What is a brain tumor?

Brain tumors are the most common solid tumors in children. Approximately 1,500 children in the US are diagnosed with a brain tumor each year. Brain tumors, either malignant or benign, are tumors that originate in the cells of the brain. A tumor is an abnormal growth of tissue. A benign tumor does not contain cancer cells and usually, once removed, does not recur. Most benign brain tumors have clear borders, meaning they do not invade surrounding tissue. These tumors can, however, cause symptoms similar to cancerous tumors because of their size and location in the brain. Malignant brain tumors contain cancer cells. Malignant brain tumors are usually fast growing and invade surrounding tissue. Malignant brain tumors very rarely spread to other areas of the body, but may recur after treatment. Sometimes, brain tumors that are not cancer are called malignant because of their size and location, and the damage they can do to vital functions of the brain. Brain tumors can occur at any age. Brain tumors that occur in infants and children are very different from adult brain tumors, both in terms of the type of cells and the responsiveness to treatment.

Anatomy of the brain

The central nervous system (CNS) consists of the brain and spinal cord. The brain is an important organ that controls thought, memory, emotion, touch, motor skills, vision, respirations, temperature, hunger, and every process that regulates our body. The brain can be divided into the cerebrum, the brainstem, and the cerebellum:

Cerebrum (supratentorial, or front of brain) - composed of the right and left hemispheres. Functions of the cerebrum include: initiation of movement, coordination of movement, temperature, touch, vision, hearing, judgment, reasoning, problem solving, emotions, and learning.

Brainstem (midline, or middle of brain) - includes the midbrain, the pons, and the medulla. Functions of this area include: movement of the eyes and mouth, relaying sensory messages (i.e., hot, pain, loud), hunger, respirations, consciousness, cardiac function, body temperature, involuntary muscle movements, sneezing, coughing, vomiting, and swallowing. Cerebellum (infratentorial, or back of brain) - located at the back of the head, its function is to coordinate voluntary muscle movements and to maintain posture, balance, and equilibrium.

What causes brain tumors?

The majority of brain tumors have abnormalities of genes involved in cell cycle control, causing uncontrolled cell growth. These abnormalities are caused by alterations directly in the genes, or by chromosome rearrangements which change the function of a gene. Patients with certain genetic conditions (i.e. neurofibromatosis, von Hippel-Lindau disease, LiFraumeni syndrome, and retinoblastoma) also have an increased risk to develop tumors of the central nervous system. There have also been some reports of children in the same family developing brain tumors who do not have any of these genetic syndromes. Research has been investigating parents of children with brain tumors and their past exposure to certain chemicals. Some chemicals may change the structure of a gene that protects the body from diseases and cancer. Workers in oil refining, rubber manufacturing, and chemists have a higher incidence of certain types of tumors. Which, if any, chemical toxin is related to this increase in tumors is unknown. Children who have received radiation therapy to the head as part of prior treatment for other malignancies are also at an increased risk for new brain tumors.

What are the symptoms of a brain tumor?

The following are the most common symptoms of a brain tumor. However, each child may experience symptoms differently. Symptoms vary depending on size and location of tumor. Many symptoms are related to an increase in pressure in or around the brain. There is no spare space in the skull for anything except the delicate tissues of the brain and its fluid. Any tumor, extra tissue, or fluid can cause pressure on the brain and result in the following symptoms:

Increased intracranial pressure (ICP) - caused by extra tissue or fluid in the brain. Pressure may increase because one or more of the ventricles that drain cerebrospinal fluid (CSF, the fluid that surrounds the brain and spinal cord) has been blocked, causing the fluid to be trapped in the brain. Increased ICP can cause the following: o Headache. o Vomiting (usually in the morning). o Nausea. o Personality changes. o Irritability. o Drowsiness. o Depression. o Decreased cardiac and respiratory function and eventually coma if not treated.

Symptoms vary depending upon which part of the brain the tumor is found. Symptoms of brain tumors in the cerebrum (front of brain) may include:

Seizures.

