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Brain Tumours in Childhood
Brain tumours are the second most common cancer in childhood, after leukaemia. While there have been many improvements in treatment, brain tumours remain amongst the most difficult childhood cancers to cure. There are important factors that determine the treatment approach and expected outcome of each individual child. In general terms, the following factors come into consideration:
- How fast growing does a tumour appear to be from the history?
- What is the position of the tumour and from what part of the brain did it arise?
- How large is the tumour and what parts of the brain has it invaded?
- What important functions are affected and what damage has been done so far?
- Is the flow of fluid around the brain blocked by the tumour?
- Can some or all of the tumour be surgically removed?
- Has the tumour spread to other parts of the brain or the spinal cord?
- What is the appearance of the tumour under the microscope?
The name given to various brain tumours is primarily determined by this last factor. The pathologist will examine the tumour under the microscope and identify the type as well as the "grade". The "grade" is an attempt to assess the level of aggressiveness or malignancy of the tumour. A combination of the site, type and grade of an individual tumour will enable prediction of future course to some extent. While some tumours grow very slowly and may even remain static for sometime, others rapidly invade the surrounding structures and spread elsewhere. Before any operation is attempted it is usual to evaluate the site, size, spread and associated complications regarding each tumour. This is performed by using an appropriate scan of the brain and sometimes of the spinal cord. The complex technology involved in obtaining highly detailed pictures of the human brain is not discussed here. The main scan types used include: computerised tomography (CT) and magnetic resonance imaging (MRI).
Treatment very often commences with the surgeon. At operation, sometimes only a biopsy is possible. This is required in order to get the specific diagnosis established. Tumour resection (removal) is attempted whenever this can be accomplished safely. One very important determinant of the possibility of cure is the effectiveness of surgical resection. However, in some tumours even a biopsy is too dangerous because of potential damage to a normal brain. For example, tumours in the brain stem may need to be treated without a pathological diagnosis.
Sometimes, surgical removal of the tumour alone is sufficient therapy. Often, however, further measures to kill residual cancer cells are required. The most widely used option is radiation therapy. Occasionally, and particularly in very young children, chemotherapy may be more appropriate and at other times a combination of both will be required. As the approach to treatment involves several experts in their field, a team effort is required to come up with the best plan for each individual child. A neurologist doctor, primarily responsible for your child's care, will seek the views (consultations) of not only the neurosurgeon but also of the radiation therapist and paediatric oncologist (chemotherapy expert). You will have an opportunity to meet with these people, hear their views and then have the overall suggestions of the team put to you by the neurologist.
Each treatment option has both benefits and side effects. The Patient and Family Information Book contains specific chapters with respect to both chemotherapy and radiation therapy side effects. If a chemotherapy programme is suggested, a great deal more detail will be discussed with regard to the individual drugs and their scheduling. There is written information about each of the drugs proposed as well as the tests to be undertaken which will check for the side effects that may occur.
In general terms, chemotherapy is not nearly as well established in childhood brain tumours as is radiation therapy. If has proven to be a very reasonable choice for very young children who are likely to suffer most from side effects of radiation therapy. In most other instances it is a combination of both of these modalities that will provide the best chance of curing the cancer.
Whatever further treatment is regarded as
appropriate after the operation, further tests to check on the tumour will
be conducted over months or years. In the first instance repeat brain scans, and sometimes
scans of other parts of the body, will be used to judge whether the tumour is starting to
grow back or spread. There will also be regular checks of neurologic and intellectual
function. Other tests are available to check on potential damage done to various organs or
functions. Brain tumours can sometimes take a long time to recur.
Therefore, it is difficult to talk about cure until many years have gone by
and the tumour has shown no evidence of growing back. Tests tend to be
done less and less frequently as time goes by.
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