Which Diseases Are Treated at Pediatric Surgery Unit

Considering WHO's definition of a child that is "an individual between 0 and 18 years of age," that's the age group we serve. Pediatric Surgery emerged as an independent branch in the first quarter of the last century, and in the beginning, it involved all types of surgery. In parallel with advances in knowledge, experience and technology, our field's framework was gradually defined with more precision. We carry out general surgery, urology, chest and thoracic surgery, gynecology and plastic-reconstructive surgery that remain outside the scope of orthopedics, heart surgery, eye surgery, otorhinolaryngology surgery for pediatric diseases.

Children should never be considered miniature adults. They have unique anatomic, physiologic and emotional characteristics. While there are universal surgical principles, pediatric surgery differs in both general approach and in technical features. Advances in science and technology allow us to comfortably carry out invasive procedures
(for example, endoscopic, laparoscopic, robotic).

What are the advances in diagnoses and treatments in pediatric surgery in the last 10 years? Can you provide some examples?

• Laser and ultrasonic technological products that began to be used in surgeries.
• Very detailed radiological examinations and embolization methods for safe surgery.
• Emergence of robotic surgery
• Popularization of laparoscopic and endoscopic surgeries.
• Widespread use of interventional radiology procedures
• Advances in anesthesia drugs and practices.
• Advanced technological level and automation of infant and pediatric intensive care units.

Which diseases are treated at AMC's Pediatric Surgery unit?

• Congenital anomalies (obstruction in the esophagus-stomach-intestines or colon or rectum, dislocated heart or part or all of intestines, non-separated arms or legs, syndactyly, deficiencies or excesses, cleft lip and cleft palate)
• Nausea, failure to defecate or uncontrolled defecation, failure to urinate or incontinence, bloody stool after birth
• Congenital hernia that may present on the groins, belly or stomach in later years
• One or two undescended testicles
• Water-filled cysts in the sac or groin
• Painful, red swelling in the sac
• Urinating from below or above the penis
• Non-separated foreskin
• Kidney and urinary tract diseases that cause repeating urinary tract infections, kidney stones and widening of kidney and urinary tract roads.
• Deformations in the rib cage or back
• Crooked neck
• Painful or painless, runny swellings in the neck that may sometimes repeat, goiter
• Benign tumors called hemangiomas/arteriovenous malformations that present as a red mole in the head, neck and almost all parts of the body
• Pediatric benign tumors and cancers that may present in organs such as liver, spleen, kidneys, adrenal glands, stomach, intestines and bladder
• All types of central catheter and port catheter applications for children.
• All congenital and acquired intraabdominal inflammations including appendicitis that present with symptoms such as stomach pain, high fever, nausea, vomiting, etc.
• Childhood traumas and burns

What are the frequently performed pediatric surgeries at AMC?

We handle about 750-850 cases per year with our team.
Our pediatric intensive care unit, newborn intensive care unit, pediatric radiology and pediatric anesthesiology departments allow us to safely handle all cases. Our full-time pediatric nephrology, pediatric cardiology, pediatric neurology, pediatric endocrinology and pediatric hematology/oncology and newborn specialists, and specialists from perinatology and other consulting branches of pediatric diseases are our greatest supporters.

We successfully perform hypospadias, undescended testicles, groin hernia, kidney and urinary tract obstructions, repair of infants with congenitally closed anus, front abdominal wall anomalies (omphalocele, gastroschisis, etc.), all types of stomach-esophagus and intestinal surgeries. Since we are a comprehensive and accredited Oncological Sciences Medical Center, we also frequently perform neuroblastoma, nephroblastoma, teratoma and rabdomyosarcoma surgeries, even on patients at advanced stages.

What is the probability of success in treating congenital anomalies through surgery?

Considering advancing technological options and the point reached by science, we can say that there is no congenital anomaly that cannot be cured or supported. The important thing is to enable early diagnosis methods, and carrying out prenatal screening regularly and healthily. This will allow making preparations for anomalies that are identified in advance, and both infants and mothers can receive the best service and achieve the best results.

Which type of cancer is the most frequent cause for pediatric cancer surgery in AMC? Can you provide some information about the working method/process of AMC in pediatric oncology cases?

In adults, measures to be taken may prevent a significant portion of cancers, and screening tests allow early diagnosis. For example, by stopping smoking, most of the lung cancers and many cancers for which the leading cause is smoking, such as throat cancer, may be prevented. Diet, obesity, regular exercise also plays a part in preventing adult cancers.

