What is Pediatric Oncology Surgery?

Pediatric oncology surgery is a specialized field focused on the surgical diagnosis, staging, and treatment of childhood cancers. Cancer in children differs significantly from adult cancers in types, behavior, and treatment response. Our fellowship-trained pediatric surgeons at Western Surgical Group work as integral members of multidisciplinary pediatric oncology teams, collaborating closely with pediatric oncologists, radiation oncologists, radiologists, pathologists, and other specialists to provide comprehensive cancer care.

The surgeon’s role in treating childhood cancer is multifaceted: obtaining tissue for accurate diagnosis through biopsy, surgically removing tumors when possible, placing long-term venous access devices for chemotherapy delivery, performing “second-look” surgeries to assess treatment response, managing cancer-related complications, and providing ongoing surgical support throughout the child’s cancer journey. Our approach emphasizes complete tumor removal when achievable while preserving organ function and minimizing long-term effects on growth and development.

While a cancer diagnosis is devastating for families, it’s important to know that childhood cancers often respond very well to treatment. Survival rates for many pediatric cancers now exceed 80-90% thanks to advances in treatment protocols. We’re committed to providing expert surgical care while supporting children and families through this challenging experience with compassion, clear communication, and coordination with the entire care team.

Multidisciplinary Approach to Pediatric Cancer

Treating childhood cancer requires a team approach. We coordinate care with:
  • Pediatric oncologists (cancer specialists)
  • Radiation oncologists
  • Pediatric radiologists
  • Pathologists specializing in pediatric tumors
  • Pediatric anesthesiologists
  • Genetic counselors
  • Social workers and child life specialists
  • Pediatric intensive care teams

This collaborative approach ensures your child receives comprehensive, coordinated care based on the latest treatment protocols.

Types of Pediatric Tumors We Treat

Neuroblastoma: The most common cancer in infants, arising from nerve tissue. Can occur anywhere along the sympathetic nervous system but most commonly in the adrenal glands or abdomen. Treatment involves surgery to remove the tumor, often combined with chemotherapy and sometimes radiation. Prognosis varies significantly based on age at diagnosis, tumor stage, and genetic factors.

Wilms Tumor (Nephroblastoma): The most common kidney cancer in children, typically affecting children ages 3-4. Treatment involves surgical removal of the affected kidney (nephrectomy), usually after chemotherapy to shrink the tumor. Most children with Wilms tumor have excellent outcomes, with cure rates exceeding 90% for favorable histology tumors.

Hepatoblastoma: A rare liver cancer affecting young children, usually under age 5. Treatment involves chemotherapy followed by surgical removal of the tumor, which may require removing a portion or majority of the liver. The liver’s remarkable ability to regenerate allows for extensive resection when necessary. Prognosis depends on tumor stage and whether complete surgical removal is possible.

Soft Tissue Sarcomas (Rhabdomyosarcoma): Cancers arising from muscle or connective tissue that can occur anywhere in the body. Treatment is multimodal, typically combining surgery, chemotherapy, and sometimes radiation. The surgical approach depends on tumor location and size, with the goal of complete removal while preserving function.

Germ Cell Tumors: Tumors arising from reproductive cells, occurring in the ovaries, testes, or along the midline of the body. Types include teratomas (which can be benign or malignant), yolk sac tumors, and other variants. Treatment depends on tumor type, location, and whether it’s benign or malignant. Many germ cell tumors have excellent cure rates.

Adrenal and Pancreatic Tumors: Rare tumors of these organs requiring specialized surgical expertise. Treatment depends on tumor type but often involves surgical removal when possible.

Thoracic Malignancies: Including pleuropulmonary blastoma (a rare lung cancer), bronchial carcinoid tumors, and chest wall Ewing’s sarcoma. Treatment typically involves surgical resection combined with chemotherapy and sometimes radiation.

Melanoma: While less common in children than adults, pediatric melanoma does occur and requires surgical removal with appropriate margins, possible lymph node evaluation, and close follow-up.

Lympho-vascular Malformations: While often benign, some vascular tumors can behave aggressively and require surgical intervention as part of comprehensive treatment.

Surgical Procedures in Pediatric Oncology

Diagnostic Biopsy: Obtaining tissue samples for pathologic diagnosis, which is essential before starting cancer treatment. Biopsies may be performed using needle techniques, laparoscopically, or through open surgery depending on tumor location.

Tumor Resection: Surgical removal of the cancer, aiming for complete resection with negative margins (no cancer cells at the edges of removed tissue) while preserving organ function when possible.

