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.
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.
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:
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:
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:
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.
Different children may exhibit different symptoms, depending on their age and the form of tumour. Some of the common symptoms are:
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.
When a child is referred to a specialist, a thorough physical examination is carried out. The tests used for diagnosis include the following
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.
Some of the after effects of treatment are:
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.
Another after effect of treatment is that it may make the child feel nauseous or sick.
Radiation or chemo can adversely affect the vision. It may become weak or blurry after the treatment.
The treatment may have a serious impact on the movement due to muscle weakness, hearing, balancing, speech or swallowing.
It is common to feel tiredness and weariness after undergoing the treatment.
Skin may turn flaky, red or tender and in some cases, even darker after radiotherapy.
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.
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.
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.