Visual changes. Slurred speech. Paralysis or weakness on half of the body or face. Increased intracranial pressure (ICP). Drowsiness and/or confusion. Personality changes.

Symptoms of brain tumors in the brainstem (middle of brain) may include:

Seizures. Endocrine problems (diabetes and/or hormone regulation). Visual changes or double vision. Headaches. Paralysis of nerves/muscles of the face, or half of the body. Respiratory changes. Increased intracranial pressure (ICP).

Symptoms of brain tumors in the cerebellum (back of brain) may include:

Increased intracranial pressure (ICP). Vomiting (usually occurs in the morning without nausea). Headache. Uncoordinated muscle movements. Problems walking (ataxia).

The symptoms of a brain tumor may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is a brain tumor diagnosed?

In addition to a complete medical history and physical examination of your child, diagnostic procedures for a brain tumor may include:

Neurological exam - your child's physician tests reflexes, muscle strength, eye and mouth movement, coordination, and alertness. Computerized tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce crosssectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays. Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. A MRI of the brain usually shows more details of the brain than a CT scan, and is the diagnostic test of choice in brain tumors. Bone scan - pictures or x-rays taken of the bone after a dye has been injected that is absorbed by bone tissue. These are used to detect tumors and bone abnormalities. Myelogram - an x-ray of the spine, similar to an angiogram. Lumbar puncture/spinal tap - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing. CSF is the fluid which bathes the brain and spinal cord. There may be situations in which a lumbar puncture would be contraindicated in brain tumors.

Diagnosis of a brain tumor depends mostly on the types of cells in which the tumor begins and the tumor location.

What are the different types of brain tumors?

The different types of brain tumors include the following:

Gliomas The most common type of brain tumor is a glioma. Gliomas begin from glial cells, which are the supportive tissue of the brain. There are several types of gliomas, categorized by where they are found, and the type of cells that originated the tumor. The following are the different types of gliomas: Astrocytomas Astrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor. Astrocytomas are generally subdivided into high-grade or low-grade tumors. High-grade astrocytomas are the most malignant of all brain tumors. Astrocytomas are further classified for presenting signs, symptoms, treatment, and prognosis, based on the location of the tumor. The most common location of these tumors is in the cerebellum, where they are called cerebellar astrocytomas. These persons usually have symptoms of increased intracranial pressure, headache, and vomiting. There can also be problems with walking and coordination, as well as double vision. Brain stem gliomas Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure, but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination. Ependymomas

Ependymomas are also glial cell tumors. They usually develop in the lining of the ventricles or in the spinal cord. The most common place they are found in children is near the cerebellum. The tumor often blocks the flow of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing increased intracranial pressure. This type of tumor mostly occurs in children younger than 10 years of age. Ependymomas can be slow growing, compared to other brain tumors, but may recur after treatment is completed. Recurrence of ependymomas results in a more invasive tumor with more resistance to treatment. Optic nerve gliomas Optic nerve gliomas are found in or around the nerves that send messages from the eyes to the brain. They are frequently found in persons who have neurofibromatosis, a condition a child is born with that makes him/her more likely to develop tumors in the brain. Persons usually experience loss of vision, as well as hormone problems, since these tumors are usually located at the base of the brain where hormonal control is located. These are typically difficult to treat due to the surrounding sensitive brain structures. Primitive neuroectodermal tumors (PNET) PNET can occur anywhere in the brain of a child, although the most common place is in the back of the brain near the cerebellum. When they occur here, they are called medulloblastomas. The symptoms depend on their location in the brain, but typically the child experiences increased intracranial pressure. These tumors are fast growing and often malignant, with occasional spreading throughout the brain or spinal cord. o Medulloblastomas Medulloblastomas are one type of PNET that are found near the midline of the cerebellum. This tumor is rapidly growing and often blocks drainage of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing symptoms associated with increased ICP. Medulloblastoma cells can spread (metastasize) to other areas of the central nervous system, especially around the spinal cord. A combination of surgery, radiation, and chemotherapy is usually needed to control these tumors. Craniopharyngioma Craniopharyngioma are benign tumors that occur at the base of the brain near the nerves from the eyes to the brain, and the hormone centers. Most persons with this type of brain tumor develop symptoms before the age of 20. Symptoms include headaches, as well as problems with vision. Hormonal imbalances are common, including poor growth and short stature. Symptoms of increased intracranial pressure may also be seen. Although these tumors are benign, they are hard to remove due to the sensitive brain structures that surround them. Pineal region tumors Many different tumors can arise near the pineal gland, a gland which helps control sleep and wake cycles. Gliomas are common in this region, as are pineal blastomas (PNET). In addition, germ cell tumors, another form of malignant tumor, can be found in this area. Tumors in this region are more common in children than adults, and make up 3 to 8 percent of pediatric brain tumors. Benign pineal gland cysts are also seen in this location, which makes the diagnosis difficult between what is malignant and what is benign. Biopsy or removal of the tumor is frequently necessary to tell the different types of tumors apart. Persons with tumors in this region frequently experience headaches or symptoms of increased intracranial pressure. Treatment depends on the tumor type and size.

