Brain Tumours In Children

Brain tumours can affect children of all ages. It is important to understand that it may develop and affect children differently than adult brain tumour A child’s body and brain are still in the developing stage, so the symptoms and treatments may also vary. Brain tumours, can cause substantial long-lasting damage to the neurological and intellectual functioning of the child.

What Is A Brain Tumour?

When the cells of the brain start dividing and growing unusually, a mass of cells may form. This lump of cells in the brain is called tumour.

Types Of Brain Tumours

Tumours are classified keeping in mind the cell types they multiply from, the location of the tumour in the brain and the rate at which they can possibly develop and spread. They can broadly be divided into the following:

• Primary Tumours: originating in the brain.
• Metastatic: Originating in other some other area of the body and eventually spreading to the brain.
• Benign: Non-cancerous and slow growing.
• Malignant: Cancerous and fast growing.

The most common brain tumour in children that can occur at any age is glioma. Gliomas constitute for almost 75 percent of the paediatric brain tumours. Gliomas develop in glial cells that are supportive or gluey tissue of the brain. Glial tumours are majorly of two types: astrocytoma and ependymomas. Gliomas adversely effects the functioning of the brain and can be life threatening. The types of tumours can be classified into the following categories:

1. Low-Grade Vs. High-Grade

Brain tumours can be categorised into grades depending on how irregular the tumour cells and tissues appear when seen under a microscope. Keeping the variances in the microscopic appearance as reference, doctors allocate a mathematical grade to the tumours. Brain tumours can be graded on a scale of 1 to 4. Scale 1 and 2 are low grade tumours and scale 3 and 4 are high grade tumours. Grades are a pointer of the likely growth and extent of tumours. Grades of tumour also help determine the type and course of treatment.

Low grade tumours are those which develop slowly. The cells appear almost similar to normal cells when seen under a microscope. They are usually contained and generally don’t spread to other areas. The chances of them reappearing after being fully removed are generally low. High grade tumours, in comparison, grow very quickly and possibly spread to adjoining areas. They are aggressive or malignant in nature and may require a comprehensive set of treatments to tackle them. They are likely to reappear even after exhaustive treatment. Low grade tumours have improved chance of prognosis than high grade tumours.

2. Localized vs. Invasive

Brain tumours which usually remain contained in their primary place of origin are called localized tumour. They are unlikely to spread to other parts of the brain and are relatively easier to treat. Brain tumours that possibly spread and intrude into to the nearby areas are referred to as invasive tumours. They are more difficult to treat as it is very hard to remove them fully.

3. Primary vs. Secondary

Primary brain tumours originate in the brain. Secondary brain tumours are those tumours that start in some other part of the body but gradually spread to the brain. Most paediatric brain tumours are primary.

Types of Primary Brain Tumours

The common types of primary brain tumours are as follows:

• Astrocytoma: Astrocytoma generally appears in children of 5 to 8 years. This type of tumour grows from astrocytes which are cells in the shape of a star. These cells form the supportive or “gluey” tissue of the brain. They may appear in the cerebrum or cerebellum part of the brain. Astrocytoma tumours are graded from scale I to scale IV depending on the behaviour of the normal or abnormal cells. Low grade astrocytoma (scale 1 and 2) grow slowly and are generally contained. High grade astrocytoma (scale 2 and 4) grow rapidly and may spread to other areas. Most paediatric astrocytoma tumours are low-grade. There are four grades of these tumours:

1. Pilocytic Astrocytoma (grade 1): This type of tumour grows slowly and is usually localized. Pilocytic astrocytoma can be cerebellar astrocytoma (appear in the cerebellum) and desmoplastic infantile astrocytoma.
2. Diffuse Astrocytoma (grade 2): This kind of tumour intrudes into the nearby brain tissue but they grow at a considerable slow rate. Types of Diffuse Astrocytoma are Fibrillary, Gemistocytic, Protoplasmic astrocytoma.
3. Anaplastic Astrocytoma (grade 3): These occur rarely but are aggressive in nature.
4. Glioblastoma Multiforme (grade 4): These are of two kinds; primary and secondary. Primary tumours occur more commonly and are highly malignant in nature. The secondary tumours appear as a low grade tumour but may develop into a malignant tumour.

