World Cancer Day 2023: Can Brain Tumor In Children Be Cancerous? Here What Experts Say

The disease burden of cancer is increasing at a very drastic rate and is now also affecting the younger generation. According to the World Health Organization (WHO), almost 75,000 children in India suffer from cancer every year.

Among these, brain tumors are one of the most common types of cancers in children with almost 1 out of 4 childhood cancers being brain tumors.

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Tumors can be cancerous or non-cancerous

Although brain tumors can be cancerous (malignant) or non-cancerous (benign), the risk of it developing into cancer is high in children as most of the initial symptoms often go unnoticed by parents. Other than the brain, there is very little space in the skull to expand. As a result, brain tumors increase the pressure in this enclosed region. Malignant tumors grow rapidly compared with benign ones, increasing the risk of life-threatening consequences.

There are various types of malignant brain tumors like medulloblastoma, gliomas that can be low grade or high grade, PNETs, Diffuse Intrinsic Pontine Gliomas (DIPG). DIPG is different from the other gliomas and are worst of the lot.

The type of tumor, its location inside the brain, whether it has affected any critical areas of the brain (known as ¡°eloquent¡± areas), your child's age and overall health, as well as the likelihood of recovery, all influence treatment and prognosis. Recent advances in our understanding of these tumors have shed some light upon the eventual behavior of these tumors. There are certain molecular markers that have been associated with prognosis and predict response to their treatment. But in general, the high-grade tumors have poor treatment outcomes.

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Early symptoms of tumor

1. Frequent headaches that often gets worse in the morning

2. Vomiting, especially forceful projectile ones

3. Fits or seizures

4. Lethargy or losing interest in day-to-day activities

5. Abnormal eye movements

6. Blurred or double vision

7. Irritability

In some cases, the child may also suffer from an enlarged head as their skull bones are not completely developed. If left untreated, the child may also slip into a coma and increase the risk of mortality.

Test and diagnosis of brain tumor

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There are several factors that determine the treatment of malignant brain tumor. Some of these include:

1. Location: A brain scan, preferably an MRI, can reveal the location of the tumor along with its characteristics that guide subsequent treatment decisions. Moreover, there are several locations where a tumor can grow that are not suitable for surgery since the brain contains so many important structures. Imaging with Tractography is used sometimes to establish the tumor's accessibility and the safest course of action for therapy.

2. Type: The type of brain tumor can be identified and the likelihood of its growth or recurrence can be determined by examining the tumor cells under a microscope along with certain tests on the specimen called as IHC and Molecular markers.

3. Grade: This refers to assessing the tumor cells' aggressiveness and chances of recurrence after surgery. The tumor becomes more aggressive the higher its grade.

Unlike benign tumors, malignant brain tumors have a higher risk of progression and eventually poor outcomes. They grow quickly and can affect areas around the original tumor as well as other parts of the brain. Additionally, they have a higher propensity for recurrence. A child experiencing any of the above symptoms must get diagnosed at the earliest. In case, the tumor is cancerous, it can be identified by the grade and appearance of the tumor under the microscope interpreted along with the MRI characteristics. The next step after identifying the tumor is consultation. Based on the complication, the Neuro oncologist guides the whole family to develop the best treatment plan for the child.

Brain tumor treatment

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Depending on the type of tumor, its grade, and its location, the following treatment options are suggested to the patient:

Surgery

Most brain tumors in infants and children require surgical removal. As a first step, the Neuro surgeon may prescribe surgery to remove as much of the tumor as safely possible and to reduce intracranial pressure caused by the tumor. For low-grade tumors that have been fully removed, surgery may be the only intervention necessary, although a follow-up checkups are necessary.

Radiation therapy

This treatment directs high-energy radiation beams at the tumor and a limited amount of surrounding tissue having potential microscopic invasion. Radiation is used with extreme caution, precision, and expertise in deciding the doses as per the tumor type, grade, and MRI appearance in children as it may affect the overall functioning of their brain. For high-grade tumors, Radiation therapy is usually required in up to 6 weeks of regimens, frequently combined with oral chemotherapy. For certain tumors like DIPGs that occur in the brainstem, Radiation therapy is the only form of treatment that has shown some benefits.

Chemotherapy

Chemotherapy is used to treat a wide range of brain cancers, including aggressive and high-grade tumors. It is mainly given as adjuvant treatment after surgery and/or radiation depending upon the tumor type. Oral chemotherapy is also used along with radiation therapy for ¡°Radio-sensitization¡±. Chemotherapy can be given orally as pills, intravenously (IV, through veins), or into the cavity left following surgical removal of a brain tumor.

Recent advances have been encouraging in the treatment of these dreaded tumors of children. A multidisciplinary approach including a Neuro Oncologist, Neurosurgeon and Rehabilitative team is often required to maximize the outcomes and improve the growth potential and Quality of Life in these children.

About the author: Dr. Karan Chanchalani is a Consultant in Radiation Oncology at Manipal Hospital, Baner-Pune. All views/opinions expressed in the article are of the author.