There are no established screening tests similar to the ones in adults for children. Early diagnosis of these patients is only possible by knowing the findings and symptoms relating to these diseases, and ensuring swift diagnosis. Most of our pediatric patients apply at a very advanced stage. Despite this fact, the survival rate is above 65%. Early diagnosis may increase this rate to 70-80%. Our duty in this is both training new doctors, and informing the public, the parents through the media.

Pediatric cancers are very different from adult cancers in terms of treatment response rates and long-term survival. Pediatric cancers constitute 4% of all cancers. Today, one in every 900 child in developed countries is a pediatric cancer survivor (had cancer and got cured). Every year, approximately 2500-3000 pediatric cancers are diagnosed every year.

Thanks to important advances in cancer diagnosis and treatment, survival rates in childhood cancers is over 70-80% in developed countries. The success rate is even higher in cases that are diagnosed early.

30% of pediatric cancers are leukemias, and the remaining 70% are solid tumors.

Cancer is not contagious. In general, it also is not an inherited disease. A type of pediatric cancer that is known to be inherited is hereditary retinoblastoma, which is an eye tumor. Some inherited diseases increase cancer risk. Diseases that suppress the immune system cause an increased risk of cancers originating from lymph tissue. In recent years, many studies were conducted on the effects of extremely low frequency electromagnetic fields (EFM) on cancer development in children, but no significant increase was found for common EFM exposures (microwave ovens, etc). Studies on high frequency magnetic fields are ongoing.

What are the warning signs in pediatric cancers?

The adult screening tests that allow early diagnosis of cancer in adults are not available for children. This is why one has to know about the most common warning signs and symptoms of pediatric cancers. The most common findings and symptoms are:

• Swollen lymph nodes in the neck, armpit and groin
• Swelling in any part of the body
• Paleness, fatigue
• Frequent fever
• Bruises, purple spots on the skin
• Nose, gum bleeding
• Headache, vomiting
• Feverless seizures
• Imbalance, gait disorder, vision impairment
• Bone, joint pains
• Persisting cough, shortness of breath despite infection treatment
• Retarded development, excessive weight loss
• Blood in urine, difficulty urinating and defecating
• Shiny pupil, crossed eyes

Cancers in Adolescence

Cancer rate in this age group is twice the rate in the group below 15. Adolescent cancer types are also different from adult cancer types.

It is important to note that skin tumors are increasing in adolescents in recent years. That's why measures such as protection from ultraviolet radiation, not being exposed to sunlight for prolonged periods and using protective creams should be reminded.

How are cancers treated?

Cancer treatment is a teamwork. It is important for cancer patients to be treated in fully-equipped centers, with a multi-disciplinary team under the leadership of the pediatric oncologist. There are three main types of cancer treatment.

• Surgery
• Drug therapy (Chemotherapy)
• Radiation therapy (Radiotherapy)

These types of treatment are used in various combinations depending on the type of cancer and age of the child. Adding chemotherapy to surgery and radiotherapy significantly increased survival rates in pediatric cancers. Approximately 70-80% of children who get cancer can be cured today. In order to allow these children to live a long life as a healthy individual in society, we have to both cure children from cancer through effective treatments, and to plan treatment with minimum late-term side effects.

Today, treatments are arranged according to staging and risk classifications that involve clinical, biological and genetic features in childhood cancers. Furthermore, biological treatments, targeted therapies and vaccination studies are carried out for some tumor types. While some of these were effective, some didn't produce the desired benefits. Supportive treatment is very important for specific treatments. Cancer treatment is a long and difficult process. Children have to stay away from their social environment, friends and school for a period of time. The child has to be psychologically and socially supported in this period.

As a result, the probability of curing childhood cancers is high.

Thanks to our cutting-edge facilities in our hospital and our multi-disciplinary approach, we treat all kinds of pediatric cancer cases. First, we examine the cases in detail, with all aspects, and then we discuss it with the family in our Pediatric Oncology Council. Then we carry out all the interventions necessary in line with the recent universal cancer treatment standards. Particularly in nephroblastomas, teratomas and rabdomyosarcomas and other soft tissue tumors, our survival rate is about 80% in all stages.

Do you have any recommendations for parents in terms of awareness? Would you recommend routine controls for children?

It is important for all children to be regularly examined by a doctor both for monitoring their development, and for general examination. If a pediatric cancer sign or symptom is observed, the doctor should be immediately consulted and the patient should be referred to a fully-equipped healthcare institution if there's a suspicion of cancer. We must remember that early diagnosis increases success.