Sacrococcygeal teratoma (SCT)

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What is a sacrococcygeal teratoma?

Sacrococcygeal teratoma (SCT) are rare tumours that grow at the base of the spine of a baby during pregnancy.

The tumours are almost always benign (non-cancerous).

All babies with SCTs will need surgery.

If SCTs are not removed there is a small chance they can become malignant (cancerous).

SCTs affect 1 in every 40,000 babies.

In Manchester we have the only specialist SCT clinic in the UK. We operate and look after lots of babies with SCTs and have expert doctors who specialise in this condition.

Diagnosis

Usually sacrococcygeal teratomas are diagnosed on routine scans during pregnancy.

Occasionally SCTs are found when babies are born. Very rarely they are found in adults.

Extra ultrasound and MRI scans can confirm the diagnosis and find out more information about the type of SCT before your baby is born. The means doctors can help you decide on the best way to care for your baby.

Types of SCT

Type 1

The tumour is mainly outside the body with a very small part inside.

Type 2

The tumour is mostly outside the body with part inside.

Type 3

The tumour is mostly inside the body with a small part outside.

Type 4

All of the tumour is inside the body.

Sacrococcygeal teratomas also vary greatly in their internal make-up. Some are mainly fluid filled (cystic) whilst others may be entirely solid. Most are a combination of the two.

Complications

Hydrops

Hydrops is a serious complication of SCT where fluid collects in a baby’s tissue during pregnancy. It usually disappears after giving birth.

Hydrops is caused by the heart having to work harder because of the blood the tumour is using.

Sometimes babies with hydrops need a procedure whilst they are still in the womb (fetal intervention).

If babies with hydrops become extremely unwell they will need to be delivered urgently. Sometimes babies with hydrops do not survive.

Maternal mirror syndrome

Maternal mirror syndrome is when the mothers of babies with hydrops have symptoms that are similar.

These include:

  • fluid retention (swelling)
  • protein in urine
  • high blood pressure

Maternal mirror syndrome is a serious condition and if you have the condition, you will be offered extra appointments and check ups.

Treatment

During pregnancy the baby’s mother will have:

  • extra antenatal appointments under the care
  • extra scans to check the baby’s growth
  • an induction of labour or caesarean on a planned date
  • the opportunity to discuss SCT with a consultant neonatal surgeon who specialises in SCT surgery

Giving birth

You will be offered an induction of labour or caesarean at St Mary’s Hospital (part of the Manchester Centre for Neonatal Surgery).

During the birth, doctors from the neonatal team will be in the room so they can care for your baby as soon as they are born.

Your baby will be taken to the neonatal unit (NICU) so the doctors can check how well they are.

The NICU is in the same building as the maternity unit.

Occasionally, babies need emergency surgery and will be taken straight to our specialist operating theatres.

Your baby’s treatment

All baby’s with SCT will need an operation.

To find out about the tumour your baby will also have:

  • ultrasound scans
  • MRI scan

Before the operation

The surgeon will explain the operation and answer any questions you have.

Parents/guardians will be asked to sign a consent form to give permission for the operation to go ahead.

In some babies the tumour is extremely large and may rupture (burst) prior to surgery. If this is the case there is a risk the baby will not be able to survive.

Surgery

Your baby will have open surgery under general anesthetic.

The tumour and the coccyx (tailbone) will be removed. Removing the coccyx reduces the chance of the tumour coming back in the future.

Larger tumours or tumours that are inside the body (types 3 and 4) are more difficult to remove.

Sometimes a cut in the tummy is also needed to remove tumours from inside the body.

The operations can take between 2 and 12 hours.

Recovery from surgery

After the operation, your baby will recover in the NICU.

Your baby is likely to be able to breast or bottle feed within a few days of the operation.

During the operation, your baby will have a catheter put into their bladder to drain their urine (wee). This is usually removed after around 48-72 hours. Your baby will have an ultrasound scan the day after the operation to check the bladder is emptying fully.

Your baby can go home when:

  • they are feeding well
  • they are gaining weight
  • the wound is healing

Outlook

Approximately one in three children who are born with a SCT will have long term problems.

There is a small risk the tumour will regrow.

After the removal of SCT, some children can have:

  • problems emptying their bladder
  • constipation

Follow up

Until your child is 3 years old, they will be reviewed every 3 months.

After your child is 3 years old, they will be reviewed once a year.

At these appointments your child will have:

  • a ‘tumour marker’ blood test – this blood test checks for signs that the tumour may have regrown but is too small to
    see on scans
  • an ultrasound scan of the urinary system and pelvis