# Pediatric Surgical Oncology Fundamentals — GCMD Library living collection

Updated: n/a · 8 episodes · 38 cited statements

## Episodes
### Core Concepts
- [An Introduction to Pediatric Surgical Oncology](https://library.globalcastmd.com/watch/an-introduction-to-pediatric-surgical-oncology-16260) — article · [machine version](https://library.globalcastmd.com/watch/an-introduction-to-pediatric-surgical-oncology-16260.md)
- [Pediatric Surgical Oncology](https://library.globalcastmd.com/watch/pediatric-surgical-oncology-16261) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-surgical-oncology-16261.md)
- [What is new in pediatric surgical oncology?](https://library.globalcastmd.com/watch/what-is-new-in-pediatric-surgical-oncology-16285) — article · [machine version](https://library.globalcastmd.com/watch/what-is-new-in-pediatric-surgical-oncology-16285.md)

### Training & Education
- [Development and Implementation of a Global Pediatric Oncology Surgery Fellowship Curriculum: A Consensus-Driven and Collaborative Effort to Address Workforce Challenges](https://library.globalcastmd.com/watch/development-and-implementation-of-a-global-pediatric-oncology-surgery-fellowship-16271) — article · [machine version](https://library.globalcastmd.com/watch/development-and-implementation-of-a-global-pediatric-oncology-surgery-fellowship-16271.md)
- [Evolution of pediatric surgical oncology as a subspecialty](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290) — podcast · 26:59 · [machine version](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290.md)
- [Pediatric Oncology, An Issue of Surgical Oncology Clinics of North America](https://library.globalcastmd.com/watch/pediatric-oncology-an-issue-of-surgical-oncology-clinics-of-north-america-16294) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-oncology-an-issue-of-surgical-oncology-clinics-of-north-america-16294.md)
- [Pediatric Cancer, An Issue of Surgical Oncology Clinics of North America, E-Book](https://library.globalcastmd.com/watch/pediatric-cancer-an-issue-of-surgical-oncology-clinics-of-north-america-e-book-16299) — article · [machine version](https://library.globalcastmd.com/watch/pediatric-cancer-an-issue-of-surgical-oncology-clinics-of-north-america-e-book-16299.md)

