Brain and Spinal Nervous System Tumours

Brain tumours in children

Brain tumours in children arise from different types of cells in the brain. There are more than 100 different types, most of which are very rare. The most common brain tumours in children are astrocytoma, medulloblastoma and ependymoma and choroid plexus tumours (1).

What type of cancer are brain & CNS tumours?

Brain and spinal tumours affect the Central Nervous System known as the CNS. They come from different types of cells in the brain and are classified according to the cell type and area of the CNS in which they began. Most CNS tumours start in glial cells, the supporting cells of the brain.

Cancerous brain tumours that start in glial cells are known as gliomas and include astrocytomas, ependymomas and oligodendrogliomas. Another group of tumours arise from embryonal cells. These tumours include medulloblastoma and PNET. That is short for primitive neuro-ectodermal tumour. Altogether there are more than 100 different types of brain tumour, most of which are very rare.

Tumours classified as low grade are very slow growing and remain in the part of the brain in which they started. High grade brain tumours are likely to be more aggressive in spreading into the brain tissue which surrounds them. This can cause pressure and damage to the surrounding areas.

For example, astrocytomas are themselves divided further into four grades:

Grade 1: pilocytic astrocytoma
Grade 2: diffuse or low grade astrocytoma
Grade 3: anaplastic astrocytoma
Grade 4: glioblastoma.

Incidence

Over 400 children a year are diagnosed with brain, CNS or intracranial tumours in Great Britain. They are the second most common group of cancers and the most common group of solid tumours that occur in this age group, accounting for more than a quarter (26%) of all childhood cancers in Great Britain.

Treatment

What would you expect to happen during treatment?

Brain tumour treatment will vary according to the precise type of tumour, its grade, its position and the extent to which it may have spread. Doctors will carry out a range of tests to obtain this information, including taking a biopsy and the use of a CT or MRI scan.

The main treatment for most brain tumours in children is surgery. If a tumour cannot be completely removed surgically, or if there is a chance that some cancer cells have been left behind, radiotherapy may be given afterwards. Radiotherapy may also be used as the main treatment if surgery is not possible, however, it is usually avoided in children under the age of three years, as there is a greater risk of harm to the developing brain.

Chemotherapy is used routinely to treat medulloblastoma and is increasingly being used to treat other types of brain tumours. It may also be used in situations where the tumour cannot be removed completely with surgery.

You may be given steroids. These do not treat the tumour but can improve symptoms by reducing the swelling that often surrounds brain tumours. Anti-convulsants may also be given to prevent fits.

Other possible treatments may be considered such as proton beam therapy, this is a form of radiotherapy. Higher doses of chemotherapy which kill the bone marrow cells as well can be given but with stem cell rescue. Stem cells are collected prior to the treatment and given afterwards.

How effective are the treatments – What are the survival rates?

Children will have regular follow-ups to monitor their progress, to check for any signs of relapse and for any problems that may arise as a result of the treatment they have received.

Treatment by surgery, radiotherapy or chemotherapy may affect a child’s physical and intellectual development. The risk is greater in children who are very young as their brain is growing quickly. Thus it follows that different treatments may be recommended for children of different ages.

The possible risks of any treatment given will be explained by the child’s doctor before treatment begins.

The average 5-year spinal and brain tumour child survival rate varies widely between tumour subgroups.

The average 5-year spinal and brain tumour child survival rate is 74% in England, but this figure varies widely between tumour subgroups.

In teenagers and young adults (those between 15 and 24 years old) the average 5-year survival rate of brain, other central nervous system (CNS) and intracranial tumours in the UK is 79.9% for young men and 82.5% for young women, but these figures vary widely between tumour subgroups.

Astrocytomas account for around 43% of children’s brain, CNS or intracranial tumours in Great Britain1 and have an average 5-year survival rate of 81% in England.

Childhood ependymomas and choroid plexus tumours have an average survival rate of 76% in England, and childhood medulloblastomas tumours have an average survival rate of 63% in England.

Diffuse Intrinsic Pontine Glioma (DIPG) is considered to be incurable. Sadly, most children die within months of diagnosis and fewer than 10% live longer than two years.

Can it come back?

Relapse means that the tumour recurs, either in the same site as the original tumour or in a new site. Both benign and malignant tumours can recur. It is therefore important for the child to have regular follow up appointments and MRI scans.