• Ependymoma: Ependymomas originate from the ependymal cells that are present along the ventricles of brain and the centre of the spinal cord. This kind of tumour can be divided into sub ependymomas (grade 1), myxopapillary ependymomas (grade 1), which grow slowly, ependymomas (grade 2) the most commonly occurring ependymal tumour and anaplastic ependymomas (grade 3) which grow very fast. These types of tumour develop in different parts of the brain and spinal cord.
• Brain stem gliomas: These types of tumours are quite rare and develop in the brain stem’s tissue. They are normally very challenging to remove surgically. Brainstem gliomas begin in the brain or spinal column and steadily spread to other parts of the nervous system. These tumours may show no symptoms till it has grown very large.

• Medulloblastomas: Paediatric medulloblastomas are malignant high-grade tumours that develop in the cerebellum and tend to spread through the cerebrospinal fluid.
• Craniopharyngiomas: These tumours are benign and normally do not invade other parts of the brain or body. They are generally a mix of solid mass and cysts filled with fluid. They occur in the lower part of brain close to the pituitary gland.
• Germ cell tumours: These tumours normally develop in the testes or ovaries and can also form in other parts of the body like brain, chest, abdomen and lower part of the spine. They can be either malignant or benign. Types of germ cell tumours are yolk-sac tumours, germinomas, mature and immature teratomas.
• Pontine gliomas: These tumours are high grade tumours, very aggressive in nature. They grow in the pons (middle) of brainstem. These tumours are difficult to remove as they develop in the nerve cells of the brainstem which is an essential part of brain that is responsible for many motor functions of the body.
• Optic nerve gliomas: These tumours grow slowly and are located in or about the optic nerve that links the eye to the brain. As the tumour grows, it puts pressure on the optic nerve and can severely harm the eyesight.

Causes of Brain Tumours In Kids

The cause of brain tumours in children is not clearly known. Experts are of the view that some changes (mutations) that happen in the DNA of normal brain cells causes them to divide and multiply. Some researchers believe that the reason for tumours can be genetic. Children may inherit certain genetic conditions from their parents that may cause the cells in their body to grow abnormally. Inherited syndromes like Neurofibromatosis, Li-Fraumeni, Hippel-Lindau syndrome greatly increase the risk of brain tumours. Environmental causes like radiation can also be a probable cause of tumours in kids.

Childhood Brain Tumour Signs And Symptoms

Different children may exhibit different symptoms, depending on their age and the form of tumour. Some of the common symptoms are:

• Vomiting or nausea.
• Frequent headaches.

• Seizures or fits.
• Tiredness and sleepiness.
• Irritability.
• Enlarged head (Macroencephaly)
• Abnormal motor functions like walking, balancing, co-ordination.
• Blurry or distorted vision.
• Delayed or detained puberty.

As some of these symptoms are very similar to those of other commonly occurring paediatric diseases, it may be difficult to diagnose brain tumours. Also, the symptoms may progress slowly. However, in case of any doubt regarding the symptoms, it is advisable to consult a doctor immediately.

Diagnosing Brain Tumours In A Child

When a child is referred to a specialist, a thorough physical examination is carried out. The tests used for diagnosis include the following

1. Neurological Scans: This involves checking balance, vision, coordination and reflexes among other aspects, to determine which part of the brain the tumour may be in
2. Imaging tests: like MRI or CT scan will be done to confirm the presence of the tumour.
3. Biopsy: If a tumour is detected, a biopsy (tissue removed from the tumour) will be performed to determine the type and grade of tumour. The tumour cells will be studied in detail and analysed so that the likely prognosis can be planned. If the location allows it, a surgery( partial or full) may be advised to remove it.