### Research & Outcomes
- [Developing the research roadmap together: a report from the patient-centered outcome research institute (PCORI) and pediatric surgical oncology research collaborative (PSORC)](https://library.globalcastmd.com/watch/developing-the-research-roadmap-together-a-report-from-the-patient-centered-outc-16266) — article · [machine version](https://library.globalcastmd.com/watch/developing-the-research-roadmap-together-a-report-from-the-patient-centered-outc-16266.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=0) Introduction and emergence of pediatric surgical oncology as a subspecialty (Ep 5)
- [3:27](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=207) Wilms tumor: diagnosis, genetic profiling, and treatment paradigms (Ep 5)
- [10:06](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=606) Pediatric liver tumors: hepatoblastoma, PRETEXT staging, and international collaboration (Ep 5)
- [17:13](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1033) Minimally invasive surgery in pediatric oncology: applications and limitations (Ep 5)
- [20:43](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1243) Fertility preservation and radiation exposure in pediatric cancer patients (Ep 5)
- [25:31](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1531) Closing remarks (Ep 5)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Changes in molecular and genetic profiling of tumors has caused a paradigm change in surgical oncology, particularly in pediatrics where biological considerations affect treatment pathways and prognostication. — Roshni Dasgupta (clinical) [Ep 5 · 2:54](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=174)
- Wilms tumors generally present in children under the age of 4, usually with an asymptomatic palpable mass often found during a well-child check. — Roshni Dasgupta (clinical) [Ep 5 · 4:55](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=295)
- Imaging paradigm for suspected Wilms tumor starts with ultrasound, followed by CT or MRI depending on tumor appearance and genetic predispositions. — Roshni Dasgupta (clinical) [Ep 5 · 5:12](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=312)
- In Wilms tumor, metastatic disease alone is not a contraindication to primary surgical resection if the local stage appears resectable, unlike in other pediatric cancers. — Roshni Dasgupta (clinical) [Ep 5 · 5:50](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=350)
- Loss of heterozygosity at 1P and 16Q are poor prognostic factors in Wilms tumor, occurring in about 5% of patients and requiring more intensive therapy. — Roshni Dasgupta (clinical) [Ep 5 · 6:14](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=374)
- Gain of 1Q occurs in about 30% of Wilms tumor patients and requires more intensive therapy. — Roshni Dasgupta (clinical) [Ep 5 · 6:34](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=394)
- Patients under age 2 with Wilms tumors under 550g can be treated with surgery alone without chemotherapy, avoiding late effects. — Roshni Dasgupta (clinical) [Ep 5 · 6:44](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=404)
- In North America, Wilms tumor patients are typically operated on upfront, whereas in Europe the protocols favor giving chemotherapy first to shrink tumors. — Roshni Dasgupta (clinical) [Ep 5 · 8:14](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=494)
- In North America, neoadjuvant chemotherapy for Wilms tumor is given to patients with very high risk of rupture or extensive caval metastasis. — Roshni Dasgupta (clinical) [Ep 5 · 8:27](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=507)
- Genetic data (loss of heterozygosity at 1P and 16Q) has led to increased therapy intensity but does not dictate surgical management, which is primarily based on anatomical factors. — Roshni Dasgupta (clinical) [Ep 5 · 9:10](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=550)
- Patients with Wilms tumor have over 90% survival when taking all comers, so the focus has shifted to therapy reduction and preventing late effects. — Roshni Dasgupta (epidemiological) [Ep 5 · 9:36](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=576)
- About two-thirds of liver tumors in children are malignant. — Roshni Dasgupta (epidemiological) [Ep 5 · 10:57](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=657)
- Infantile hemangiomas in children are different from adult liver hemangiomas (which are venous malformations); infantile hemangiomas proliferate and then involute. — Roshni Dasgupta (clinical) [Ep 5 · 11:00](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=660)
- Hepatoblastoma is the most common liver tumor in children, usually presenting under age 3. — Roshni Dasgupta (epidemiological) [Ep 5 · 11:24](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=684)
- Children with hepatoblastoma generally do not have underlying liver disease, unlike adults with hepatocellular carcinoma who often have cirrhosis or chronic liver conditions. — Roshni Dasgupta (clinical) [Ep 5 · 12:00](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=720)
- Most hepatoblastoma patients have elevated AFP, and there is characteristic diagnostic imaging for hepatoblastoma. — Roshni Dasgupta (clinical) [Ep 5 · 13:20](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=800)
- Hepatoblastoma is staged using the PRETEXT staging system, done prior to any treatment, with annotation factors for vascular involvement, hepatic vein involvement, metastatic disease, and multifocality. — Roshni Dasgupta (clinical) [Ep 5 · 13:30](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=810)
- PRETEXT 1 and 2 hepatoblastoma patients are treated upfront with surgical resection; these have a nice margin around hepatic veins and are easily resectable. — Roshni Dasgupta (clinical) [Ep 5 · 13:55](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=835)
