Sacrococcygeal Teratoma

What Is a Sacrococcygeal Teratoma?

A sacrococcygeal (say-crow-cox-a-jee-al) teratoma is a tumour which is made of three layers of tissue cells which usually appear on the lower back or buttocks of a developing baby. It is a rare condition, occurring approximately once in every 35-40,000 births. Girls are four times more likely to be born with this than baby boys. Generally SCT’s are benign tumous, but it is possible that there are cancer cells inside the tumour. When your baby is born the teratoma will be tested to see what type of cells it contains. The majority of sacrococcygeal tumours are not cancerous.

What Caused This to Happen?

Nothing you did or didn’t do during your early pregnancy caused this to happen! It is not exactly known why sacrococcygeal teratomas begin to grow, but we do know that they contain several types of cells

What Does This Mean for the Rest of the Pregnancy?

You will have lots of ultrasounds and clinic appointments for the remainder of your pregnancy to monitor the growth of the teratoma and your baby. While most teratomas are solid or have cysts inside, sometimes the baby’s heart has to pump harder if there is blood flowing through the teratoma. Your baby will be closely examined each time you have an ultrasound to ensure his or her heart is not working too hard. You will likely be asked to deliver your baby at a perinatal centre where surgeons can assess the teratoma once your baby is born. You will meet a pediatric surgeon prior to your baby’s birth also, and they will be able to answer questions you may have.

Are Their Any Fetal Interventions for SCT?

Fetal surgery for SCT is not routinely done in Canada, and is only offered in most American hospitals if the baby is very sick and might not survive.

What Will Happen Around the Time of the Baby’s Birth?

If your baby’s teratoma is small, you will most likely be able to deliver naturally. If the teratoma is larger (usually > 10cm is a good cutoff), you will likely require a cesarean section. This is to prevent the tumour bursting during the birth. Your health care team will review what options are best for you and your baby regarding the actual birth.

After s/he is born, your baby will be transferred to a Neonatal Intensive Care Unit (NICU) and thus may require transfer to a children’s hospital. You will have lots of opportunities to see your baby before s/he is moved. A pediatric surgeon will examine the teratoma and discuss with you the best options for treatment. Your baby will have surgery to have the teratoma removed; the timing will depend on the size and how stable your baby is after birth. The surgery usually takes place sometime in the baby’s first week of life.

Your baby may be able to have milk before the operation, but it may need to be given through a feeding tube. You will be able to breastfeed your baby once s/he has recovered from the operation but it is important that you begin expressing or “pumping” milk as soon as possible after the birth.

What Does This Mean for My Baby in the Future?

The long term effects of being born with a sacrococcygeal teratoma are directly related to the size of the tumour, and how easily it was able to be removed. Your surgeon will see you at clinic appointments for several years. Your child will need yearly follow up to ensure there is no regrowth of the tumour. Some children have difficulty with toilet training if their teratomas were large. Your surgeon will review all of the long term effects with you throughout your time as their patient.

Where Can I Find More Information?

BORN Ontario

References:

Makin, E.C., Hyett, J., Ade-Ajayi, N., Patel, S., Kypros, N. & Davenport, M. (2006). Outcome of antenatally diagnosed sacrococcygeal teratomas: single center experience. Journal of Pediatric Surgery: 41(8): 388-393.

Gabra, H.O., Jesudason, E.C., McDowell, H.P., Pizer, B.L. & Losty, P.D. (2006). Sacrococcygeal teratoma: a 25 year experience in a UK regional center. Journal of Pediatric Surgery: 41 (8): 1513-1516.

Schmidt, B., Haberlik, A., Uray, E., Ratschek, M. Lackner, H. & Hollworth, M.E. (1999). Sacrococygeal teratoma: clinical course and prognosis with a special view to long term functional results. Pediatric Surgery International: 15 , 573-576.

Hedrick, H.L., Flake, A.W>, Crombleholme, T.M., Howell, L.J., Johnson, M.P., Wilson, R.D., Adzick, N.S. (2004). Journal of Pediatric Surgery. 39(3), 430-438. Benachi, A., Durin, L., Maurer, S.V., Aubry, M-C., Parat, S., Herlicoviez, M., Nihoul-Fekete, C., Dumez, Y. & Dommergues, M. (2006). Prenatally diagnosed

sacrococcygeal teratoma: a prognostic classification. Journal of Pediatric Surgery, 41(8), 1517-1521.

Rescoria, F.J., Sawin, R.S., Coran, A.G., Dillon, P.W. & Azizkhan, R.G. (1998). Long term outcome for infants and children with sacrococcygeal teratoma: a report from the childrens cancer group. Journal of Pediatric Surgery, 33(2), 171-176.

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