Treatment for brain tumors

Specific treatment for brain tumors will be determined by your child's physician based on:

Your child's age, overall health, and medical history. Type, location, and size of the tumor. Extent of the disease. Your child's tolerance for specific medications, procedures, or therapies.

Expectations for the course of the disease. Your opinion or preference.

Treatment may include (alone or in combination):

Surgery - Surgery is usually the first step in the treatment of brain tumors. The goal is to remove as much of the tumor as possible while maintaining neurological function. Surgery for a biopsy is also done to examine the types of cells the tumor is made of for a diagnosis. This is frequently done if the tumor is in an area with sensitive structures around it that may be injured during removal. Chemotherapy Radiation therapy Steroids (to treat and prevent swelling especially in the brain ) Anti-seizure medication (to treat and prevent seizures associated with intracranial pressure) Ventriculoperitoneal shunt (Also called a VP shunt.) - A VP shunt may be placed in the head to drain excess fluid from inside the brain. A VP shunt helps control the pressure inside the brain.

Lumbar puncture/spinal tap (to test pressure in the central nervous system, to look for suspicious cells, and give medication if needed). There may be situations in which a lumbar puncture would be contraindicated in brain tumors. Bone marrow transplantation Supportive care (for the side effects of the tumor or treatment) Rehabilitation (to regain lost motor skills and muscle strength; speech, physical, and occupational therapists may be involved in the healthcare team) Antibiotics (to treat and prevent infections) Continuous follow-up care (to manage disease, detect recurrence of the tumor and to manage late effects of treatment)

Long-term outlook for a child with a brain tumor

Prognosis greatly depends on:

The type of tumor. The extent of the disease. Size and location of the tumor. Presence or absence of metastasis. The tumor's response to therapy. The age and overall health of your child. Your child's tolerance of specific medications, procedures, or therapies. New developments in treatment.

Pertussis
Whooping cough
Last reviewed: November 2, 2009.

Pertussis is a highly contagious bacterial disease that causes uncontrollable, violent coughing. The coughing can make it hard to breathe. A deep "whooping" sound is often heard when the patient tries to take a breath.

Causes, incidence, and risk factors

Pertussis, or whooping cough, is an upper respiratory infection caused by the Bordetella pertussis or Bordetella parapertussisbacteria. It is a serious disease that can cause permanent disability in infants, and even death. When an infected person sneezes or coughs, tiny droplets containing the bacteria move through the air, and the disease is easily spread from person to person. The infection usually lasts 6 weeks. Whooping cough can affect people of any age. Before vaccines were widely available, the disease was most common in infants and young children. Now that most children are immunized before entering school, the higher percentage of cases is seen among adolescents and adults.

