Brain Cancer (Child)

Brain

The brain is one of the most complex and magnificent organs in the human body. It is a delicate organ consisting of billions of nerves protected by the skull. The brain receives input from the sensory organs and in response, sends output to the muscles. It controls the functions of all the other organs.

The brain is the processing center of a constant stream of sensory data. It controls all the muscle movements, the secretions of glands, breathing and internal temperature. Every creative thought, feeling, and plan is developed by the brain. The brain’s neurons record the memory of every event.

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The brain contains-

about 86 billion nerve cells (neurons) — the “gray matter”
billions of nerve fibers (axons and dendrites) — the “white matter”
The neurons are connected by trillions of connections called synapses.

Parts of the brain:

The main parts of the brain are:

The cerebrum – Cerebrum is located at the top of the head and is the largest part of the brain. It’s made up of two hemispheres. The cerebrum is responsible for controlling thinking, learning, memory, problem solving, emotions and touch.
The cerebellum – The cerebellum is the back part of the brain, and it controls movement, balance and coordination.
The brain stem – The brain controls the flow of messages between the brain and the body, it also takes care of breathing, body temperature, heart rate and blood pressure, eye movements and swallowing.

What is Brain Cancer (Children)?

Brain and spinal cord tumors are masses of abnormal cells in the brain or spinal cord that have grown out of control. Brain tumours are the most common form of solid tumours among children. Brain tumors destroy brain cells indirectly by pushing on other parts of the brain.

This pressure gradually gives way to several symptoms of brain cancer. Brain tumors are classified based on the location of the tumor, the type of tissue involved, and the type of tumor. The tumors that originate in the brain are called primary brain tumors and they are further classified into:

Benign (Not cancerous)
Malignant (Invasive)

Benign tumors do not spread into nearby tissues or spread to distant areas, and are generally not life threatening. But the malignant tumors can spread throughout the body thus posing a danger to life. Sometimes, tumors that start out less aggressive can change their behaviour and become aggressive.

Types of Brain Tumors

There are many different types of brain tumors. Some are cancerous while others aren’t. Brain tumors are categorized based on its location, the type of cells involved, and the pace of growth. Based on multiple factors tumors are grouped into the following categories:

Astrocytomas or low grade tumors are slow-growing tumors most common among children in the age group of 5 to 8. Pilocytic astrocytomas are generally benign tumors but diffuse astrocytomas are usually slow growing, but may not be benign.
Medulloblastomas are the most common type of brain cancer found in children below the age of 10.
Ependymomas can be benign or malignant. These are further subcategorized based on their location and type. The therapy and prognosis varies for each subtype.
Brainstem gliomas are very rare tumors that occur only in children. The average age at which they develop is about 6. These tumors usually do not cause any prominent symptom until they grow very large in size.
Craniopharyngiomas are non-cancerous tumors that form at the base of the brain near the pituitary gland. Though these tumors are more common among children but may also occur in adults in late 50’s or 60’s.
Germ cell tumors usually form in the testes or ovaries but can also form in the brain and central nervous system. Childhood central nervous system (CNS) germ cell tumors rarely spread outside of the brain and spinal cord
Pontine gliomas are cancerous, high-grade tumors that form in a part of the brainstem called the pons.
Optic nerve gliomas form in or around the optic nerve, which connects the eye to the brain. Most optic nerve gliomas are noncancerous and slow-growing.

Occurrence Rate of Brain Cancer among children

Tumors of the central nervous system are the second most common childhood tumor after leukemia, accounting for about 35% of all childhood malignancies. They are also the leading cause of cancer-related deaths in children. Childhood central nervous system (CNS) tumors differ significantly from adult brain tumors in reference to their sites of origin, clinical presentation, tendency to disseminate early, histological features and their biological behaviour. A recent study on paediatric cancer concluded that childhood cancer incidence appears to be increasing in India.

In India, due to lack of registration of newly diagnosed cases with local cancer registries, the exact number of tumor cases goes unnoticed and is underestimated. Due to the high incidence and mortality of childhood CNS tumors, they form the most demanding group of tumors for neuro-oncologists. According to a recent study, the most common brain tumors in the pediatric age group in descending order are astrocytoma, medulloblastoma, craniopharyngioma followed closely by ependymoma.

Tumor type in Childhood	AAR per million
(0-14 years)	Boys	Girls
Leukemia	35.7-61.3	22.3-40.2
Lymphoma	9.9-25.6	2.9-10.1
Central-nervous-system tumor	6.6-19.8	3.0-16.0
SNS tumor	1.5-12.6	1.8-5.3
Retinoblastoma	1.9-12.3	1.3-6.7
Renal tumor	3.1-9.5	1.8-7.0
Hepatic tumor	0.5-2.0	1.0-1.8
Bone tumor	2.8-9.0	2.3-6.2
Soft tissue Sarcoma	2.8-7.2	1.6-7.6
Germ cell tumor	1.3-12.9	0.2-1.3
AAR : Age-adjusted rates; Source: NCRP report 2009–2011 [4].