- PRETEXT 3 and 4 hepatoblastoma patients with multifocal disease are treated with chemotherapy upfront, then surgical resection after 2-3 cycles. — Roshni Dasgupta (clinical) [Ep 5 · 14:06](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=846)
- Hepatoblastoma patients with multifocal disease who have minimal response after two cycles of chemotherapy are referred to transplant centers, as transplant is a viable option. — Roshni Dasgupta (clinical) [Ep 5 · 14:19](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=859)
- Pediatric tumors are rare—the most common types have between 700-800 cases per year, orders of magnitude less than adult cancers like breast or lung cancer. — Roshni Dasgupta (epidemiological) [Ep 5 · 15:24](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=924)
- International data sharing through cooperative groups is integral to studying pediatric tumors, understanding outcomes, and developing common treatment paradigms across surgery, chemotherapy, and radiation. — Roshni Dasgupta (clinical) [Ep 5 · 15:40](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=940)
- The Pediatric Hepatic International Tumor Trial (PHITT) includes European and Japanese colleagues, does central radiological reviews, and has improved patient care while generating new research questions. — Roshni Dasgupta (clinical) [Ep 5 · 16:39](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=999)
- Minimally invasive surgery in pediatric oncology has been primarily diagnostic, including thoracoscopic biopsies of lung nodules and is frequently used for ovarian tumors. — Roshni Dasgupta (clinical) [Ep 5 · 17:59](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1079)
- A new study is planned comparing thoracoscopy versus thoracotomy in patients with osteosarcoma. — Roshni Dasgupta (clinical) [Ep 5 · 18:20](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1100)
- Robot use in pediatric oncology is limited by patient body size; in patients weighing 4-5 kg, robots are difficult to use due to port size constraints. — Roshni Dasgupta (clinical) [Ep 5 · 18:35](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1115)
- Robots have been used for retroperitoneal nodal dissections in patients with paratesticular rhabdomyosarcoma. — Roshni Dasgupta (clinical) [Ep 5 · 18:53](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1133)
- The same oncological operation must be achievable minimally invasively as can be done open; if not, the procedure should not be done minimally invasively. — Roshni Dasgupta (opinion) [Ep 5 · 20:17](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1217)
- Pediatric cancer now has about 85% overall survival, resulting in many survivors whose biggest concern is ongoing fertility. — Roshni Dasgupta (epidemiological) [Ep 5 · 21:52](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1312)
- Fertility consults should be offered to all patients undergoing any chemotherapy, with risk assessment based on therapy type. — Roshni Dasgupta (guideline) [Ep 5 · 22:12](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1332)
- Cyclophosphamide dose greater than 4 g/m² poses significant risk of premature ovarian insufficiency and azoospermia. — Roshni Dasgupta (clinical) [Ep 5 · 22:19](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1339)
- Testicular exposure to more than 4 Gy of radiation can cause permanent azoospermia, and this dose can be reached just with scatter radiation. — Roshni Dasgupta (clinical) [Ep 5 · 22:36](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1356)
- In females, 10-15 Gy of radiation (achievable with scatter alone) can cause significant ovarian damage. — Roshni Dasgupta (clinical) [Ep 5 · 22:51](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1371)
- In prepubertal boys, fertility preservation requires testicular biopsy and tissue preservation, but maturation of that testicular tissue has not yet been achieved. — Roshni Dasgupta (clinical) [Ep 5 · 23:11](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1391)
- Prepubertal ovarian preservation is important but maturation has not yet been realized. — Roshni Dasgupta (clinical) [Ep 5 · 23:32](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1412)
- In postpubertal patients, ovarian stimulation (requiring about 2 weeks of hormonal stimulation) and sperm banking are used, similar to adults. — Roshni Dasgupta (clinical) [Ep 5 · 23:45](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1425)
- In pediatric radiology, ultrasound and MRI are used much more commonly than CT scans to minimize radiation exposure, even for conditions like appendicitis. — Roshni Dasgupta (clinical) [Ep 5 · 24:50](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1490)
- Pediatric cancer patients are followed with plain radiographs or MRIs depending on disease process, and sometimes ultrasound is amenable for surveillance. — Roshni Dasgupta (clinical) [Ep 5 · 25:10](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=1510)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Pediatric cancer remains one of the top causes of death in children despite advances over the last several decades. — Tim Pollock summarizes what Dr. Roshni Dasgupta said [Ep 5 · 1:19](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=79)
- Specific focus on pediatric oncology has only been established over the last 50 years. — Tim Pollock summarizes what Dr. Roshni Dasgupta said [Ep 5 · 1:27](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=87)
- Surgical oncology has become a clear subspecialty within pediatric surgery. — Tim Pollock summarizes what Dr. Roshni Dasgupta said [Ep 5 · 1:36](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=96)
- Renal tumors are the second most common abdominal tumor in the pediatric population, behind only neuroblastoma. — Tim Pollock summarizes what Dr. Roshni Dasgupta said [Ep 5 · 4:18](https://library.globalcastmd.com/watch/evolution-of-pediatric-surgical-oncology-as-a-subspecialty-16290?t=258)

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