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Boston, MA 02115
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My Child Has:
Sacrococcygeal Teratoma (SCT)
Programs that treat this condition
 Advanced Fetal Care Center  
What is a sacrococcygeal teratoma?
A sacrococcygeal teratoma (SCT) is a tumor that develops at the base of the coccyx (tailbone). It is seen in 1 in every 35,000 live births, and is the most common tumor in the newborn. These are usually non-malignant when diagnosed after birth, and, after treatment, full recovery is likely.
How is sacrococcygeal teratoma diagnosed?
A sacrococcygeal tumor is usually diagnosed during pregnancy by a highly specialized prenatal ultrasound. You may be referred to a doctor who specializes in this kind of an ultrasound if the levels of alpha-fetoprotein (AFP) in your blood are high. A blood test to determine AFP levels is a routine part of prenatal care and is usually taken sometime between the 15th and 20th week of pregnancy. You may also be referred for this kind of an ultrasound if your uterus is larger than it should be during that particular week of pregnancy. If an SCT is causing the enlarged uterus, an increase in amniotic fluid (polyhydramnios) or the large size of the tumor is usually to blame.

If the fetus has a sacrococcygeal teratoma, the ultrasound will show a large mass. The mass may be either cystic or solid in appearance or commonly a mixture of both. Measurements will be taken to determine how far into the abdomen the teratoma extends and what organs it may have affected. Many times the mass can cause pressure on internal organs like the bladder, and may lead to obstruction and enlargement of the kidneys (hydronephrosis)

The tumor that is mostly solid has a large amount of blood vessels, and this causes the fetus' heart to pump extra hard to circulate blood through both his body and the tumor. This extra work may cause the fetus to develop heart failure (hydrops). This will be monitored closely by fetal echocardiography, which looks directly at fetal heart function.

How is a sacrococcygeal teratoma treated?
Most newborns that are born with SCT will undergo surgery to remove the mass and reconstruct the perineum after birth. These babies usually do very well. A small number of patients, however, experience progressive enlargement of the tumor very quickly prior to birth, which can lead to heart failure (hydrops). These are the patients who are offered prenatal intervention.

There are two types of prenatal interventions. Your doctor will discuss with you which of them is right for you. For the first procedure, the mother's uterus is opened, and the baby is taken out of the uterus, and, while the fetus is still attached to and sustained by the mother's placenta, the tumor is removed. The fetus is then returned to the mother's uterus to be carried as close to term as possible. Open fetal surgery can cause preterm labor and early delivery, so mothers are monitored closely after surgery.

The second procedure, which does not involve opening the uterus, is called radio frequency ablation. During this procedure, a needle is placed into the mother's uterus and into the tumor. Radio frequency waves are sent through the needle to destroy the blood vessels that lead to the tumor. Without blood flow to the tumor, it does not grow and the hydrops resolves. After delivery of the baby, the mass is completely removed in the operating room, and reconstruction is performed if needed.

What happens after delivery to babies who underwent fetal surgery?
Babies who underwent radio frequency ablation require surgery after delivery for complete removal of the tumor. For those who had open fetal surgery, some reconstructive surgery to properly close the perineum may be needed. However, fetal skin is remarkably resilient and may heal on its own without any scarring. Depending on the development of the tumor's cells, no further treatment may be needed, or your child's physician may determine that chemotherapy may be necessary.
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