Brain tumours can cause many different signs and symptoms. There is a difference between a sign and symptom. Patient will feel a symptom, but a sign is usually detected in medical tests. Both signs and symptoms are assessed when making a diagnosis.

The symptoms of brain tumor are caused due to the tumor growth pressing on the surrounding parts of the brain, or by causing a build up of spinal fluid, a condition known as hydrocephalus. Signs or symptoms vary depending on a child’s age and the location of the tumor; however headaches are often the most common symptom.

But any general headache does not assure the presence of a tumor. Headache patterns that may occur with brain tumors include:

Headaches that are worse when waking up in the morning and go away within a few hours
Headaches that get worse with coughing or exercise, or with a change in body position
Headaches that occur while sleeping and with at least one other symptom such as vomiting or confusion.

Sometimes, the only symptoms of brain tumors are mental changes, which may include:

Changes in personality and behaviour
Unable to concentrate
Increased sleep
Memory loss
Problems with reasoning

Other possible symptoms include:

Gradual loss of movement or feeling in an arm or leg
Hearing loss with or without dizziness
Speech difficulty
Unexpected vision problem, including vision loss in one or both eyes.
Problems with balance
Weakness or numbness

Depending on the location of tumor in different parts of the brain or spinal cord the symptoms vary. But these symptoms can be caused by any disease in that particular location – they don’t certify the presence of a brain or spinal cord tumor. Brain and spinal cord tumors often cause problems with the specific functions of the region they develop in. For example:

Tumors in the parts of the cerebrum can cause weakness or numbness in a part of the body.
Tumors in or near the parts of the cerebrum responsible for language can cause problems in speech or understanding words.
Tumors in the front part of the cerebrum can sometimes affect thinking, personality, and language skills.
Tumors in an area of the brain called the basal ganglia typically cause abnormal movements.
Tumors in the cerebellum can cause trouble walking or with other normal functions.
Tumors in the back part of the cerebrum, or around the pituitary gland, the optic nerves, or certain other cranial nerves can cause vision problems.
Tumors in or near other cranial nerves might lead to loss of hearing, balance problems, weakness of some facial muscles, or trouble swallowing.
Spinal cord tumors may cause numbness, weakness, or lack of coordination in the arms and/or legs, as well as bladder or bowel problems.

In most cases, brain tumor symptoms are subtle and gradually become worse as the size of the tumor increases. Because of the subtle nature of symptoms, they may appear like common childhood conditions, thus making brain tumors diagnosis difficult. It is highly recommended to see a doctor, if the child is facing any of the mentioned difficulty.

The exact causes of most brain and spinal cord tumors are yet to be unveiled. However, researchers have discovered some of the changes that occur in normal brain cells which may lead to the formation of tumors. Though clear causes for Brain and Spinal Cord tumours are still debatable, certain risk factors have been recognized.

Inherited Genetic Condition: Brain and spinal cord tumors are usually caused by unaccounted mutations in the DNA. Genes in our DNA that controls cell growth and division are called oncogenes. The other genes that slow down cell division, or cause cells to die at the right time, are called tumor suppressor genes. Sometimes mutations in the DNA turn on oncogenes or turn off tumor suppressor genes thus leading to growth of cancer cells. These gene changes can be either inherited from a parent or they occur spontaneously during a person’s lifetime.

Some of the more well-known syndromes include:

Neurofibromatosis type 1 (von Recklinghausen disease)
Neurofibromatosis type 2
Tuberous sclerosis
Von Hippel-Lindau disease
Li-Fraumeni syndrome
Gorlin syndrome (basal cell nevus syndrome)
Turcot syndrome
Cowden syndrome
Hereditary retinoblastoma
Rubinstein-Taybi syndrome

Excessive Radiation exposure: Other than radiation, there are no known lifestyle-related or environmental causes of childhood brain tumors.

As of now, there are no known life style related or environment related factor except exposure to radiation that would cause brain and spinal cord tumors in children. Hence, there is no known way to protect against most of these Cancers.

Since, most tumors in the brain or spinal cord do not usually spread, they are not formally staged. Some of the most important factors that determine your child’s prognosis include:

The type of tumor
The grade of the tumor
The location and size of the tumor
If the tumor can be removed by surgery
Child’s age
Child’s functional level
The spread of the tumor through the cerebrospinal fluid (CSF) to other parts of the brain or spinal cord.
The spread of tumor beyond the central nervous system.

Survival rate is a generic view of the data collected over a period of time depicting the percentages of patient that survived the disease. But, since there are multiple unique factors with each case, it is important to better understand his or her condition and prognosis. The age of the child, his/her health conditions and the extent to which the tumor has affected the child’s ability to function are also important factors.

The survival rate for brain tumor varies depending on the type of tumor. Here is the data showing a 5 year survival rate estimate.