Central Venous Access Placement: Inserting long-term intravenous catheters (Port-a-Cath or Broviac/Hickman catheters) for chemotherapy administration, blood draws, and supportive care, avoiding repeated needle sticks.

Second-Look Surgery: Evaluating treatment response and removing residual tumor after chemotherapy or radiation therapy.

Metastasectomy: Removing cancer that has spread to other locations like lungs or liver when isolated metastases are present and complete removal is feasible.

Why Pediatric Surgical Expertise Matters in Cancer Care

  • Understanding of pediatric tumor biology and behavior
  • Specialized techniques for operating on small bodies and delicate tissues
  • Knowledge of growth and development considerations
  • Experience with pediatric cancer treatment protocols
  • Minimally invasive approaches when appropriate
  • Focus on long-term outcomes and quality of life
  • Coordination with pediatric oncology teams

What to Expect

The pediatric cancer journey typically begins with diagnostic workup including imaging studies (CT, MRI, PET scans), laboratory tests, and often biopsy. Once cancer is diagnosed, your child’s case will be discussed at a multidisciplinary tumor board where specialists collaborate to develop an individualized treatment plan based on tumor type, stage, location, and your child’s overall health.

Surgical timing depends on the specific cancer. Some tumors are removed first (upfront resection), while others are treated with chemotherapy first to shrink the tumor before surgery (neoadjuvant therapy). Hospital stays vary from outpatient for simple biopsies or port placement to a week or more for major tumor resections. Recovery depends on the extent of surgery and your child’s overall condition.

Throughout treatment, we maintain close communication with families, explaining each step, addressing concerns, and supporting you through this difficult journey. Our goal is not just cancer cure but also minimizing treatment effects and supporting your child’s quality of life during and after cancer therapy.

Divisions Involved in Your Care

Diagnoses We Treat

Frequently Asked Questions

Surgery serves multiple critical roles in pediatric oncology: obtaining tissue for definitive diagnosis and molecular characterization, completely removing tumors when possible (which may be curative for localized cancers), staging the cancer to guide treatment decisions, placing central venous catheters for chemotherapy delivery, performing second-look operations to assess treatment response, removing residual tumor after chemotherapy, and managing treatment complications. The specific surgical role depends on cancer type, stage, and location.

Treatment for childhood cancer is individualized based on tumor type, stage, and risk factors. Most pediatric cancers require multimodal treatment combining surgery with chemotherapy and sometimes radiation. Some early-stage, low-risk tumors may be cured with surgery alone, while others need aggressive combined therapy. The pediatric oncology team develops a comprehensive treatment plan that may involve surgery before, after, or between courses of chemotherapy. We'll explain the complete treatment plan for your child's specific cancer.

Yes—many childhood cancers are highly curable. Overall survival rates for childhood cancer now exceed 80-85%, with some types having cure rates above 90%. Children's cancers often respond better to treatment than adult cancers. Factors affecting curability include cancer type, stage at diagnosis, genetic characteristics of the tumor, age of the child, and response to initial treatment. Even when cure isn't possible, many children can achieve long-term disease control with good quality of life. Your oncology team will discuss realistic expectations for your child's specific situation.

Our surgical approach prioritizes minimizing long-term effects while achieving cancer cure. Most children recover well from cancer surgery. Potential long-term considerations depend on what organs are involved and may include functional changes if organs are removed (like needing thyroid hormone after thyroid cancer), growth considerations for bone or soft tissue removed during growth years, fertility considerations for pelvic tumors, and cosmetic concerns from scars. We discuss these considerations when planning surgery and work to preserve function whenever possible. Many survivors go on to lead normal, healthy lives.

This is incredibly difficult. We recommend age-appropriate honesty—children sense when something serious is happening and often cope better when informed. Use simple terms for young children ("the doctor will remove the lump that's making you sick") and more detailed explanations for older children and teens. Child life specialists at the hospital can help prepare your child using age-appropriate techniques. Maintaining routines when possible, allowing your child to express fears, and staying positive while honest helps. We're here to support your entire family through this process.

Comprehensive support services are available throughout your child's cancer journey. This includes social workers who help with practical needs, child life specialists who help children cope with medical experiences, psychological services for emotional support, nutritionists to maintain adequate nutrition during treatment, physical and occupational therapists for rehabilitation, school liaisons to coordinate educational needs, and support groups for parents and siblings. Financial counseling and assistance programs may help with treatment costs. You're not alone—a full team supports your family through this difficult time.