Treatment for your child’s tumor depends on a few things, such as the tumor type. We also look at the tumor’s stage. The stage tells us the tumor’s location, if the cancer has spread, and how far it spread. We look at the tumor’s grade, and whether it looks low grade or high grade.

Treatment may include surgery, chemotherapy, and sometimes hormone therapy, immunotherapy, or radiation therapy. Your child’s treatment will match the type of tumor they have, and your child’s personal needs. Our goal is to cure the tumor with the fewest side effects.

How we treat carcinomas and other rare solid tumors in kids

Surgery to treat the cancer

Surgery is the most common treatment for carcinomas and rare tumors in children. Our surgeons use a minimally invasive approach when possible. Minimally invasive procedures use small incisions (cuts). This method causes less pain, fewer side effects, and a faster recovery after surgery. We can use robotic surgery for some operations, such as robotic colorectal surgery.

Types of tumor surgery include:

• Resection (surgery to remove the tumor).
• Adrenalectomy (removing the whole adrenal gland) for some children with adrenocortical carcinomas.
• Complete or partial colectomy (removal of the colon) for some children with colorectal cancer. Our surgeons can do bowel reconstruction in some kids to make a special pouch inside their body to collect bowel movements. Other people may have a permanent ostomy. Learn more about pediatric colorectal surgery at MSK.
• Surgery alone may be the only treatment you child needs for neuroendocrine tumors.

Colorectal surgery to lower cancer risk

This surgery is for children and teens with a very high chance of getting colorectal cancer. Their higher risk could be inherited, because of the genes passed on to them from their parents. Or they could have a higher risk because they have many polyps. These are growths in the colon that are not cancer.

To keep cancer from starting, the surgeon removes part or all of the colon, the rectum, or both. We use minimally invasive surgery and do colorectal reconstruction when possible.

Hormone therapy

If your child has an adrenocortical carcinoma, they may take hormone replacement therapy after surgery. Low levels of certain adrenal hormones can affect your child’s blood sugar and blood pressure. Hormone replacement therapy can fix some of these problems.

Hormone therapy is also used for digestive neuroendocrine tumors that have spread or cannot be taken out with surgery. Examples include the hormones octreotide or lanreotide. They keep the tumor from making extra hormones.

This treatment is given as an injection. Sometimes we attach a small amount of a radioactive substance to octreotide or lanreotide to kill cancer cells. This is called peptide receptor radionuclide therapy.

Chemotherapy and targeted therapies

Your child may not need chemotherapy (chemo) if tumor cells have not spread to nearby lymph nodes or other areas. Chemo medicines often are given intravenously (by vein). Your doctor will talk with you about which anti-cancer drugs they will use and how they will be given.

Targeted therapies work by taking aim at the abnormal (not normal) molecules that can fuel a tumor’s growth. They are sometimes used to treat neuroendocrine tumors. Our research studies, known as clinical trials, are exploring targeted therapies for other tumor types.

Many targeted therapies can be taken orally (by mouth).

Immunotherapy

Immunotherapies are treatments that boost the immune system’s ability to find and kill cancer cells. Two of these drugs, nivolumab and ipilimumab, are used for colorectal cancer that came back in kids 12 and older. Another immunotherapy, pembrolizumab, is being assessed in clinical trials as a treatment for adrenocortical tumors.

Some immunotherapies work by releasing the brakes that stop immune cells from attacking cancer cells. Cancer cells can trick the immune system so it will not attack them. Immune cells have brakes that stop them from attacking healthy cells. When we remove the brake, immune cells can see and kill cancer cells.

Radiation therapy

Your child may have radiation therapy if the cancer has come back or spread. Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. For some types of thyroid cancer, doctors use radioactive iodine therapy.

Finding new treatments

MSK Kids researchers are doing clinical trials to test new therapies for young people with carcinomas and other rare tumors. Your care team will tell you if joining a clinical trial is right for your child. Your child may be able to get a new drug that’s not available elsewhere.

Side effects of cancer therapy in kids

Treatments have different side effects. Your child’s side effects depend on the type of treatment they had. Your care team will tell you what to expect. They will support your child and help manage any side effects.

If your child has surgery, your surgeon will let you know how long the surgery may take. They will tell you how long your child may be in the hospital.

There may be some swelling and discomfort around the incision site. Our pain care team makes sure your child is as comfortable as possible. Your surgeon will tell you when your child can go back to their regular activities.

If your child has chemotherapy, side effects can include nausea and vomiting, less appetite, hair loss, and mouth sores. Radiation therapy can cause skin irritation and fatigue (feeling tired).

Not everyone who gets chemotherapy or radiation therapy has all these side effects.

Late effects of cancer treatment

Some children treated for cancer have side effects that start a long time after treatment. They can happen months or years after treatment. Examples of late effects of childhood cancer therapies include:

• Physical problems, such as trouble hearing, infertility (trouble getting pregnant), and kidney problems.
• Changes in feelings, mood, learning, thinking, or memory.
• Second cancers (new types of cancer), such as leukemia.

At MSK Kids, we try whenever possible to use treatments that have the best chance of curing the cancer with the lowest risk of late effects.

What to expect after treatment

We will keep monitoring (checking) your child’s health after their treatment ends. You must come in for visits every now and then so we can be sure the tumor is gone. We will do blood tests and scans to check for any signs it may have come back. If your child had adrenocortical carcinoma or a neuroendocrine tumor, we will check their hormone levels.

We encourage the children we treat for these tumors to get follow-up care through the MSK Kids long-term follow-up program. They will assess your child carefully and look for the kinds of problems treatment can cause.

Our social workers provide counseling, offer information and support, and can guide you to resources. Child life specialists, teachers, and others on the MSK Kids team work together to meet your child’s needs beyond treatment.