When is surgery required for a solid tumor?
There are two times your child may have surgery for a solid tumor.
- To diagnose the tumor by learning its type. This is called diagnostic surgery, or a biopsy.
- To remove all or as much of the tumor as possible as part of your child's solid tumor treatment.
Sometimes a doctor is able to take out all or most of the tumor during the first surgery so the second surgery isn’t needed.
Successfully operating on your child’s growing body requires specialized expertise and experience. The Surgery team at St. Jude takes the toughest cases. These include children with tumors other hospitals’ pediatric surgeons may consider inoperable.
Getting a biopsy
If your child’s doctor needs to know more than what the scans show, he or she will want a piece of tissue to study. The procedure for getting that piece is called a biopsy or diagnostic surgery. The piece of tissue that’s removed is also called a biopsy.
There are different ways to do biopsies. The kind your child has depends on where the tumor is.
Needle biopsies
Needle biopsies are done in the operating room (OR) as well as in Interventional Radiology (IR). There are two ways your child may have a needle biopsy.
- Through the skin.
- With an open surgical procedure. This is always done in the OR. During this procedure, the surgeon does a needle biopsy into the tumor’s mass.
Your child’s pathologist will be on standby to receive the biopsy specimen. When possible, the pathologist will examine it right away under a microscope to tell the surgeon what kind of tumor it is. Sometimes the biopsy will go to pathologists in the lab to examine.
Your child may be able to have a type of needle biopsy that only requires a local anesthesia. With a “local,” the surgeon injects the anesthesia so it will numb the area where the biopsy will be taken. Your child may stay awake or be given a sedating medicine to help calm him or her, and that may cause sleepiness.
Surgical biopsies
Your child’s surgeon may need to make a cut in the skin to get to the tumor. In this case, your child will get a general anesthesia, which puts him or her to sleep. Before any surgery, you and your child will both give your consent for the surgery to take place.
Most of the time, one parent can go into the OR with the child. You can stay next to your child until he or she falls asleep.
To know exactly where the tumor is, the surgeon looks at MRIs or CT scans taken by a pediatric radiation oncologist. Next, the surgeon uses an instrument—often a needle—to get a small piece of the tumor. Sometimes the doctor can take out the whole tumor or at least a lot of it.
While your child is still asleep, the surgeon may do other procedures. For instance, the doctor may take out a lymph node or some bone marrow to check it for cancer. Or, the surgeon may insert a port for the oncologist to give the chemotherapy that will start after the surgery.
Evaluating the biopsy
The surgeon gives the sample to a pathologist. The modular, integrated operating rooms in The Eric Trump Foundation Surgery and ICU Center let these doctors share the biopsy quickly. Using monitors, they can look at the sample together without being in the same room.
The pathologist uses a microscope to look for cancer cells. If there are no cancer cells in the tumor, it’s called benign. Tumors with cancer are called malignant.
The pathologist determines the type of the tumor as well as characteristics like how fast it may grow and spread. It’s from this evaluation that you learn about the tumor’s stage and grade.
- The stage describes where the cancer is in the body, where it started and where it has spread. The stage is like a snapshot of what the tumor looks like now.
- The grade describes what the tumor cells look like and how fast they are likely to grow and spread. The grade is like a prediction of what the tumor will do.
Your child’s treatment team uses the information from the pathologist and from your child’s health and medical history to plan how to treat the tumor. In some cases when the surgeon is able to remove all of the tumor, no more treatment is needed. In these instances, the surgery is considered “curative.”
Follow-up care
After surgery, your child will go to the Intensive Care Unit (ICU). This is a place children stay when they need closer monitoring. Afterward, most children go to an Intensive Care Step-Down Room.
You will have a room attached to the ICU after surgery. The parent room lets you monitor your child during the recovery period.
Leaving the operating room isn’t the end of your child’s care. At St. Jude, there are multiple resources for ongoing support for both your child and the whole family. Some of the support will depend on the type of cancer and surgery your child has. But every patient has access to support, such as:
- Psychologists to help patients and families manage stress and resolve conflicts
- Dentists in the Dental Clinic to help with teeth or mouth problems that result from treatment.
- Clinical Nutrition to give nutritional care to patients and nutrition information to patients and families
- Rehabilitation services including audiology, occupational therapy, physical therapy and speech-language pathology
After the biopsy: Planning treatment for a solid tumor
After your child’s multidisciplinary team has a diagnosis, they will map a treatment plan. The plan depends on this information:
- Size of the tumor
- Amount of tumor left after the biopsy
- Whether there are cancer cells in the lymph nodes. The fluid in lymph nodes travels throughout the body in vessels similar to the way blood travels in blood vessels. If there are cancer cells in the lymph node, the cancer can spread more easily.
- Whether or not the tumor has spread. If so, has it spread only to nearby places or farther away?
The treatment for solid tumors is usually some combination of chemotherapy, radiation therapy and surgery.
Your child’s team determines the order and strength of these treatments based on the type of solid tumor, pathologist’s findings, and your child’s health and medical history.