Symptoms
Initial symptoms, similar to the common cold, usually develop about a week after exposure to the bacteria. Severe episodes of coughing start about 10 to 12 days later. In children, the coughing often ends with a "whoop" noise. The sound is produced when the patient tries to take a breath. The whoop noise is rare in patients under 6 months of age and in adults. Coughing spells may lead to vomiting or a short loss of consciousness. Pertussis should always be considered when vomiting occurs with coughing. In infants, choking spells are common. Other pertussis symptoms include: Runny nose Slight fever (102 F or lower) Diarrhea

Signs and tests

The initial diagnosis is usually based on the symptoms. However, when the symptoms are not obvious, pertussis may be difficult to diagnose. In very young infants, the symptoms may be caused by pneumonia instead. To know for sure, the health care provider may take a sample of mucus from the nasal secretions and send it to a lab, which tests it for pertussis. While this can offer an accurate diagnosis, the test takes some time, and treatment is usually started before the results are ready. Some patients may have a complete blood count that shows large numbers of lymphocytes.

Treatment
If started early enough, antibiotics such as erythromycin can make the symptoms go away more quickly. Unfortunately, most patients are diagnosed too late, when antibiotics aren't very effective. However, the medicines can help reduce the patient's ability to spread the disease to others. Infants younger than 18 months need constant supervision because their breathing may temporarily stop during coughing spells. Infants with severe cases should be hospitalized.

An oxygen tent with high humidity may be used. Fluids may be given through a vein if coughing spells are severe enough to prevent the person from drinking enough fluids. Sedatives (medicines to make you sleepy) may be prescribed for young children. Cough mixtures, expectorants, and suppressants are usually not helpful and should NOT be used.

Expectations (prognosis)
In older children, the outlook is generally very good. Infants have the highest risk of death, and need careful monitoring.

Complications
Pneumonia Convulsions Seizure disorder (permanent) Nose bleeds Ear infections Brain damage from lack of oxygen Bleeding in the brain (cerebral hemorrhage) Mental retardation Slowed or stopped breathing (apnea) Death

Calling your health care provider

Call your health care provider if you or your child develops symptoms of pertussis. Call 911 or get to an emergency room if the person has any of the following symptoms: Bluish skin color, which indicates a lack of oxygen Periods of stopped breathing (apnea) Seizures or convulsions High fever Persistent vomiting Dehydration

Prevention
DTaP vaccination, one of the recommended childhood immunizations, protects children against pertussis infection. DTaP vaccine can be safely given to infants. Five DTaP vaccines are recommended. They are usually given to children at ages 2 months, 4 months, 6 months, 15-18 months, and 4-6 years. The Tdap vaccine should be given around age 11 or 12, and every 10 years thereafter. During a pertussis outbreak, unimmunized children under age 7 should not attend school or public gatherings, and should be isolated from anyone known or suspected to be infected. This should last until 14 days after the last reported case. Some health care organizations strongly recommend that adults up to the age of 65 years receive the adult form of the vaccine against pertussis.

How do people get pertussis? Pertussis spreads easily from person to person. People get pertussis by breathing in droplets expelled from the nose or throat of an infected person during coughing or sneezing. It is also spread by direct contact with discharges from the nose or throat of an infected person.

How is pertussis spread? Pertussis is spread from one person to another through respiratory droplets from the nose or throat of an infected person by coughing or sneezing, and then inhaled by another person close by. Germs can also be picked up by hands and spread though touching your eyes, nose or mouth, although this is not as common. People who spend long periods of time with an infected person, such as household members are more likely to get pertussis. In most cases, school classmates, co-workers, and people in clinic waiting rooms are not at risk.

How is pertussis spread?

The germs that cause pertussis live in the nose, mouth and throat, and are sprayed into the air when an infected person sneezes, coughs or talks. Other people nearby can then breathe in the germs. Touching a tissue or sharing a cup used by someone with pertussis can also spread the disease. The first symptoms appear about 7 to 10 days after a person is exposed. People with pertussis can spread the disease starting up to 2 weeks before until 3 weeks after the cough starts, or until they have finished 5 days of an appropriate antibiotic treatment.