Treatment

A neurosurgeon will decide upon the treatment after determining the location, type, extent and grade of the tumor. Other factors that are considered include the age and general health of the child, and the response to particular medicines or treatment. In most cases, chemotherapy and radiation are needed along with surgery. A team of specialists will decide upon the best possible treatment with minimal side effects. Treatment of paediatric brain tumours comprise of:

1. Surgery

Most cases of childhood brain tumour require surgery. It may also be needed for biopsy where a sample of the tissue is removed for detailed study. The neurosurgeon may suggest surgery to get rid of as much of the affected tissue as it is safely possible, to reduce the intracranial pressure in the brain. The location plays a key role. For example, if the tumour is diffused in the brainstem, it becomes very difficult to remove it completely. In such cases, the option of partial surgery may be explored.

2. Radiation Therapy

Radiation therapy involves destroying or shrinking of affected tissues by using high-energy rays. This therapy is used cautiously as the brains of the children are still in the developing stage and it may have long lasting side effects like strokes, seizures, delayed or contained development.

3. Chemotherapy

Chemotherapy refers to the usage of drugs to eliminate the tumor cells. It may be administered through IV catheter, pills or directly injected into the cerebrospinal fluid. Its purpose is to either stop or reduce the development of the cells. Chemo is a systemic therapy which means it may distress the whole body. It may have temporary side effects like hair loss, nausea, fatigue but it has less long lasting adverse effects than radiation.

4. Other Medications Your Child Might Need

After surgery or radiation, steroids may be given to reduce the inflammation caused by the tumour or its treatments. At times, some steroids may be given after chemotherapy to counter side effects like nausea. Anticonvulsants may also be prescribed to prevent seizures especially after surgery.

After Effects Of Treatment

Some of the after effects of treatment are:

• Hair loss:

There may be hair loss after chemotherapy and radiation therapy. Though hair lost after chemotherapy may grow back again, it may not be able to regrow after radiation therapy.

• Nausea:

Another after effect of treatment is that it may make the child feel nauseous or sick.

• Abnormal Vision:

Radiation or chemo can adversely affect the vision. It may become weak or blurry after the treatment.

• Physical Problems:

The treatment may have a serious impact on the movement due to muscle weakness, hearing, balancing, speech or swallowing.

• Fatigue:

It is common to feel tiredness and weariness after undergoing the treatment.

• Skin Problems:

Skin may turn flaky, red or tender and in some cases, even darker after radiotherapy.

Follow-up Care After Treatment

Follow up care after treatment is very important as the after effects of treatment may not become apparent immediately. Moreover, every child has a different healing process. Therefore, it is essential to keep the child under careful observation. Most of the physical side effects of the treatment can be controlled by physiotherapy, speech therapy and other occupational therapies. It is essential to keep in mind the probable psychological effects on the child which can be handled by roping in the support of the school, teachers and the child’s friends. Regular follow-up visits should be scheduled to monitor the effects of the treatment on the child and also to safeguard against the risk of a relapse of tumour.

What Are The Long Term Side Effects?

Long term side effects of the ailment and its treatment may be different for every kid. It also depends on the location of the tumour and the kind of therapy given. Some children may experience cognitive delays, which involve difficulty in learning, memory and problem-solving abilities. In some cases, children may register delayed or constrained growth. They may experience early or late puberty because of the treatment. The treatment may cause emotional distress in children due to changed social interaction, the sense of being different from others. The visible physical side effects of the treatment may lead to psychological problems too.

How To Cope With Brain Tumor As A Family?

The diagnosis of paediatric brain tumour can leave the family shaken and distraught. You can seek the help of many support groups which offer information about the clinical trials and any new research done in this field. They also provide emotional care and support and advice on how to deal with the kids in an age-appropriate manner to help them cope with the tumour and its treatment. Parents must take care to pick a school can make certain adjustments to accommodate the needs of the child like less schoolwork, alterations in the homework, testing system, added rest or bathroom trips. Teachers can make the child comfortable in the class and help others kids to accept and not treat the child differently.

With the advancement in technology and medication there is reason to hope for better results. More and more children diagnosed with brain tumours are being successfully treated today. Early detection and swift medical attention along with right treatment and suitable follow up care is very important.