as the size and location of the tumor. Sometimes a biopsy of the tumor to help make the diagnosis of tumor type is the first procedure performed. Not all tumors are cancer and every cancer is treated a little bit differently.
Once a child’s cancer has been confirmed, surgery can become a central part of the overall treatment plan. In the case of pediatric cancer surgery, the operation is usually combined with chemotherapy or radiation therapy. Patients may receive these additional treatments before surgery (neoadjuvant) to shrink the tumor and make the procedure less invasive. They may also receive them after surgery (adjuvant) to kill any cancer cells that couldn’t be removed during the procedure.
Occasionally, children are born with alterations in their DNA (genes) that cause cancer. In children identified with these conditions, strict screening protocols may be recommended. Some of these children may have operations on potentially involved organs even before a cancer is detected. Almost all pediatric cancer patients require chemotherapy. In order to administer chemotherapy to children, a special form of intravenous catheter is typically used. It will be placed by a surgeon, in a short procedure requiring brief anesthesia. The IV catheter then remains in place for the entirety of the treatment plan.
What does pediatric cancer surgery involve?
Prior to surgery, the surgeon will spend time with a child’s caregiver, reviewing the procedure and explaining how to best support the child throughout the process.
The goal of pediatric cancer surgery is to remove as much of the tumor as possible, without injuring or removing any adjacent structures. Surgeons may remove just the tumor, or even a small portion of the tumor, leaving a scar where the incision was made. Or, in some cases, they may elect to remove the affected organ to keep the cancer from spreading further. It all depends on the type of cancer and where it’s located.
Pediatric cancer surgery is usually performed by a pediatric surgeon who has completed several years of additional training over and above the training required to operate on adults. A specialist in pediatric cancer surgery is not only familiar with the surgical treatment for pediatric cancers, but also knows what it means to take care of children and families who are dealing with cancer. Likewise, our surgeons are supported by an experienced team of pediatric anesthesiologists who understand the nuances involved in administering anesthesia to children.
What are the side effects of cancer surgery in children?
Any time surgery is performed, there’s a risk of complications, including the following:
- Bleeding and blood clots
- Damage to nearby tissues or other organs
- Reaction to anesthesia
Pediatric cancer surgery can also lead to more long-term effects, depending on the organ that’s involved. For example, surgery for a brain or central nervous system tumor may affect speech or motor movements. Most patients, however, are able to fully recover and go back to “life as normal.” Ultimately, doctors recommend lifelong follow-up survivorship care, including emotional support for all patients who undergo cancer surgery during childhood.
What is unique about Yale Medicine’s approach to treating pediatric cancer?
At Yale Medicine, we have a large team of individuals dedicated to providing the best cancer care for children,” says Dr. Christison-Lagay. “Our dedicated team of oncologists are part of a North American cooperative group of physicians who are constantly investigating the best ways to treat children’s cancer. We have a rich network of child support services to help your child and your family cope with a new diagnosis of cancer.”
Our medical doctors, surgeons, pathologists, and radiation oncologists meet weekly as a group to discuss and coordinate patient care. Our pediatric and pediatric subspecialty surgeons form a robust consortium of doctors who are able to treat tumors arising in any and every organ. “We feel that every child has a right to the highest quality of treatment and the chance to be cancer free,” she says.