Transmission
Pertussis is a very contagious disease only found in humans and is spread from person to person. People with pertussis usually spread the disease by coughing or sneezing while in close contact with others, who then breathe in the pertussis bacteria. Many infants who get pertussis are infected by older siblings, parents or caregivers who might not even know they have the disease (Bisgard, 2004 & Wendelboe, 2007).Symptoms of pertussis usually develop within 7 10 days after being exposed, but sometimes not for as long as 6 weeks. Pertussis vaccines are very effective in protecting you from disease but no vaccine is 100% effective. If pertussis is circulating in the community, there is a chance that a fully vaccinated person, of any age, can catch this very contagious disease. If you have been vaccinated, the infection is usually less severe. If you or your child develops a cold that includes a severe cough or a cough that lasts for a long time, it may be pertussis. The best way to know is to contact your doctor.

BRAIN TUMORS IN CHILDREN

"I am truly sorry, but your child has a brain tumor..." The World of Childhood Brain Tumors has no "Welcome" sign leading into it. No matter what anyone says to minimize the situation, this statement is the most painful sentence a human can hear. The combination of fear, shock, pain is much to bear. "To see such innocence, so roughly shaken by this terrible trial, at such a young age, is nothing short of incomprehensible." I still hear this sentence, uttered by a visibly shaken parent. Instead of my becoming more routine and distant, the visceral terror that it engendered in me (the supposed allknowing physician/advisor), the delivery of such information has grown more and more difficult, even personal. I watch my own small children grow and develop. As a physician, one realizes more than ever, there is no place for impersonal behavior when caring for the children who are afflicted by a brain tumor, benign or otherwise--their families as well. No amount of experience or training can help one to ease or minimize the situation. When we discuss special areas such as:

Outcome: Does "excellent long-term results" mean a ten-year survival for a 3-year old-- your child living long enough to be frustrated by death at the age of thirteen? We parents think only of 50 and 60 year plans. Five and ten-year plans are unacceptable. We want to know that our grandchildren will not live to see their parents die at a young age.

Quality of life: Does that mean that a 5-year old child will have no hair, be skinny and slow to walk and play with his friends and classmates? How can we parents bear to live through the process of trying to give our child a childhood instead of a world of I.V. tubes, doctors who speak of life-and-death, hospital corridors and toys that our children will never play with?

Doctors: Who are they? Can we do anything to keep them human, warm, and caring for our child? How do we deal with our own resentment for the fearful news, difficult therapies and their human frailty? How do we keep our child happy to see them? Most children cringe at the mere mention of visiting a doctor-with-a-shot-to-give, or a visit to the dentist with his drills and instruments?

Hospitals: How do we keep these innocents away from such large and frightening monoliths? We parents: How can we possibly bear all of this without frightening our little, loving child? Hope: Yes, there IS hope! God and goodness are your guide. Your child is truly a precious gift. No matter what cards we are dealt, a child's joy and innocence are somehow never lost. In the worst of times, a child's pain often becomes the parent's teacher. And, when we expect the best for our children, we often get it despite all odds.

