Solid Tumors in Children

What are the signs and symptoms of solid tumors?

Because solid tumors can occur throughout the body for different reasons, the symptoms children experience can be very different. Some children may feel pain in a specific body part; others may feel tired or lose weight unexpectedly. Some children may have no symptoms at all.

Talk to your child's primary care doctor if your child is experiencing pain for no apparent reason.

What tests are needed to diagnose solid tumors?

In most cases, diagnosis of a solid tumor requires a biopsy, though there are some exceptions, such as retinoblastoma, where a diagnosis is made by an eye exam.

A biopsy is a small sample of tissue obtained by a surgeon. Obtaining a biopsy is critical so that an exact diagnosis can be made and the proper treatment plan selected.

Biopsies are surgical procedures that are usually done in the operating room while the patient is asleep so that they don't experience any pain. The tissue from the biopsy is looked at under a microscope by a pathologist, a specialist at identifying problems with cells like cancer, who makes the diagnosis. Usually, it takes a day or two to gather all the information needed to make a diagnosis, although in some cases it may take longer.

Often, further genetic and other testing of the tumor tissue is done. This helps your child's doctors at Children's Colorado learn more about the tumor and be better able to predict its behavior and the most effective treatments.

What happens after my child is diagnosed with a cancerous tumor?

Once a diagnosis is made, the next step is to figure out if the tumor has spread in the body, a process called tumor staging. Staging varies for each tumor type. Staging is important because it helps your child's doctors decide the best treatment. Tumors that are widespread usually require more intensive treatment.

One part of staging involves getting X-rays and scans. A CT scan or MRI scan is usually done to look at the area where the tumor is, as well as to look at areas where the tumor is most likely to spread. PET scans are sometimes used to look for any areas in the body that use sugar faster than usual, indicating they have increased metabolic activity. Cancer cells often have increased metabolic activity, so PET scans are a sensitive way to find any areas in the body where cancer may be hiding.

Special scans may be done for specific tumor types, such as MIBG scans for neuroblastoma. Some cancers like to spread to the bone marrow, the substance inside of bones that make blood cells, so a bone marrow aspirate and biopsy is done as part of the staging process. About a teaspoon of bone marrow is obtained through a needle inserted into the marrow space through the back hipbones. Because this procedure is painful, it is almost always done while the patient is asleep in the operating room. It may be done at the same time as the biopsy of the tumor. In addition, basic blood tests are done to check blood counts and organ functions like kidneys and liver.

Why choose Children's Colorado for solid tumor testing?

All of these scans and tests can be done as an outpatient and don't require that your child stay in the hospital. However, it usually it takes a few days in the clinic to finish all the tests. Treatment isn't started until testing is finished so that your child's care team can plan the best course of treatment for your child.

Whenever possible, we prefer that these tests be done at Children's Colorado. This helps our oncologists get all of the necessary information and ensures the testing is as kid-friendly as possible. Our pediatric surgeons, radiologists, anesthesiologists and phlebotomists are experienced in working with children and their families. If these tests are done elsewhere, however, we will of course use it to provide the best care possible.

What are solid tumor treatment options?

Once a diagnosis is made and the staging is complete, the solid tumor team at Children's Colorado will plan your child's treatment. Treatment for malignant (cancerous) solid tumors almost always involves surgery and chemotherapy (drugs used to cancer cells or keep them from growing) and sometimes radiation therapy (X-rays that kill cancer cells or keep them from growing).

A multidisciplinary team will plan your child's treatment, led by a pediatric oncologist (cancer doctor) and other specialists including pediatric surgeons, an orthopedic oncologist, a pediatric radiation oncologist, pediatric pathologists, pediatric radiologists and pediatric oncology nurses and advance practice providers. Other specialists, such as pediatric urologists, ophthalmologists and ears, nose and throat surgeons are involved if the location of your child's tumor needs more specialized care. We also have social workers, child life specialists and a child psychologist who are able to provide advice and support to patients and families coping with cancer.

Treatment is based on the specific type and stage of solid tumor a patient has. In some cases, treatment may be surgery alone.

What to expect from chemotherapy

Most cases of cancerous tumors will require treatment with chemotherapy. Many of the chemotherapy drugs we give require placement of a special type of IV called a central line. This special IV is placed by a pediatric surgeon in the operating room while the patient is asleep so that they don't experience any discomfort. It stays in place during chemotherapy, and then is removed. Different treatment protocols use different chemotherapy drugs, so once your child's treatment plan is decided, we will take time to explain what to expect from each of the drugs.

Sometimes we need some extra tests, such heart or lung function tests, before giving chemotherapy so we can monitor potential side effects. Sometimes, the chemotherapy will be given in our clinic and you will be able to go home the same day. Other times, chemotherapy will require a stay in the hospital for a few days.

What to expect from radiation therapy

If treatment for your child includes radiation therapy, you will meet our pediatric radiation oncologist early in the treatment course to find out what to expect. Radiation treatments are given at the Anschutz Cancer Pavilion, which is across the street from Children's Colorado.

With modern treatments, most children with cancer are cured of their disease. Cure rates depend on many factors, such as the age of the patient, the type of tumor, where the tumor is located, and whether it has spread to other parts of the body. In cases where effective treatments haven't been developed, where cancer doesn't respond to treatment, or where the cancer comes back after treatment, we may involve our Experimental Therapeutics Program, which offers cutting-edge therapies for more difficult to treat diseases. In some situations, treatment may also involve high-dose chemotherapy with stem cell transplant through our Bone Marrow Transplant Program.

Why choose Children's Colorado for treatment of your child's cancerous tumor?

Each year at Children's Colorado, we diagnose and treat more than 200 children with cancer. Our multidisciplinary solid tumor team meets on a weekly basis to discuss our new and active patients, in order to decide the best course of treatment for every patient. We also meet every other week in our tumor board to discuss all of our new solid tumor patients in a more formal way, reviewing the patient's history, laboratory findings, radiology results and biopsy results and presenting the treatment plan for discussion by the group. These continuous meetings mean your child's case will be reviewed often and any changes in his or her health will be addressed quickly in order to provide the best possible treatment.

Providers at the Center for Cancer and Blood Disorders at Children's Colorado also participate in The Children's Oncology Group (COG), a National Cancer Institute-supported clinical trials group, which is the world's largest organization devoted exclusively to childhood and adolescent cancer research. The COG brings together more than 8,000 experts in childhood cancer at more than 200 children's hospitals, universities and cancer centers across North America, Australia, New Zealand and Europe.

If a clinical trial through COG is available, we will likely discuss whether you would like your child to participate. If a clinical trial is not available, we do not feel that study participation is the best option for your child, or you decide not to participate, then we will provide you with the best up-to-date treatment available based on the results of the latest treatment studies.

Through our Experimental Therapeutics Program, we also participate in clinical trials through the Pediatric Oncology Experimental Therapeutics Investigators' Consortium (POETIC) and, for patients with neuroblastoma, the New Approaches to Neuroblastoma Therapy (NANT) consortium.

Learn more about Piper's journey

• The Oncology Program at Children's Colorado
• The Wellness Program at Children's Colorado for cancer patients and their families
• The Hereditary Cancer Risk Assessment Clinic at Children's Colorado provides genetic counseling services.  
• The National Cancer Institute has a great deal of information about all types of childhood cancers. 
• CureSearch for Children's Cancer provides information about experimental treatments for childhood cancers.
• Histiocytosis Association is a national organization to raise awareness and support research into histiocytic disease.