A delicate challenge: Managing gynaecological tumours in children, adolescents

Gynaecological tumours such as ovarian tumours in children and adolescents present complex diagnostic, emotional, and treatment challenges for young patients, families, and healthcare providers. The Malaysian Society of Paediatric Haematology and Oncology estimates the incidence of paediatric cancer is about 77.4 cases per million children aged below 15 years old. [https://maspho.org/cancer-information/#whats-cancer]

Paediatric cancers are significantly different than those seen in adults and react distinctly to treatment. Early awareness and a multidisciplinary approach are key to improving outcomes and preserving the future quality of life for affected children, said Dr Shona Alison Edmonds, a consultant paediatric surgeon, at the recent 2nd International Paediatric Symposium organised by Sunway Medical Centre, Sunway City.

Although only about five paediatric gynaecological tumour cases—most commonly ovarian tumours—present to Shona and her team each year, the disease impact on patients is huge. Many patients had subtle signs that were not noticeable for up to several months while some presented with acute pain that required emergency care. They typically had symptoms of chronic constipation, frequent urination, and abdominal bloating.

“Chronic constipation in a previously regular child should raise concern, especially if unresponsive to laxatives or diet,” said Shona. Another warning sign pointing to pressure from a pelvic mass is frequent urination without a urinary tract infection (UTI). Occasionally, the child or her parents may observe unexplainable abdominal fullness, hardness or swelling. All of these signs call for further investigation, beginning with an ultrasound, she added.

The lack of awareness among the public and healthcare professionals is a major barrier to timely diagnosis. “There’s a misconception that children don’t get gynaecological tumours, especially prepubertal girls. When teenagers show symptoms, it’s often misattributed to infections or sexual activity, delaying proper intervention,” said Shona.

Systemic delays are commonly due to patient’s family seeking alternative treatments or postponing medical check-up fearing negative news, and doctors who may be unaware of the correct referral pathway. She pointed out that children with a suspected tumour should be seen and managed primarily by a paediatric oncologist.

Planning ahead for long-term care
“While fertility preservation is important, it must never come at the expense of a child’s survival; tumour treatment takes priority. Older girls may delay treatment by 2 weeks to preserve eggs; in younger girls, ovarian tissue cryopreservation offers hope,” said Shona. Awareness related to fertility preservation is growing among parents, hence it is important to involve fertility specialists in the treatment planning, she added.

In terms of long-term well-being, disease management should include psychological support during and after treatment to help children and their family cope with the trauma. “Caring for the children’s development require care beyond the tumour itself,” Shona emphasised.

She added that young patients with gynaecological tumours should be managed holistically by a multidisciplinary team that addresses all aspects of their well-being. Coordinated care becomes crucial with a paediatric oncologist as the gatekeeper and involves paediatric surgeons, radiologists, pathologists, psychologists or psychiatrists, social workers, play therapists, and adolescent and fertility gynaecologists.