Solid Tumor Treatment Process

Your child will undergo a series of blood tests and diagnostic imaging studies when they are admitted to St. Jude. These include:

• A complete blood count (CBC). This reveals whether your child has anemia, a low platelet count, or an infection.
• A set of blood chemistries (sodium, potassium, etc.). These tests tell your doctors whether your child's kidney and liver function are normal, and whether nutrition is adequate.
• A set of blood coagulation tests. These determine whether your child is prone to bleed or not.
• A urinalysis. This shows whether your child's kidneys are working well and whether there is blood in the urine.
• Bone marrow aspirate and biopsy. This is done to see whether the tumor has spread into the bone marrow cavity.

After completing the initial diagnostic tests, your child may get one or more diagnostic imaging tests. These tests look at the tumor itself. They may include:

• Bone scan, also called a nuclear medicine bone scan, in which your child receives a radioactive liquid that helps cameras show if tumors have spread to your child's bones. These special cameras rotate around your child's body to take 3-D pictures.
• CT (computed tomography) scan, which uses special X-ray equipment to create a 3-D picture of the inside of your child’s body. The scan shows the presence of a tumor, and whether it has spread.
• MRI (magnetic resonance imaging) scan in the area of primary tumor involvement. This will show where the tumor is, how big it is, and if it can be safely removed by surgery.
  
• PET (positive emission tomography) scan, which shows how organs such as the brain, kidneys and liver, are working. A computer turns a signal from a tracer into 3-D pictures. 
• Spinal tap, which uses a sample of spinal fluid to see if the tumor has spread into tissue called the meninges around the brain and spinal fluid, or into the sinuses, or around the eye orbit.
• Ultrasound, which uses high-frequency sound waves to make pictures called sonograms. These machines get pictures of soft tissues that don’t show up well on X-rays.

Parents' Quick Guide to Medical Tests for Solid Tumors

The results of these tests are used to determine what stage the tumor is in (I, II, III, or IV). The amount of treatment given to your child depends upon the tumor size and stage.

After your doctors have established a diagnosis and have staged the disease, they will develop a treatment plan. The treatment plan will depend several factors. They include:

• the size of the tumor,
• the potential of surgery to remove the tumor,
• the amount of tumor left after surgery,
• the presence of cancer cells in regional lymph nodes, and
• whether or not the tumor has spread to other organs or tissues. This is called metastasis.

Doctors often need to study a piece of tissue (taken during a biopsy) to learn about your child’s tumor. The treatment team hopes to get enough details from the biopsy to suggest a treatment plan. In some cases, the surgeon will try to remove the tumor at the same time.

Your child may have one of two kinds of biopsy procedures:

• Needle biopsy: In many cases, a child can have a type of needle biopsy with only a local anesthesia to numb the area where the biopsy will be taken. If your child has a needle biopsy, the doctor may have your child stay awake, or may give your child a medicine that may cause sleepiness as well as reduce anxiety.
• Surgical biopsy: In some cases, a child will need a surgical biopsy. If the surgeon can remove the entire tumor at that time, then the biopsy is the start of treatment.

Sometimes doctors can learn all they need about your child’s tumor from seeing it in the images from one of the medical scans listed above. For instance, the tumor may be in a place that makes it too dangerous to remove or it may be too big to be removed easily.

If this is the case for your child, his or her first treatment may be chemotherapy to try to shrink the tumor. That treatment may go on for several weeks or months. If the tumor shrinks enough, your child will have surgery to remove as much of the tumor as possible.

When a pathologist looks at the biopsy under a microscope, he or she gets details that allow the treatment team to decide on the next steps. Here’s a simple overview of some of the common treatment plans:

• No more treatment needed because the biopsy removed all of the tumor
• Additional surgery to take out more of the tumor
• Chemotherapy, with or without radiation, after surgery to kill cancer cells the surgeon wasn’t able to remove
• Chemotherapy, with or without radiation, after surgery to help keep the cancer from coming back

Exceptional care from solid tumor experts

When your child comes to St. Jude for solid tumor treatment, he or she will have not one doctor, but a whole team of doctors, nurses, medical experts and support staff. Why? Because we know treating children with solid tumors is complex. It requires the coordinated care of many experts. 

Every member of your team is dedicated to your child’s treatment and care. 

Your child's oncologist

At some hospitals, whoever is on duty that day or week is your doctor. Not at St. Jude. We want you to recognize the person walking through the door. We want the person walking through the door to know your child and your family.

One doctor will oversee your child's team, and your child’s care. When your child has a tumor, that doctor is from the Solid Tumor Team. He or she is usually an oncologist, a doctor that specializes in treating cancer. When your child has a solid tumor, the oncologist will further specialize in solid tumors.

This leader is called the attending physician. Your child's attending physician will meet regularly with the members of your child's treatment team. Each person on that team is selected based on the kind of care and support your child needs. 

Your child's treatment team: all the specialists you need, in one place

St. Jude puts all the specialists you need all in one place, on your child's team.

Together, the team will decide the right combination of treatments for your child. Most often for solid tumors, that’s a mix of chemotherapy, radiation therapy and surgery.

Your child's team may include these solid tumor team members.

• Medical oncologists are cancer doctors. They are experts in using chemotherapy “chemo” and other medicines to treat cancer.
• Surgeons are doctors who perform operations. If they focus on cancer in children, they are called pediatric oncology surgeons.
• Radiological scientists are doctors. Some are radiation oncologists who treat tumors with radiation and nuclear medicine.
• Radiologists are experts in evaluating results from diagnostic imaging such as CT scans, MRIs, PET scans, ultrasound or X-rays. These results show how well treatment is working as well as track the spread of cancer.
• Nurse practitioners are advanced practice nurses. They may interpret diagnostic tests, prescribe medicine or order chemo.  They are supervised by an oncologist.
• Nurses and oncology nurses can have many roles. They may provide nursing care, give chemo, do research or help educate patients.
• Basic scientists have doctorate degrees. They are researchers in clinical trials.
• Pathologists are doctors who are experts at looking at cells, tissues and organs to diagnose disease.
• Pharmacists help patients and families understand how to take medicine safely.

Many other people may also be involved in your child’s care. Each of them plays an important role in your child’s care. And each of them knows how much you depend on them doing their job to help make your child well.

• Endocrinologists, who check to make sure your child’s body is making the right amount of hormones. After treatment for a solid tumor in the head or brain, children may have problems with:
  • Energy: Loss of vigor
  • Growth: Slow growth, especially height
  • Obesity
  • Puberty: Delayed or early
• Ophthalmologists, who check on issues with your child’s eyes.
• Psychologists, who check on issues such as the following:
  • Attention and memory
  • Comprehension and problem solving
  • Decision making
  • Emotional state
  • Social and personal behaviors
  • Managing pain in ways other than taking medicine
• Rehabilitation experts help your child with physical or communication problems that may result from the cancer or its treatment. Rehabilitation services may include:
  • Audiology for problems with hearing and auditory equipment
  • Occupational therapy to help improve every day functions like getting out of bed or dressing him- or herself
  • Orthotic care devices or to help with movement or prevent pain with movement, including braces, shoe inserts or splints
  • Physical therapy to help with balance, flexibility, pain or stability
  • Prosthetic care to help with adjusting to artificial limbs or eyes
  • Speech-language pathology
• Social workers counsel patients and families. They may help you make the transition from the hospital to home, find support groups, or cope with the changes in your life or family due to treatment.
• Clinical nutritionists help patients with special needs plan menus. They make sure all patients get the nutrients they need.