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Diagnosis |
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Side Effects of Treatment |
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Blood Counts and Transfusions |
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Scans |
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Bone Marrow Transplants |
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Finishing the Treatment |
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Relapse |
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Paediatric Surgery in Cancer - Advice to Parents
The Surgical Team
Usually, the surgical team consists of a consultant, (a senior surgeon) registrar and a
resident. Please feel free to ask any of these three people about the operation on your
child. Registrars and residents can always be found in the hospital whereas the consultant
usually comes around at certain times. The surgical team will be responsible for the care
of your child during and for a variable period after the operation until the child has
recovered from the operation.
The treatment of cancer in children has been found all over the world to be managed best by a team of Oncologists, surgeons, radiotherapists, psychologists. This group of people work together meeting regularly to discuss all the children who are currently in hospital.
Surgery is the oldest method of treatment for cancer and up to the mid twentieth century was the only treatment until radiotherapy and chemotherapy were introduced. The addition of these other two methods have been responsible for the increase in survival particularly in children.
Surgeons take part in the general management of the patient but are particularly interested in treating localised disease and not generalised disease which is the province of the Oncologists. We are all concerned with quality of life and it is not acceptable to remove all the cancer if this will lead to a marked deterioration in the quality of your child's life.
The areas that surgeons deal with are as follows:
- Diagnosis and staging
- Curing
- Enhancing the action of chemotherapy by debulking
- Prophylaxis
- Alleviating symptoms
- Intravenous access
Whatever the operation, a general anaesthetic is nearly always necessary. The surgeon and the anaesthetist will visit you and your child and discuss with you the nature of the operation and the anaesthetic. A premedication is often given to quieten the patient and you may go with the child to the operating theatre and even be there while he/she is being anaesthetised.
After the operation every effort will be made to ensure that your child will have no pain whatsoever and there are various methods to deal with this. Intravenous drugs such as morphine, can be given. Local anaesthetic will probably also be given to your child whilst he/she is asleep so that the wound will hopefully be numb and therefore cause him/her no pain. After major operations you may well expect your child to be in the intensive care, and have an intravenous drip. A tube in his nose will be in place if an abdominal operation has been performed. If a chest operation has been performed then almost always a drain will be inserted into the chest wall to drain away excess fluids and air for at least 48 hours.
- Diagnosis and staging
It is vital for the treatment to have a precise tissue diagnosis. Staging, which means how far the tumour has advanced, is essential in determining which drugs should be given. The surgeon may therefore be called upon to take a small piece of tissue for sampling and also have a look around and see how far the tumour has spread. - Cure
If the tumour is well localised and has not spread to surrounding tissues then the surgeon will attempt to remove all the tumour. There are some tumours which are, unfortunately, not sensitive to drugs and the operation will be the only way of achieving a cure. Even those tumours that are sensitive to drugs will have a better chance of complete remission if the surgeon can remove all of the tumour. - Helping the action of chemotherapy by debulking
Even if the tumour is initially too big to remove, it may well be shrunken by chemotherapy and another attempt (a second look) will be made to try and remove the tumour completely. Even if a tumour cannot be removed completely removing it by, say 60% to 90%, will enable the drugs to be more efficient. - Prophylaxis
There are some abnormalities such as polyps that predispose to cancer. Therefore, the surgeon may remove those to prevent cancer forming. - Alleviating symptoms
Certain cancers can cause distressing symptoms such as pain. For example, if there is intestinal obstruction the surgeon may be called upon to bypass the obstruction and relieve distressing symptoms. - Intravenous access
Very often the surgeons are asked to insert a tube into a vein to help with the giving of the chemotherapy. There are essentially two types of canalage:
- The central venous line whose entry site can be seen going into the skin.
- The portocath where the port is buried under the skin and the needle passed through the skin into the port and thence onto the vein. The site of the entry into the skin is always a fair way away from the site of the entry of the canula into the vein (usually in the neck) because this prevents infection, and infection causes the canula to block. As it is obviously important to keep the canula open as long as possible the double incision technique is used.
Hopefully, you will see other children in the ward with these types of canulae before your child has the operation so you will be able to see exactly what is going to happen. The surgeon will, of course, answer any questions you will have about this procedure.
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