Sacrococcygeal Teratoma
Treatment

Pregnancy Care and Planning Delivery

Because all sacrococcygeal teratomas must be surgically removed after birth, arrangements should be made for the infant to be born in a specialized hospital with pediatric surgery expertise.

Small or medium-sized tumors without excessive blood flow should be followed with regular ultrasounds to make sure the tumor doesn't grow and its blood flow doesn't increase.

Fetuses with large, mostly solid tumors need to be monitored frequently between 18 and 28 weeks of pregnancy for rapid growth of the tumor, the development of excessive blood flow to the tumor, and heart failure. A small number of these fetuses develop heart failure due to extremely high blood flow through the tumor. These fetuses may be candidates for fetal intervention.

Fetal Intervention

Fetal intervention is offered only if there is evidence of heart failure in the fetus. Heart failure is usually diagnosed by ultrasound.

Fetuses who develop evidence of heart failure (hydrops) require fetal intervention. If it is late enough in the pregnancy — past 32 weeks — the baby may be delivered for intensive management after birth. Before that, fetal intervention may be advised to reverse the otherwise fatal heart failure. Open fetal surgery is performed, in which the SCT is removed. This procedure was developed at the UCSF Fetal Treatment Center, and has proven successful in a number of cases.

As with all fetal interventions, at UCSF we have tried to develop minimally invasive methods that don't require opening the uterus — in this case, cutting off blood flow to the tumor instead.

In one method, instead of surgically opening the uterus and removing the tumor, a needle is inserted through the mother's abdomen and uterine wall and into the blood vessels that feed the tumor. Radiofrequency waves are then used to destroy the blood vessels. Without blood flow, the tumor does not grow and the heart failure is reversed. However, damage caused by the probe itself may be difficult to control.

Another method for cutting off blood flow to the tumor is the injection of drugs, such as alcohol, that cause blood to clot.

None of these methods has so far proven effective in all cases.

Women who have fetuses with advanced hydrops and placetomegaly (slightly thickened placenta), or who have maternal pre-eclampsia, are not candidates for fetal intervention, as we have found that these symptoms indicate an irreversible situation.

Treatment After Birth

All babies with sacrococcygeal teratoma should be delivered at a specialized hospital with pediatric surgery expertise. Tumors larger than 10 centimeters in diameter will require a caesarean delivery. The neonatologist (pediatrician specializing in the care of newborns) will provide support in the intensive care nursery until the baby is stable enough for surgery.

Surgical removal of small tumors is straightforward, but removal of large tumors can be very difficult and dangerous. The baby may require blood transfusions and intensive support for days or weeks after surgery. Most will get through this difficult period and enjoy a normal life.

At UCSF, it is our practice to follow children who have had an SCT closely. Children should have yearly blood tests for elevated alpha feto-protein (AFP) levels, which can signal recurrence of the tumor and, possibly, a malignancy. We also recommend follow-up with an oncologist (cancer specialist) and a pediatric surgeon.

If the tumor is quite large and the surgeon performs an extensive complicated removal, there is an increased likelihood of long-term issues. A few babies may have difficulty with urination or bowel movements.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Intensive Care Nursery
1975 Fourth St., Third Floor
San Francisco, CA 94158
Phone: (415) 353-1565
Fax: (415) 353-1202

Fetal Treatment Center
1855 Fourth St., Second Floor, Room A-2432
San Francisco, CA 94158
Phone: (800) 793-3887
Fax: (415) 502-0660
Appointment information

Surgery Clinic
1825 Fourth St., Fifth Floor, 5B
San Francisco, CA 94158
Phone: (415) 476-2538
Fax: (415) 476-2929
Appointment information