Medulloblastoma is a type of aggressive brain tumour that originates in the cerebellum, the area at the base of the skull (known as the posterior fossa) responsible for controlling balance and other complex motor and cognitive functions. Although it can grow rapidly and has the potential to spread to other parts of the nervous system and body (such as the bones or bone marrow), medulloblastoma typically responds well to treatment.

The signs and symptoms of medulloblastoma can vary among patients. They often relate to increased pressure within the skull or dysfunction of the cerebellum. Common symptoms include:

• Headaches, which may be more severe in the morning and improve throughout the day.
• Nausea or vomiting, particularly upon waking in the morning.
• Issues with motor skills, such as feeling clumsy or having difficulty with handwriting.
• Unusual tiredness or lethargy.
• Tilting the head to one side.
• Problems with balance and walking difficulty.

If the medulloblastoma spreads to the spinal cord or other parts of the brain, symptoms may also include:

• Back pain.
• Difficulty with walking or mobility.
• Inability to control bladder and bowel functions.

It is important to remember that these symptoms can also be caused by other health conditions. Any concerning symptoms should be discussed promptly with a medical professional.Diagnosis

If medulloblastoma symptoms are present, a doctor will conduct a physical examination and ask about overall health. A neurological exam is also typically performed to check reflexes, muscle strength, vision, and other functions of the brain and spine.

Should initial findings be abnormal, the patient may be referred to a specialist such as a neurologist, neurosurgeon, or neuro-oncologist, who are experts in nervous system diseases.

One or more of the following diagnostic procedures may be used to confirm the presence of medulloblastoma, determine if it has spread, and monitor the effectiveness of treatment:

• Imaging Tests: These include CT (Computed Tomography) scans, MRI (Magnetic Resonance Imaging) of the brain and spine, and PET (Positive Emission Tomography) scans.
• Surgery (Craniotomy): If imaging reveals a tumour in the lower back part of the brain, surgery is often the first step. An operation called a craniotomy is performed to remove as much of the tumour as possible. This procedure is essential to confirm the diagnosis and is the initial phase of treatment. If complete tumour removal is not possible, a biopsy may be needed to remove a small tissue sample for microscopic examination.
• Additional Tests for Disease Spread: Following tumour removal, tests are required to assess the extent of the disease. These include:
• A brain MRI taken after surgery.
• A whole spine MRI.
• A spinal tap (lumbar puncture), where a needle is used to collect a small amount of cerebrospinal fluid (CSF) from the spinal canal. This fluid is analysed for the presence of tumour cells that may have spread.
• In specific cases, a CT or PET scan of the body may be necessary to check for spread outside of the nervous system.

Medulloblastoma Classification

After surgical removal, medulloblastoma is classified into one of two risk categories:

• Standard-Risk Medulloblastoma:
• Less than 1.5 centimetres of tumour remains after surgery.
• Cancer has not spread to other parts of the nervous system or body.
• The patient is at least three years old or older.
• High-Risk Medulloblastoma:
• More than 1.5 centimetres of tumour remains after surgery or the cancer has spread to another part of the nervous system or body.
• The patient is younger than three years old.
• The patient has the anaplastic/large cell variant of medulloblastoma.

Research is continuously refining the understanding of the molecular subtypes of medulloblastoma in both children (at least four distinct subtypes) and adults (three main subtypes), which is used to define the most effective personalised treatment approach.Treatment

At SSCHRC, medulloblastoma treatment is a highly specialised and customised process delivered by a multidisciplinary team. This team includes world-renowned neurosurgeons, neuropathologists, neuro-oncologists, neuroradiologists, and radiation oncologists who collaborate to create a care plan centred on the patient’s specific needs. The goal is to provide the most advanced therapies while minimising potential short- and long-term side effects and maintaining the patient's quality of life.

Leading Advancements in Treatment

SSCHRC offers advanced technologies and less-invasive treatment options that provide the best hope for successful outcomes with minimal impact on physical and mental function. These advancements include:

• BrainSuite (Intraoperative MRI).
• New Targeted Therapies.
• Immunotherapy: SSCHRC is pioneering the use of immunotherapy, which harnesses the body's own immune system, as a treatment for medulloblastoma that has returned (recurrent disease).
• Clinical Trials: A wide range of clinical trials are conducted, including trials for targeted therapies and minimally invasive procedures that deliver medication directly to the tumour.

Thanks to these advanced treatments, more than two-thirds of children with medulloblastoma can be successfully treated, and many adults also achieve successful treatment. However, treating recurrent medulloblastoma remains challenging. Specialist teams within the Hospital and the Brain and Spine treatment at SSCHRC focus on treating relapsed brain tumours, including medulloblastoma.

Our Medulloblastoma Treatments

• Adults: All adults with medulloblastoma receive craniospinal radiation (to the brain and spine) after surgery to stop or slow the growth of any remaining tumour or tumour cells that may have spread into the cerebrospinal fluid.
• Children: Depending on their age and condition, some children also receive radiation therapy.

SSCHRC doctors employ new radiation therapy techniques to target tumours more precisely, delivering the maximum necessary dose with the least damage to healthy cells. Advanced methods include:

• Focused Conformal Radiation Therapy: Aimed precisely at the tumour and the surrounding area.
• Intensity-Modulated Radiotherapy (IMRT): Shapes the radiation beam to the tumour to lessen exposure to the rest of the brain or other organs.

Targeted Therapies for Medulloblastoma

Targeted therapies are designed to treat the specific genetic and molecular profile of a cancer, helping the body fight the disease. SSCHRC doctors and researchers are dedicated to pioneering and leading national and international clinical trials to treat brain tumours, including medulloblastoma, with novel targeted agents. Our experts collaborate globally to understand the biology and molecular subtypes of medulloblastoma, including relapsed tumours, to design truly personalised therapies.