Brain Tumours in Children: Symptoms, Diagnosis, and Treatment Options

Brain tumours are the second most common cancer among children, involving about 20% of paediatric cancer cases.

Brain tumours are the leading cause of solid tumour cancer death in children.

Thus, it becomes important to be able to diagnose these brain tumours early and treat them before it is too late.

The paediatric age group presents a special problem in diagnosis on two counts:

1. The child is often unable to complain about their symptoms

2. The symptoms in children do not follow the same linear equations as adults.

Excessive crying, lethargy, excessive sleep, excessive urination, and marked irritability may be the only signs of brain tumours in children.

Forceful unprovoked vomiting may sometimes denote an underlying brain tumour, often diagnosed as a stomach upset, thus losing valuable time.

Enlarging head size in an age group of under 18 months, dancing eyes, abnormal gaze, and imbalance in a child who was otherwise walking normally till a few days ago are all symptoms that beg to be investigated for brain tumours. A child whose power of spectacles changes frequently must be investigated for a brain tumour.

Eyes that look downward with the white of the eye prominently seen above the cornea, inability to focus and a high-pitched cry are features of some types of brain tumours. Excessive growth spurt with coarsening of features may be because of hormone-secreting tumours. A sudden, unprovoked epileptic attack may herald the occurrence of a brain tumour in a child. Difficulty swallowing, drooling, and nasal twangs in the voice are signs of a critically located brain cancer in children. Sometimes the symptoms are sudden in onset and may be due to obstruction in the CSF (water circulation in the brain) pathway.

While not all brain tumours in children are cancerous, a large percentage are malignant, and the grades of malignancy can vary from low to high.

Once a brain tumour is suspected, the child must be investigated.

While a CT scan is a quick screening test in adults, an MRI of the brain is preferred in children. CT scans pose a small but definite radiation hazard in infants and children with developing brains. These days, MRIs use sophisticated programmes to differentiate between a cancerous and non-cancerous lesion.

Most brain tumours will require surgery as the first step of the treatment. The aim of surgery is to remove the tumour completely. This can achieve a cure in the case of benign tumours. In the case of malignant tumours, it can ameliorate (improve) the symptoms and make them more amenable to supplementary modes of treatment like radiation and anti-cancer medicines.

Sometimes tumours are located in those parts of the brain where surgical approaches pose a risk of unacceptable neurological damage; in such cases, a biopsy is obtained using navigational techniques to initiate further treatment.

Unlike adults, it is rare to find tumours from other parts of the body manifest themselves in the brain, but if suspected, then a PET scan is a good investigative tool.

The surgery is mostly safe, with mortality figures remaining less than 1.5% on average; however, some degree of morbidity can occur in nearly 50% of operated brain tumours in children.

Mostly these surgeries are carried out under high magnification using a microscope, and where possible, an endoscope is used to remove these tumours.

Some brain tumours, like those in the brain stem, are treated directly by radiotherapy.

All in all, brain tumour surgery in children is safe and not something to despair about, but at the same time, it is not to be deferred or ignored before it is too late.