Childhood brain tumours – How is it diagnosed?
Brain tumours are masses or lumps of abnormal cells that can occur anywhere in the child’s brain. There are many kinds of brain tumours, some are benign (non-cancerous) while others are malignant (cancerous).
The symptoms associated with brain tumours depend on the location of the tumour. The common symptoms include a headache with persistent vomiting, often worse in the mornings, changes in walking, balance or speech. Regression of milestones and a rapidly enlarging head may be seen in an infant. Some children develop seizures, and some may develop a new stroke.
Diagnostic process
These children are usually seen by a GP or paediatrician or may be taken to casualty. Once they have been examined, they are sent for a CT or MRI scan.
CT scans are quick and take about five to 10 minutes. They usually require a drip to be inserted so that the radiologist can give contrast, a specific dye, into the vessels so that certain parts of the brain are better defined on the scan.
An MRI may be required of the brain and sometimes also of the entire spinal cord. This takes much longer than a CT scan and gives more detail about the brain and spine. In young children, both CT scans and MRIs are performed under general anaesthetic. This keeps the children very still during the scan which is necessary to get the best image quality.
Referrals
Once the tumour has been diagnosed on imaging, these children are usually referred to a neurosurgeon. These specialists can, depending on the size and the location of the tumour, perform an operation to either biopsy the tumour or remove it. The tumour is then sent to the pathology laboratory, where a pathologist looks at the tissue under a microscope, before the diagnosis is made.
Once the diagnosis has been made, these children are then referred to a paediatric oncologist for further management. This may include a watch-and-wait-approach, chemotherapy, radiation therapy, further surgery, or a combination of them. A lumbar puncture and bone marrow aspirate and trephine may also form part of the staging process, depending on the type of the tumour.
Childhood cancer is rare and comprises less than 1% of all malignant disease. It occurs in about 1 in 650 children, or 140 children per million. It’s estimated that almost half the children with cancer in SA will never be diagnosed.
The most common types are as follows:
- Leukaemia 34%
- Brain tumours 22%
- Lymphoma 11%
- Nephroblastoma 6%
- Neuroblastoma 6%
- Soft tissue sarcoma 6%
- Bone tumours 5%
Dr Kate Bennett is a paediatric oncologist; she qualified as a paediatrician in 2009 and then as a paediatric oncologist in 2011. She has a special interest in the treatment of paediatric leukaemia and lymphoma, immune thrombocytopaenia, and sickle cell anaemia.
Header image by Freepik
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