Dr Edmonds says symptoms can be early but signs of gynaecological tumours are often overlooked.
GYNAECOLOGICAL tumours in children and adolescents are often overlooked in Malaysia.
Though rare, ovarian tumours present complex diagnostic, emotional and treatment challenges for young patients, families and healthcare providers, according to a media statement by Sunway Medical Centre (SMC).
The Malaysian Society of Paediatric Haematology and Oncology estimates an incidence of about 77.4 per million children under 15, with cancers that differ markedly from those found in adults and respond differently to treatment, it added.
SMC consultant paediatric surgeon Dr Shona Alison Edmonds said early awareness and a multidisciplinary approach were key to improving outcomes and preserving the future quality of life for affected children.
Dr Edmonds and her team, who see about five paediatric gynaecological tumour cases annually, said although rare, their impact is significant.
Most patients are infants to teenagers, with ovarian tumours being most common, she said.
Some present acute pain needing emergency care, but many show subtle signs that can go unnoticed for weeks or months, especially in girls without prior gynaecological issues, she noted.
“Chronic constipation in a previously regular child should raise concern, especially if unresponsive to laxatives or diet,” she said.
Frequent urination without a urinary tract infection (UTI) was another warning sign, said Dr Edmonds.
She highlighted that abdominal bloating was another clue, but often an overlooked symptom.
“Parents or the child might notice vague fullness, hardness or swelling.
“Sometimes, the child feels a lump or discomfort that’s hard to explain,” she said, adding that these signs warrant further investigation, usually starting with a simple ultrasound.
Dr Edmonds said a major barrier to timely diagnosis was lack of awareness among the public and medical practitioners.
“There’s a misconception that children don’t get gynaecological tumours, especially pre-pubertal girls.
“When teenagers show symptoms, it’s often misattributed to infections or sexual activity, delaying proper intervention,” she said.
She also highlighted systemic delays such as fear of negative news or seeking alternative treatments on the part of the patient, while some physicians might not know the correct referral pathway.
“A child with a suspected tumour should be seen and managed by a paediatric oncologist.
“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 two weeks to preserve eggs; in younger girls, ovarian tissue cryopreservation offers hope,” she said, adding that awareness on this was growing in Malaysia.
Dr Edmonds said caring for the children’s development required care beyond the tumour itself.
She emphasised the importance of psychological support during and after treatment, stressing the need for awareness that any health conditions or cancers in children should involve paediatric care teams.
She said Health Ministry’s guidelines still defined paediatric care as up to age 12, but most gynaecological tumours occurred in teenagers.
“We don’t just treat a tumour. We treat the whole child,” she said, adding that a multidisciplinary team approach addressed all aspects of the child’s well-being.
“The paediatric oncologist usually serves as the gatekeeper.
“From there, the team is then co-ordinated to involve paediatric surgeons, radiologists, pathologists, psychologists or psychiatrists, social workers, play therapists and, increasingly, adolescent and fertility gynaecologists.”
Dr Edmonds advised families not to delay treatment and to seek a second opinion from a qualified medical practitioner.