THE BIOLOGY OF CHILDHOOD BRAIN TUMORS Pediatric brain tumors are different
Most frequently, they come from "young" cells. These are cells that are still developing ("immature" or "primitive" cells) and have not reached full maturity. They are developing at the same time as the child is developing. If one looks at the way a normal cell matures from its very beginning as a "primitive" brain cell (a precursor) through its stages of normal development, towards becoming an adult cell type, one can start to understand the logic of the progression of tumor types in children. A diagrammatic representation of the manner in which brain cells develop from the embryo to the adult is under constructiion. It will be posted soon. For every normal cell type, there is a corresponding tumor that can arise from it. Thus, there is the primitive neurectodermal tumor (PNET), the medulloblastoma, the astroblastoma, the neuroblastoma, the astrocytoma, the gangliocytoma/neurocytoma, the ependymoma and so on. There are also other unusual tumors such as the teratoma, the pinealblastoma, the esthesioneuroblastoma, etc. There are also other tumors thay come from non-brain origins such as the pituitary tumors, teratomas, meningiomas, the skull bone tumors, and blood vessel tumors such as the hemangioblastoma or cavernous angioma. Children commonly have brain tumors such as the PNET, medulloblastoma, various embryonic tumors and unusual tumors of the developing brainstem, hypothalamus and optic nerves (juvenile pilocytic astrocytomas, teratomas, etc.) There are variations of these tumors and they are rare as well as difficult to understand. Parents and children should ask as many questions as possible. The questions can help reach level of comfort confident that the problem is clearly comprehended. Knowledge of the expected and the potentially unexpected will allow you to guide your child through the process of battle against their brain tumor. No matter how harried, tired or busy your surgeon and doctors might seem, it is important to understand the problem at hand fully. This will make the efforts of all involved more effective. More often than not, knowledge helps us cope with the developing situation better. The most important point is that some of these tumors hold the promise for a true and complete cure! There is nothing more satisfactory than the complete removal of a dreadful sounding cerebellar microcystic astrocytoma or a hemangioblastoma. Families soar from the depths of despair to the heights of sublime elation when the smiling surgeon comes to the waiting room after a difficult surgery. The surgeon may not look tired at all. The smile-on-his-face says that he has just had the privilege of completely removing a tumor!

MEDULLOBLASTOMA
This tumor is probably the most common tumor of children. It arises from one of the "junior" cells of the developing brain, called the medulloblastoma. This tumor almost always grows in the middle of the cerebellum (the balance part of the brain, in the back, behind the brainstem). More often than not,

small children are found to have the tumor only after it has caused secondary problems relating to blockage of the normal flow of cerebrospinal from the ventricles to the drainage system located along the outer surface of the brain (Obstructive Hydrocephalus). This results in headaches, visual problems, and decreased alertness. Often, parents will notice "sundowning", (the eyes are "stuck" in the downward gaze position) of the baby's eyes, due to local pressure on one of the brain's centers for eye control.

EPENDYMOMA
The ependymoma arises from the cells that line the internal surfaces of the brain. These cells line the fluid spaces of the brain (ventricular system) and are relatively few in number. Some of these cells are quite specialized, having little frond-like protruberances that move the cerebrospinal fluid as it permeates into the brain from the ventricular system and back again. These tumors are rare. They are usually found on the internal surfaces of the brain and spinal cord, such as the fourth ventricle of the brain (in the back, inside) and within the central canal of the spinal cord. Occasionally they grow just beneath the surface of the lateral ventricles (called "subependymoma"). Although these tumors are capable of malignant behavior, they are almost always benign. Surgical removal often leads to a cure, especially when the tumor arises right from the surface to the fluid spaces of the brain and grows into the ventricles, an "exophytic" growth, allowing for complete removal. If you or yours has this tumor, be confident that your future holds promise.

CEREBELLAR ASTROCYTOMA
This tumor is quite cureable. The small cyst version is one that, when surgically removed, is gone for good. Forget about all the fears, just thank God that your child will do well. Even if the MRI or CAT scan shows a large cyst with surrounding tumor or a tumor "nodule" in the wall of the cyst, the surgery can go well. When the tumor is the more aggressive type, the outcome deplends on the grade/size of the tumor.

TREATMENT OF CHILDHOOD BRAIN TUMORS

The treatment of these tumors usually include a combination of approaches, each tailored to deal with the problems that children are presented with:

