Brain and spine tumours are the second most common forms of cancer in children, following leukaemia. Each year, brain tumours affect many children in India, accounting for 20% of all childhood cancers.
The brain is responsible for vital aspects of daily life, including thought, emotion, speech, vision, hearing, and movement. Messages are relayed throughout the body via the spinal cord and cranial nerves, forming the central nervous system (CNS). Tumours can develop in the spinal cord and cranial nerves as well as the brain itself.
The brain is protected by the hard, bony skull, and the spinal cord is protected by the vertebrae. Both are surrounded by a liquid called cerebrospinal fluid (CSF).
Located deep within the brain, these structures are involved in muscle movement.
Situated at the base of the brain, this vital area contains nerve fibres that transmit messages between the cerebrum and the rest of the body, and it controls essential functions like breathing and heartbeat.
Found at the back of the brain, this part helps control and coordinate movements such as walking and swallowing.
The largest, outermost part of the brain, consisting of two hemispheres. It governs emotions, reasoning, language, movement, and the senses (sight, hearing, smell, and touch), as well as the perception of pain.
The brain and spinal cord are complex structures composed of various tissues and cells, leading to many types of tumours, which can be either benign (non-cancerous) or malignant (cancerous). These different types require specific treatments and have varying prognoses.
Even benign brain tumours can cause significant problems. Although they typically grow slower than malignant tumours, their growth may damage or press against normal brain tissue or the spine.
Childhood brain and spinal cord tumours often differ from those found in adults in terms of location, the type of cell in which they originate, treatment methods, and overall outlook. Brain tumours are classified by their cell type, which determines their growth pattern and necessary treatment. The most commonly found brain tumours in children include:
The most common malignant brain tumour in children.
These form in the cerebrum from cells called astrocytes. They are generally slow-growing, though higher-grade tumours can spread more quickly. They can be difficult to remove surgically because they mix with normal brain tissue. Glioblastoma is the highest-grade and fastest-growing astrocytoma.
A dangerous tumour with a typically poor prognosis, growing in the pons, a vital area within the brain stem.
Developing in the brain lining, usually in the posterior fossa or along the spinal cord. They begin in the cells that line the ventricles or the central canal of the spine. While they rarely spread outside the CNS, they can block CSF, leading to hydrocephalus.
Aggressive tumours that can develop anywhere but are typically found in the frontal, temporal, or parietal lobes. Pineoblastomas are a type of PNET that develops in the pineal gland and can be challenging to treat.
Slow-growing tumours that start above the pituitary gland. They may compress the pituitary gland and hypothalamus, leading to hormone problems. Located near the optic nerves, they can cause vision issues and may be difficult to remove without damaging sight.
These have components of both glial and neuronal cells and generally have a favourable prognosis.
Rare tumours that start in the choroid plexus within the brain's ventricles. Most are benign and can be removed with surgery.
These tumours originate in the meninges, the tissue surrounding the outer part of the brain and spine. They are nearly always benign and usually cured by surgery, though additional treatment may be needed if they are close to vital structures.
Starting in the bone at the base of the skull or the lower end of the spine, they can injure the nervous system by applying pressure. They seldom spread to other parts of the body.
Rare tumours developing from germ cells, typically found in children, most often in the pineal gland or above the pituitary gland.
Cancers that have spread to the brain from other parts of the body. They are treated differently from primary brain cancers.
While no definitive causes for childhood brain tumours have been established, certain factors may increase a child's risk, including:
Such as:
Including Turcot syndrome, Rubinstein-Taybi syndrome, and Gorlin syndrome (basal cell nevus syndrome).
Genetic counselling may be appropriate for families with a history of brain cancer.
Childhood brain tumours frequently lead to changes in a child's hearing, memory, learning, sight, smell, or emotional state. Because these changes are often noticed early, childhood brain tumours are frequently diagnosed before they have spread widely.
Symptoms vary depending on the tumour's location and are different for every child. Signs of a possible brain tumour can include:
It is important to remember that these symptoms are often caused by conditions less serious than a brain tumour. However, any persistent symptoms should be discussed with a doctor as they may signal other health issues.
An early and accurate diagnosis significantly improves the chances of successful treatment for a childhood brain tumour.
The specialized medical team at SSCHRC possesses the expertise vital for targeting brain tumours in children, utilising advanced and accurate equipment to pinpoint the tumour's exact extent and location.
If a child presents with symptoms suggesting a brain tumour, the doctor will conduct a careful examination and inquire about the child's and family's medical history. A neurological exam may also be performed to assess reflexes, muscle strength, vision, and other functions of the brain and spine. If any abnormalities are noted, the child may be referred to a neurologist or neurosurgeon.
One or more diagnostic tests may be used to confirm a brain tumour, check for spread, and monitor the effectiveness of treatment:
These may include:
If imaging tests identify a possible tumour area, a biopsy is almost always required for a definitive diagnosis. The doctor removes a small tissue sample for microscopic examination. Biopsy methods include:
Upon a diagnosis of a brain tumour, the doctor will discuss the optimal treatment options, which are determined by the tumour's location and type, as well as the child's overall health.
One or more of the following therapies may be recommended to treat the cancer or help alleviate symptoms:
Surgery is typically the initial treatment for brain tumours in children. If complete removal is not possible, the surgeon will remove as much of the tumour as possible without causing damage to surrounding areas.
Surgery can also help to:
The most common surgical procedure is a craniotomy, which involves opening the skull. While some tumours can be removed with minimal damage, many are located in areas that make removal difficult or impossible without affecting crucial parts of the brain.
SSCHRC utilises advanced equipment, such as functional MRI (fMRI), to help map the brain area and improve surgical accuracy. Many childhood brain tumours are successfully treated with surgery alone. If additional treatment is needed, surgery can help by reducing the tumour size before radiation or chemotherapy.
Brainsuite® iMRI: For tumours in challenging locations, SSCHRC neurosurgeons can use this innovative open MRI system, allowing them to view the tumour during surgery. This maximizes tumour removal while preserving healthy brain tissue.
Radiation therapy may be used to halt or slow the growth of childhood brain tumours that cannot be removed through surgery. It is generally not used for children under three years of age. Radiation therapy may be used:
New techniques and the skill of SSCHRC doctors allow for precise targeting of brain tumours, delivering the maximum necessary radiation dose while minimizing damage to healthy cells.
SSCHRC employs advanced radiation methods, including:
SSCHRC provides the most current and advanced chemotherapy options. Chemotherapy is often used for fast-growing tumours, frequently alongside radiation and surgery. In children under the age of three, it may sometimes be used instead of radiation therapy. Chemotherapy's effectiveness for brain cancer can be limited by the blood-brain barrier, which acts as a protective shield against many chemotherapy drugs.
Targeted therapy drugs work by focusing on the specific genetic changes that drive the cancer. SSCHRC is a leader in discovering these agents, and many of its clinical trials for brain tumours focus on determining the best drug for each patient based on the molecular profile of their tumour.
Certain medications, such as anti-seizure drugs, hormones, and corticosteroids, may be prescribed to help children with brain tumours manage and relieve their symptoms.