Information and treatments

Finding accurate and reliable information about child brain tumours can be difficult, so we’ve created this page to give answers to some of the questions you might be asking. Plus, if you need to look up a few words, you can always take a look at our glossary.

What is a tumour?

A tumour is any abnormal mass of cells in the body caused by cells dividing uncontrollably. Benign tumours are those that grow slowly and do not spread whereas malignant tumours are those that grow extremely quickly and may also invade surrounding tissues. A benign tumour can still be life threatening, particularly in the brain, because as it grows and expands within the skull it puts what’s known as intracranial pressure on the brain and may cause severe damage.

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What are the signs and symptoms?

Brain tumours produce a variety of symptoms mainly due to the raised intracranial pressure. Some of the most common symptoms are headaches, nausea, drowsiness, poor coordination and seizures. Children may have behavioural changes, blurred vision, weakness in a limb or on one side of the body and speech problems.

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What are the different types of brain tumours?

Many different types of brain tumours occur in children and most of them are either named after the cell type or the area of the brain in which they occur. For example, gliomas, which account for nearly half of all paediatric brain tumours, arise from the glial cells which support the nervous system. However, many tumours may have more than one name, which can be very confusing.

  • Medulloblastomas are the most common type of malignant brain tumour in children and tend to occur in children between the ages of 4 and 10 years. They usually develop in the cerebellum at the back of the brain – however, they may spread to other parts of the brain or into the spinal cord. The symptoms are very similar to those of cerebellar astrocytomas (see below) as they occur in the same part of the brain.
  • Gliomal tumours can be subdivided into two main types. These are called astrocytomas and ependymomas. Astrocytomas are benign glial tumours and in children they often occur in the cerebellum area of the brain. They are the second most common childhood brain tumour (after medulloblastomas) and account for 15-20% of all cases. As these tumours are in the cerebellum they may interfere with the flow of cerebrospinal fluid and cause hydrocephalus – an abnormal increase in the amount of cerebrospinal fluid in the brain. A child with this type of tumour is likely to suffer from headaches, vomiting and may be unsteady on their feet. The second type of glioma, ependymomas, occur in the cells lining the cerebral ventricles and make up 8-10% of paediatric brain tumours.
  • About 30% of paediatric brain tumours are supratentorial gliomas that grow in regions of the cerebral hemispheres. Many of these tumours cause seizures.
  • A small percentage (5%) of paediatric tumours are optic pathway gliomas involving the optic nerves and the hypothalamus. This means that children with these tumours often have vision and hormone problems.

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Treating brain tumours

Brain tumours will usually first be removed by surgery. This will then be followed by a combination of radiotherapy and/or chemotherapy. Any disease of the brain may affect a child's future quality of life, particularly if the child is very young and the brain is still developing. Therefore, different treatments may be recommended for the same tumour type at different ages.

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What is chemotherapy?

Chemotherapy uses anti-cancer drugs to either slow down or kill rapidly dividing cancer cells. The drugs can either be injected or taken orally and for brain and spinal cord cancers it’s also possible to introduce them directly into the cerebrospinal fluid. The drugs travel around the bloodstream and attack the rapidly dividing tumour cells within the body. However, like radiation therapy, chemotherapeutic drugs can also kill healthy cells. This is what causes the side effects of the drugs.

Chemotherapy can be used before, during or after surgery and radiotherapy. It is usually given in cycles consisting of a treatment period followed by a period of recovery, then another treatment period and so on. Usually an individual will receive chemotherapy as an outpatient. However, depending on which drugs are given and the individual’s general health, a short hospital stay may be needed. In children, a catheter may be implanted as their veins are small and hard to access. The chemotherapy drugs and other drugs such as steroids can then be administered through this catheter.

Unlike other organs the brain is protected by a 'blood-brain barrier', which filters drugs from the blood preventing them from reaching the brain. However, some drugs can pass across the barrier and these are the ones used in the treatment of brain tumours e.g. Procarbazine, Vinicristine and Lomustine. Chemotherapy drugs can be given alone or in combination, for example the three drugs mentioned above are often combined (PCV).

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What is radiotherapy?

Radiotherapy uses high-energy rays similar to X-rays to kill cancer cells. It’s necessary because aggressive tumours spread rapidly and cannot be treated successfully by surgery alone. There are two main types of radiotherapy: external beam radiotherapy (where the radiation comes from a source outside the body) and internal beam radiotherapy (where radioactive seeds or pellets are placed directly into the tumour site).

While most radiation therapy targets malignant tumours (tumours that spread into the body) doctors have recently begun to use it on certain benign tumours that are inaccessible or in locations like the brain stem where it is dangerous to attempt surgery. Unfortunately, like chemotherapy, radiotherapy also may affect healthy tissue near the tumour or along the path of the beam travelling in and out of the body. This again causes side effects such as fatigue, nausea and hair loss.

In an attempt to combat these effects a new technique called stereotactic radiosurgery has been developed which aims high doses of radiation at the cancer whilst trying to minimise the dose received by normal brain tissue. Stereotactic radiosurgery positions the head inside a metal ring, then a single dose of radiation is administered by a Gamma knife. The Gamma knife delivers the radiotherapy to the cancer from many different angles.

Other drugs are often administered to treat brain tumours are steroids and anti-inflammatories. Some tumours cause the normal brain tissue around them to swell, especially if they’re blocking the flow of cerebrospinal fluid. Surgery and radiotherapy also produce swelling in the brain, which can cause symptoms such as headaches and vomiting. Steroids and anti-inflammatory drugs vastly improve these symptoms providing great relief.

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New approaches to treatment

  • Boron neutron capture therapy – this is an experimental form of radiotherapy that injects a chemical compound containing boron into the bloodstream, which is then concentrated in the brain tumour. Neutrons are then directed at the cancer. When the neutrons come into contact the boron, high-energy radiation is released which doesn't affect much of the surrounding tissue
  • Growth factor inhibitors – these prevent the effects of the factors that allow a cancer to grow
  • Angiogenesis inhibitors – these prevent the formation of new blood vessels that nourish cancers
  • Immunotherapy – the aim of this therapy is to stimulate the body's own immune system to help it fight the cancer

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