Pediatric Brain Tumor - Types, Causes, and Treatment

Introduction

Of all pediatric malignancies, pediatric brain tumors are the most common solid cancer in childhood and second to leukemias. About 5000 children are diagnosed every year. Prognosis depends on the location of the tumor, the age of the child, its spread, and the type of tumor. With all the new technology, more options are available for treatment.

What Are the Different Types of Pediatric Brain Tumors?

1. Choroid Plexus Carcinoma: It is a rare type of carcinoma arising from the epithelium of the choroid plexus. Begins near the brain tissue that secretes cerebrospinal fluid (CSF).

2. Craniopharyngioma: It begins near the pituitary gland, which controls various functions in the body and secrets hormones.

3. Embryonal Tumor (Malignant Tumor): The embryonal tumor begins in fetal embryonic cells in the brain. Most commonly affecting babies.

4. Ependymoma: Generally seen in the spinal cord or brain. It starts in ependymal cells in the brain and spinal cord. CSF provides nutrition, and it grows.

5. Glioma: Glioma begins with cell growth in the brain and spinal cord.

6. Medulloblastoma: The cancerous tumor in the lower part of the brain.

7. Pineoblastoma: They are growth in cells in the pineal gland. The pineal gland secretes melatonin, and melatonin controls the body's natural wake-sleep cycle.

What Are the Causes of Brain Tumors?

The exact cause is unknown. Usually, brain tumors occur due to a genetic mutation in cells. Normal cells function abnormally due to mutation in DNA, this causes an increased growth rate in the brain cells, and they even continue living when the normal cells die. It leads to the formation of a mass of cells called tumor cells. Also, the family history of the genetic syndrome results in an increased risk of a brain tumor in children.

What Are the Symptoms of Brain Tumor in Children?

Symptoms may vary depending on the location, type of tumor, size, and tumor growth rate. Some symptoms are as follows:

• Headaches: The intensity of severe headaches increases with the size of the tumor.

• Increased Brain Pressure: The feeling of increased tension in the brain.

• Unexplained nausea and vomiting

• Unexplained vision problems.

• A fuller soft spot in the skull of babies.

• Children's eye movement is abnormal.

• Speech is slurred.

• Swallowing difficulties, difficulties in feeding, or appetite loss.

• Trouble in balancing or walking

• Muscle Weakness: Loss of sensation in an arm or leg.

• Inability to concentrate.

• Increased irritability.

• The child seems confused.

• Hearing difficulties.

• Behavior changes.

What Are the Diagnostic Tools to Detect Brain Tumors?

• Neurological Examination: This will include the child's physical examination consisting of a vision test, hearing test, and checking the balance, coordination, strength, and reflexes.

• Imaging Test: MRI (magnetic resonance imaging), CT (computerized tomography), and PET (positron emission tomography) help in detecting the size and location of the tumor.

• Biopsy: Biopsy is a procedure to remove and test the sample tissue. The tissue is then sent to the lab and analyzed to determine the type of tumor and its aggressiveness. The doctor (pediatric neurosurgeon) will drill a hole in the child's skull, insert a needle, and remove tissue. If the tumor's location is in the sensitive area, a stereotactic needle biopsy will be performed.

• Precision Medicine Diagnosis: This test detects genetic mutation and the molecular basis of the tumor.

• Test For Detecting Cancer Spread: It detects if the brain tumor is caused by any other malignant tumor in the body, and it determines the start of the tumor.

What Are the Treatment Procedures for Brain Tumors?

• Surgery: Surgery is the treatment of choice only when the tumor is located in an accessible place for operation. If the tumors are small and in a favorable location, they are easy to separate from brain tissue. In some cases, tumors are located in an unfavorable sensitive location, making it difficult to remove them entirely; in such cases, the doctors will remove the maximum part, keeping some parts, avoiding a risky surgery. Surgery will reduce the symptoms.

• Traditional Radiation Therapy: Radiation therapy kills cancer cells with high-energy beams. Two types of radiation - external beam radiation (radiation outside the body) and brachytherapy (radiation placed inside the body). Radiation targets the cancer cells or the entire head, whichever is best suited.

• Proton Beam Therapy: Proton beam therapy targets only the tumor by providing them targeted doses of radiation, minimizing radiation exposure to the child's developing brain.

• Radiosurgery: A type of radiation that uses multiple beams to kill tumor cells. Also known as stereotactic radiosurgery. It is performed in a single setting, and mostly the child is sent home on the same day.

• Chemotherapy: The specific drugs are injected into the vein of a child. Drugs help to kill or shrink tumors.

• Targeted Drug Therapy: Biologic agents are used to kill the tumor. It focuses on abnormalities in cancer cells.

• Rehabilitation: Even after successful remission of the tumor cells, rehabilitation after the treatment will be necessary; rehabilitation services that can help the child are

  • Physical Therapy: To gain the muscle strength

  • Occupational Therapy: To make the child comfortable with routine activities.

  • Speech Therapy: To help the child with speech.

  • Tutoring: To help to cope with concentration problems.

• Clinical Trials: Clinical trials lead to the development of new medicines. The child can try new medicines, but the side effects are unknown.

• Alternative Medicines: Very limited research is available. They can be complementary to the treatment, as mentioned earlier. It includes play therapy, music therapy, and relaxation exercise.

What Are the Side Effects Associated With Treatment Procedures?

With surgery, there is an increased risk of infection and bleeding. Major complications include paralysis and vision or hearing loss. With radiation therapy, children can face tiredness, irritation in the scalp, temporary hair loss, nausea, and vomiting. Chemotherapy's side effects are nausea, vomiting, hair loss (temporary), and myelosuppression (decreased production of blood cells).

What Is the Role of Parents?

Help the child to cope and support. Stay with the child in the hospital, play more often, encourage the child, take the child to support groups, answer all the child's concerns, explain to them about the side effects of the treatment, take care of their diet, and keep a record journal of their sickness.

Conclusion

Brain tumors can be tricky because of their location, size, and treatment required; they can cause a considerable lifelong impairment, improper neurological function, and even life-threatening. Early detection is necessary to have good outcomes. Brain tumors require teamwork to be successfully managed.