Type of Tumor	5-Year Survival Rate
Pilocytic astrocytomas	About 95%
Fibrillary (diffuse) astrocytomas	About 80% to 85%
Anaplastic astrocytomas	About 30%
Glioblastoma	About 20%
Oligodendroglioma	About 90% to 95%
Ependymoma/anaplastic ependymomas	About 75%
PNETs	About 60% to 65%

Today, more children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Medicine is evolving everyday to meet these challenges and to keep you happy, healthy and alive!

At this time there are no widely recommended screening tests for most children to look for brain or spinal cord tumors before they start to cause symptoms. These tumours are usually detected as a result of signs or symptoms the child is having. However, through genetic tests, one may find out whether one is at an increased risk of developing Brain Cancer. If yes, the doctor might suggest other tests to detect the Cancer early.

CT or MRI scan: The CT scan uses x-rays to produce detailed cross-sectional images of the child’s brain and spinal cord. It is quick and often is the best first-line investigation, but it does not give as detailed pictures as an MRI.

An MRI scan uses no X-rays, and gives more detailed pictures, but takes much longer. Machines are noisy, and often children cannot lie still long enough to get proper images. It is sometimes necessary to have an anaesthetic for this scan.

Blood tests: These are usually done to make sure it is safe to do an operation, and can also be used to help diagnose certain types of tumour.

Biopsy: It is the process of removing a small specimen of the affected cells and examining under a microscope to find out the details like the type of tumour. A biopsy report helps the doctors to plan for the most accurate treatment strategy.

Treatment depends on the size and type of tumor and the child’s general health. Because there are different types of brain tumours, treatment will not be the same for everyone. The goals of treatment may be to cure patients, relieve symptoms, and improve brain function or the child’s comfort.

Surgery is the most preferred treatment option for most primary brain tumors. Some tumors may be completely removed. In cases where the tumor cannot be removed, surgery may help reduce pressure and relieve symptoms. Chemotherapy or radiation therapy may be used for certain tumors.

Chemotherapy uses drugs to get rid of cancer cells. Chemotherapy is given into the veins, and sometimes as a liquid or tablets by mouth.

Radiotherapy is used to treat cancer by using high energy radiation beams. The radiation beams are simply the energy that passes inside the body, and causes damage to tumour cells. Radiotherapy is delivered extremely carefully, using machines linked to the MRI scans of your child’s brain. The process usually takes a few minutes each time, but often needs to continue for five or six weeks.

Other medicines your child may need to take

Steroids

These are medicines that reduce swelling and inflammation in the brain and can help deal with the symptoms.

Anticonvulsants

These are medicines used to help prevent fits, which can be a problem before or after operations on the brain.

Treatments for specific types of tumors:

Astrocytomas: Surgery to remove the tumor is the main treatment. Chemotherapy or radiation therapy may also be necessary.
Brainstem gliomas: In this case, surgery is usually not possible because of the tumour’s location deep in the brain. Radiation is used to shrink the tumor and prolong life.
Ependymomas: Surgery is the most preferred treatment option. However, radiation and chemotherapy may also be necessary.
Medulloblastomas: Surgery alone does not cure this type of tumor. Chemotherapy with or without radiation is often used in combination with surgery.
Medicines used to treat primary brain tumors in children include:
- Corticosteroids to reduce brain swelling
- Diuretics (water pills) to reduce brain swelling and pressure
- Anticonvulsants to reduce or prevent seizures
- Pain medicines
Comfort measures, safety measures, physical therapy, occupational therapy, and other such steps may be required to improve quality of life.

Treatment of cancer is a tough process as the medicines or radiations used to cure or suppress cancer often causes multiple side effects. Some possible common side effects of radiotherapy and chemotherapy include:

Hair loss: Both radiotherapy and chemotherapy can cause hair loss. But the good thing is hair usually grows back again once chemotherapy is completed, but radiotherapy causes permanent hair loss.

Tiredness: Tiredness is very common with both treatments and may continue for weeks after chemotherapy or radiotherapy finishes.

Feeling sick: Radiotherapy and chemotherapy may make the child feel sick. This can usually be controlled well with anti-sickness drugs, which the oncologist will prescribe for your child.

Increased risk of an infection: Chemotherapy can increase the risk of infection, so it is important to contact the oncologist or specialist nurse straightaway if your child has a temperature, any signs of infection or suddenly feels unwell.

Skin changes in the treated area if your child is having radiotherapy: Radiotherapy can cause a mild form of sunburn. Skin may become red, flaky or sore if your child has fair skin and may become darker and flaky if your child has dark skin. You’ll be given advice on looking after the skin in the treated area.

Most cases of the brain cancers can be treated with surgery. But, for more complicated tumors other treatment options like radiation, chemotherapy etc. should be opted. Children with tumors may also have a much better prognosis than adults with a similar condition.

In case of experiencing any of the mentioned symptoms or having a history of cancer, an examination by a specialist is recommended once in a year.

Acknowledging the symptoms and visiting a doctor for examination helps in early diagnosis.

To know more : Brain Cancer(Child)

Brain Cancer (Child)