Introduction

Tumors in the neonatal period are rare (1). Several principles extend throughout the spectrum of neonatal tumors when compared with other tumors. Neonatal tumors are more often benign. If malignant, they are more difficult to treat and more likely to be genetic. Fetal circulation can change metastatic patterns of malignancies. In general, cancer is treated using surgery, radiation, and chemotherapy. However, in neonates, radiation is avoided and chemotherapy has increased morbidity and mortality. Additionally, neonatal tumors tend to be more primitive tumors that are less sensitive to chemotherapy. With the increasing use of prenatal ultrasound, more neonatal tumors are diagnosed prenatally, and perinatal treatment modifications can be made. This is especially important in large abdominal, oral, or cervical tumors. This chapter will review both malignant and benign tumors that occur in the newborn (Table 21.1). For malignant tumors, a basic overview, covering incidence, staging, differential diagnosis, and treatment, is included.

Epidemiology

Cancer in the newborn (defined for the purpose of this chapter as cancer diagnosed before one month of life) is a rare event. Cancers diagnosed in neonates make up only 1% of all cancers diagnosed in children under 15 years of age (2). Data from the Third National Cancer Survey (1961–71) reported the incidence of cancer in neonates being 36.5 per million live births, with 50% found on the first day of life (3). Data from the Surveillance, Epidemiology, and End Result program from 1973 to 1992 show the incidence of neonatal cancer is 26.8 per million live births (2).