Conditions
Childhood brain tumours are abnormal growths of tissue inside the skull.
Childhood brain tumours are abnormal growths of tissue inside the skull. Brain tumours can be benign (non-cancerous) or malignant (cancerous), and may be confined to a small area or spread to other areas. Primary brain tumours originate in the brain, while metastatic cancers are formed in other parts of the body and spread to the brain.
Brain tumours are the most common type of childhood cancer. Tumours occur in children and adults, but treatment may be different for children. Their cause is not known.
Tumours can destroy brain cells directly. They may also cause damage by pressing on other parts of the brain, leading to swelling and increased pressure. This can lead to very serious disorders and, in some cases, death. However, many tumours are treatable.
There are many types of brain tumour that occur in children. These are some of the more common types:
- Medulloblastomas occur the most frequently. They appear more often in boys, usually between the ages of 5 and 10. Chemotherapy and radiation may be combined with surgery to treat these tumours.
- Astrocytomas are generally non-cancerous and slow-growing. These often develop between the ages of 5 and 8, and are usually surgically removable.
- Brainstem gliomas hardly ever appear in adults, and usually develop around the age of six. The tumour may be very large before symptoms appear. Surgery is usually not feasible. Radiation and chemotherapy are used to shrink the tumour; however, the outcome is poor.
- Ependymomas make up about 8-10 percent of childhood brain tumours. These tumours are located in the brain ventricles, and block the flow of cerebrospinal fluid. Treatment may include surgery, radiation and chemotherapy.
Symptoms
These may include:
- Headache
- Vomiting and nausea
- Personality, behaviour and mood changes
- Memory problems
- Seizures
- Reduced alertness or stupor
- Vision problems
- Hearing and speech difficulties
- Decreased sensation or weakness in part of the body
- Poor coordination
- Fever
- Weakness, lethargy and illness
- Abnormal posturing
Babies may have:
- Bulging fontanelles, enlarged head circumference or separated skull sutures
- Abnormal posturing
- Abnormal eye reflexes
Some tumours do not cause symptoms until they are large, when the child's health declines very rapidly and abruptly.
Diagnosis
A physical exam can often identify signs that are specific to a tumour in a particular location.
The presence of a tumour can be confirmed by a CT or MRI scan, or an electroencephalogram (EEG).
A surgical biopsy (where a small amount of brain tissue is removed for analysis) may also be performed to detect a tumour and determine its type, and sometimes cerebrospinal fluid may be sampled and examined.
Treatment
Treatment depends on the size, location and type of tumour, and the age and health of the child. Early treatment often improves the prognosis. If total cure is not possible, treatment may aim to reduce symptoms, improve functioning and relieve discomfort.
Most brain tumours are treated with surgery. Sometimes, the entire tumour can be removed; sometimes, however, the tumour is too deep, or there is risk of damaging sensitive brain tissue; in such cases, surgery may simply reduce the size of the tumour and help reduce pressure.
A shunt (a thin drainage tube) may be inserted to drain cerebrospinal fluid in cases where the tumour has caused a fluid blockage.
Radiation therapy (high-dose) is used, but it is limited, because it can have an effect on a child's growth and brain development. Research is being done into ways to decrease or delay this treatment for growing children.
Chemotherapy (drugs that kill cancer cells) is used for more aggressive tumours.
Certain supplementary medications may also be helpful:
- Pain medication
- Corticosteroids and diuretics to reduce brain swelling and pressure
- Anti-convulsants to reduce seizures
Physical and occupational therapy, as well as counselling and support groups, may help the child and the family to cope.
Complications
- Brain herniation - the displacement of brain tissue, cerebrospinal fluid, and blood vessels, which may cause death
- Severe neurological problems and loss of ability to function
- Side effects of chemotherapy and radiation treatment.
- Recurrence of the tumour
- In some cases, the tumour is fatal
When to call a doctor
If a child has persistent headaches or other symptoms, you should call a doctor. Emergency services should be called if the child experiences seizure, stupor, or sudden vision or speech changes.
Prognosis
Advances in chemotherapy and surgical techniques mean that the outlook is always improving, and some children successfully treated for brain tumours have long life spans. Unfortunately, though, survival rates are not good for certain types of tumour.