1. Surgery:- In some cases the definitive treatment is surgery. In most, however, surgery serves as a temporizing measure that will keep a child out of trouble for long enough to get through definitive therapy that will hopefully eliminate of the tumor. Brain surgery is usually the easiest part of a child's treatment. 2. Shunting:- Quite often (e.g. medulloblastomas) childhood tumors present the blockage of the fluid spaces of the brain, (obstructive hydrocephalus). In Shunting, a thin silastic tube (the

shunt) is placed into the fluid spaces of the brain, passed under the skin into the child's tummy where the fluid is absorbed. 3. Chemotherapy:- Unfortunately, chemotherapy is the hard part of brain tumor treatment. It is only required for the more aggressive tumors. As a rule, chemotherapy should be even more aggressive than the tumor itself. The trials which are imposed both on the child and parents are legion. Bravery and an unremitting attitude of hope are required by all involved. 4. Radiation:- Because the developing brain of a child is so very sensitive to radiation therapy, it is deliberately limited. The irony of effective radiation therapy is that when it works well, the brain damage it causes might exceed that done by the original tumor. More often than not, your doctor will recommend that if any radiation is to be given, it should be held off until the child has grown older and the brain has sufficiently matured. The Good News is that REAL HOPE exists. Long term results are becoming more and more common, some children surviving fifty years and beyond. This has become especially true with the wonderful improvements in chemotherapy and surgical techniques. The promise of cures for difficult tumors is becoming a reality to more families than ever before.

What is Brain Tumour?

Brain tumours are responsible for as much as 20% of childhood cancers. Most tumours arising within the brain start in brain cells called astrocytes, resulting in astrocytomas.

Statistics on Brain Tumour

Astrocytomas are the most common type of brain tumour occurring in children less than 15 years of age. They are most common between the ages of 5 and 9 years.

Risk Factors for Brain Tumour

In general, this brain tumour occur with equal frequency in males and females. There does not appear to be significant variation between ethnic groups. The majority of cases occur in children under the age of 10 years. Research has not identified significant links between parental and environmental exposures and the risk of future development of this type of brain tumour.

Progression of Brain Tumour

The term astrocytoma refers to a number of brain tumours that differ according to structure, location and behaviour. The World Health Organisation (WHO) has categorised astrocytomas as being grade I-IV.

Grade I: Pilocytic; Grade II: Diffuse; Grade III: Anaplastic; Grade IV: Glioblastoma multiforme.

Astrocytomas of grade III are considered low grade and often carry a better outlook, whilst grades III IV are considered high grade.

Symptoms of Brain Tumour

Symptoms may include:

Morning headaches, vomiting and tiredness. These symptoms are related to increased pressure within the skull (intracranial pressure);

Children may complain of headaches and tiredness. Parents may notice a change in behaviour or school performance; Depending on the location of the tumour patients may notice such symptoms as weakness, loss of balance, visual problems and hormonal imbalances;

Seizures may occur in a small number of cases.

Clinical Examination of Brain Tumour

A thorough physical examination is often necessary. The eyes may be examined for signs of increased pressure within the skull. Depending on the location of the tumour, eyesight or eye movements may be affected. A neurological examination may show areas of weakness in one part or on one side of the body. If the tumour is affecting the balance centres in the brain, unsteadiness may be found.

How is Brain Tumour Diagnosed?

CT scan and MRI scanning of the head are the two most commonly performed tests for brain tumours.

Prognosis of Brain Tumour

A number of factors will influence outlook. These include the grade of the brain tumour (IIV), and its location within the brain. The outlook for low grade brain tumours is generally good with 60-95% rate at 10 years. High grade astrocytomas tend to have a poorer outlook, with survival at 10 years being less than 30%; brain tumour patients who survive are often afflicted by some degree of motor, cognitive or endocrine dysfunction. Brain tumours involving certain areas tend to carry a worse prognosis; for instance involvement of the visual pathways has a poorer 10 year survival rate, as well as an increased incidence of sustained visual deficits.

How is Brain Tumour Treated?

Brain tumour treatment depends on a number of factors, including the grade and location of the brain tumour. Surgery remains the brain tumour treatment of choice, particularly for low grade astrocytomas. High grade brain tumours and those that cannot be completely removed are usually treated after surgery with local radiotherapy. Many health professionals are usually involved in the treatment of brain tumours, including neurosurgery, occupational and physiotherapy, and specialties such as radiation oncology and neuroendocrinology. Counselling should be offered to all brain tumour patients and family members.