Advances in Treating Children with Cancer: The CWPW Pediatric Solid Tumor Program
Jul 1, 2014 - 11:39:02 AM
The Program, under the guidance and leadership of Mehmet Fevzi Ozkaynak, MD, is a comprehensive, multidisciplinary approach to cases in pediatric oncology and taps the vast breadth of resources contained within the CWPW subspecialist network. From pediatric surgeons to highly experienced experts in oncology and blood disorders/stem cell transplantation, CWPW's Pediatric Solid Tumor Program is an all-encompassing, finely tuned approach to diagnosing and treating a range of pediatric cancers.
"We're the pediatric hematology and oncology professionals in the region," Dr. Ozkaynak explains, adding that the most commonly seen cancers in children are leukemia and brain tumors, followed by lymphoma. There are a variety of other pediatric cancers that are not typical in adults, including neuroblastoma, rhabdomyosarcoma, a muscle tumor, and Wilms' tumor, a cancerous mass originating from the kidney. With this in mind, the Pediatric Solid Tumor Program offers comprehensive medical care in diagnosing and treating multiple forms of pediatric cancers.
CWPW has a full complement of subspecialists dedicated to diagnosing and treating all forms of pediatric cancer. With the guidance of Mitchell Cairo, MD, Chief of the Division of Pediatric Oncology and Hematology, the Pediatric Solid Tumor Program enlists pediatric surgeons, pediatric urologists, liver surgeons, adolescent gynecologists, orthopedic surgeons, and numerous other subspecialists to discuss each patient and determine the most efficacious course of treatment.
What sets the Pediatric Solid Tumor Program apart from other facilities are the unique approaches to navigating the patient through the right channels of diagnostics, with a comprehensive, multidisciplinary approach that leads to individualized, tailored treatment. When six-year-old Julianna Pierre of Middletown, NY, exhibited a host of symptoms ranging from a stomach ache and fever to vomiting and abdominal swelling, her general pediatrician immediately contacted CWPW for subspecialty expertise. Upon examination, the child was diagnosed with Wilms' tumor, a unique childhood cancer of the kidney.
Nicole Pierre, Julianna's mother, knew something wasn't right when her daughter first complained of a stomach ache. "I thought at first that it was indigestion; I gave her tea, but the next morning she wasn't looking good at all." She took Julianna to her general pediatrician, who suspected stomach flu. When Julianna began to run a fever, her doctor suggested they take the child to the emergency room. "They did blood tests, but they came back fine," Mrs. Pierre recalls. "I know my daughter, and she just wasn't right." After a sonogram, the cause of her discomfort was revealed: "They found a mass on her kidney," Mrs. Pierre says.
Physicians in the Pediatric Solid Tumor Program assessed her condition and, in conjunction with pediatric surgeons, including Samir Pandya, MD, and Whitney McBride, MD, co-surgeons on Julianna's case; as well as Oya Tugal, MD, a pediatric oncologist and hematologist, the child underwent a number of procedures, including surgery, chemotherapy and radiation. She responded well to all treatments, and is now eight years of age and in remission.
"The child presented with a renal mass," Dr. Tugal recalls. "She had abdominal pain, was vomiting, and had a fever of 103 degrees." An ultrasound and CT scan revealed a mass on her right kidney. The tumor, however, had not spread to her lungs or to any other organs. She was admitted to Maria Fareri Children's Hospital and was diagnosed with Stage III Wilms' tumor where she underwent surgery.
"This was a very challenging case," explains Dr. Pandya. "She had a very extensive tumor that extended into her inferior vena cava that had lead to a thrombosis, making surgery very difficult." Dr. Pandya was part of the group that met to discuss the case before and after surgery.
According to Dr. Pandya, Wilms' tumor is not that uncommon in children. "It can extend into the inferior vena cava and thereby make surgery more challenging. When it extends all the way up to the right atrium of the heart, the patients require chemotherapy first. However, in Julianna's case, the thrombus (clot) was just below the level of the heart by a few centimeters. She therefore fell into a grey zone, so to speak. We discussed whether to administer chemotherapy before as well as after surgery versus after surgery alone. Since it was below level of right atrium, we took out the right kidney and the tumor." Dr. Pandya found that the tumor had extended all the way up to the level of the hepatic veins. "Her own body had formed collateral circulation to drain blood back to the heart, since the inferior vena cava was blocked. We had to tie off the cava. If we didn't close it off and the tumor flipped and moved, it is conceivable that she could have suffered a fatal clot in the lungs."
The surgery took ten hours, with Dr. McBride assisting. "Within a week she was ambulating again and has never developed any swelling in her legs. That was great."
Her surgical wound healed very well, he says. She subsequently underwent chemotherapy. Dr. Pandya examined the child and she is free of disease.
"We have outstanding expertise from the surgical, medical and radiation standpoints to treat these solid tumors that children are sometime faced with," Dr. Pandya explains. "It requires multi-disciplinary approach, and we have an outstanding team here".
"Under the pioneering leadership of Dr. Gustavo Stringel, Chief of Pediatric Surgery, historically many of the region's first minimally invasive operations on children were performed. As a division we continue to push the envelope and find new frontiers in the surgical care of children. We perform the most advanced pediatric minimally invasive surgery (MIS) here in this hospital, but in children with cancer, it is often not possible to do MIS, as was the case in this instance. However, if it is possible, I would not hesitate to proceed minimally invasively as long as it is safe and in agreement with the surgical oncologic principles" he adds. "This was a success story, and we're proud of our efforts."
Julianna's parents could not be more pleased with their daughter's treatment, and with the successful outcome. "They are really terrific over there," Ms. Pierre says, referring to Drs. Ozkaynak, Pandya, and the Pediatric Solid Tumor Program team. ‘They really are excellent doctors."
"It was a hard time, but thankfully it was very, very successful," Mrs. Pierre adds. "She's a smart girl; they did not keep her back in school. She loves to study." Even before the onset of her illness, Julianna announced plans to pursue a career - in pediatric medicine.
"Everyone was excellent" throughout their daughter's ordeal, recalls Reginald Pierre, Julianna's father, who adds that he can't say enough about the physicians in the Pediatric Solid Tumor Program who treated Julianna and oversaw her recovery.
Pediatric surgeons in the Program are integrating new procedures in state-of-the-art facilities in tackling some of the most challenging cases, such as laparoscopic surgery - where surgeons operate through a small incision - when appropriate. Other advanced equipment and techniques such as radiotherapy are also implemented when warranted.
"Our surgeons are doing new things in approaching these cancers," Dr. Ozkaynak explains. "Our Program is blessed with excellent surgeons and oncologists making real inroads in diagnosis and treatment of pediatric solid tumors."
About Children's & Women's Physicians of Westchester, LLP
Children's & Women's Physicians of Westchester is one of the largest medical practices in the nation comprised of dedicated doctors and health professionals committed to providing comprehensive inpatient and outpatient care to women, infants, children and adolescents. The medical practice is located throughout the greater New York Metropolitan area, extending from New York City, throughout the Hudson Valley, including Westchester, Rockland, Dutchess, Putnam and Orange Counties as well as in Southern Connecticut. For information on our medical specialties and office locations visit our website atwww.cwpw.org.
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