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Sacrococcygeal

Teratoma (SCT)


What is it?
SCT is the most common tumour developed within the womb.  The tumour is located at the base of the foetus' spine and usually begins to develop after twenty-two gestational weeks.  These tumours are comprised of both cystic and solid components.  Largely cystic SCTs do not pose the same degree of risk to the foetus as primarily solid SCTs.  When the tumour is fluid filled is does not apply any additional stress the foetus' system, however solid SCTs contain arteries and blood vessels.  As the SCT grows, often exceeding the size of the foetus, the heart must pump blood to tumour as well as the foetus, thereby stressing the heart and causing eventual heart failure.  For these reasons, only foetuses suffering from primarily solid SCTs require inutero intervention.



                                                                                   
On the right is a baby 
                                                                                   
born with an SCT.  
                                                                                   
On the left is a 3D
                                                                                   
ultrasound of a SCT.







Diagnosis
A foetus exhibits initial signs of SCT when the mother appears tool large for her stage during pregnancy.  A blood test of the mother revealing high maternal alpha fetoprotein levels is also a key indicator.  An ultra sound can confirm the existence of the SCT.  The baby's heart rate must be carefully monitored after diagnosis and if signs of hydrops appear, through an irregular heart rate, foetal intervention is necessary.  The weak or irregular heart rate further proves that the tumour is more solid than cystic.


                
                     
The large black mass
                      in the centre of this
                      ultrasound represents
                      a malignant SCT.


Treatment
The treatment for SCT used to be extremely similar to the treatment of CCAM.  Surgeons would enter the womb and remove the tumour from the foetus' tailbone.  This procedure, however, has the opportunity for many complications for both the mother and foetus.  A new procedure has been developed that has revolutionized the treatment of foetal SCT surgeries. 

Radiofrequency ablation is a new technique that does not require the opening of the uterus.  A needle is inserted from outside the mother's body, through her abdomen and into the SCT.  Heat supplying radiofrequency waves are then pumped through the needle and into the solid tumour mass.  The heat destroys all of the arteries and blood vessels in the tumour, thereby reducing, or even eliminating, the hydrops.  The foetus can now continue developing in the womb and the SCT can be safely removed after birth. 





          This picture demonstrates the
          previously practised method
          of removing an SCT by exposing
          the foetus.







Additional Information

Eighty percent of SCTs occur in females, however the risk of malignant SCTs is higher for males.  SCTs occur in one in every forty thousand foetuses and recent evidence is dictating that it may be an autosomal dominant condition.  Foetuses affected by SCT can be delivered vaginally, unless the tumour exceeds diameter of ten centimetres.







The Anatomy and Development of the Foetus


Medical Conditions Affecting the Foetus from initial diagnosis to treatment:
Congenital Diaphragmatic Hernia (CDH)
Congenital Cystic Adenomatoid Malformation of the Lung (CCAM)
Sacrococcygeal Teratoma (SCT)
Urinary Tract Obstruction

Related Technologies:
Ultrasound
Fetoscope
Radiofrequency Ablation (RFA)


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