Brain tumours: Children

Brain tumours: Children | NHS inform Home Illnesses and conditions Symptoms and self-help Tests and treatments Healthy living Care, support and rights Scotlands Service Directory 0 Home Illnesses and conditions Cancer Cancer types in children Brain tumours: Children Brain tumours: Children Brain tumours are the most common tumours that develop in children. Children of any age may be affected. Boys are affected slightly more often than girls. More children than ever are surviving childhood cancer. There are new and better drugs and treatments, and we can now also work to reduce the after-effects of having had cancer in the past. Its devastating to hear that your child has cancer. At times it can feel overwhelming, but there are many healthcare professionals and support organisations to help you through this difficult time. Understanding more about the cancer your child has, and the treatments that may be used, can often help parents to cope. Your childs specialist will give you more detailed information and, if you have any questions, its important to ask the specialist doctor or nurse who knows your childs individual situation. Brain tumours A tumour in the brain can come from the brain itself (primary), or from another part of the body (secondary). This information is about primary brain tumours. Signs and symptoms Symptoms will depend on the size of the tumour, where it is and how it affects that part of the brain.Symptomsare caused by the pressure inside the head being higher than it should be. A growing tumour may push normal brain out of the way, or block the flow of fluid in the brain. Doctors call this raised intracranial pressure, and it can cause symptoms such as: headaches (often worse in the morning) vomiting (usually in the morning) or feeling sick fits (seizures) feeling very irritated or losing interest in day-to-day things eye problems, such as abnormal eye movements, blurring or double vision feeling very tired much more quickly than usual feeling extremely sleepy (drowsy) for no reason Brain tumours can also cause problems with balance and walking, weakness down one side of the body, or changes in behaviour. Some of these symptoms are common even without a brain tumour, and this can cause confusion in the early stages. The brain The brain is contained within the skull, which protects it. Between the brain and the skull, there are 3 layers of membrane called the meninges. These completely cover the brain and spinal cord and help to protect it. Between 2 of these layers is a space that contains a fluid called cerebrospinal fluid (CSF), which circulates around the brain and spinal cord. The main parts of the brain are: the cerebrum  this is at the top of the head and is the largest part of the brain; itsmade up of 2 halves(hemispheres), it controls thinking, learning, memory, problem-solving, emotions and touch, and it also helps us be aware of our body position the cerebellum  this is the back part of the brain, and it controls movement, balance and coordination the brain stem  this connects the brain to the spinal cord and is in the lower part of the brain just above the back of the neck; it controls breathing, body temperature, heart rate and blood pressure, eye movements and swallowing What happens when a brain tumour is suspected Knowing what a test involves can make things a bit easier. The specialist doctor and nurse will explain things but dont be afraid to ask questions. Your doctor will want to hear about the problems your child has had recently, and will examine him or her properly. This will include looking into the back of your childs eyes with an ophthalmoscope to check for swelling, which can be a sign of raised pressure in the brain. Theyll usually check other things like balance, coordination, sensation and reflexes. CT or MRI scan Most children will have a CT or an MRI scan , which looks in detail at the inside of the brain. A CT scan uses X-rays . Its quick and often is the best first-line investigation, but it does not give as detailed pictures as an MRI. It uses quite a lot of X-rays, and so it is important to make sure we do not use it on too many people if it can be avoided. An MRI scan uses no X-rays, and gives more detailed pictures, but takes much longer. Machines are noisy, and often children cannot lie still long enough to get proper images. It is sometimes necessary to have an anaesthetic for this scan. Ordinary X-rays are not usually helpful for brain tumours. Blood tests These are usually done to make sure it is safe to do an operation, and can also be used to help diagnose certain types of tumour. Biopsy Its often necessary for doctors to remove a small part of the tumour ( biopsy ) to find out exactly what type of tumour it is. It means your child will need to go into hospital for an operation under general anaesthetic. The piece of tumour removed is then examined under a microscope by a specialist doctor called a pathologist. A biopsy isnt always done; it is sometimes better to remove the whole tumour in one operation. In this case, it will be a few days before the exact type of tumour is known. Sometimes, it may be safer to do the operation in two stages. Part of the tumour might be removed in the first operation and the rest a few days later. Types of brain tumours There are different types of brain tumours and they are usually named after the type of cells they develop from. The main types are astrocytoma, ependymoma, and medulloblastoma, but there are many other, less common types. Brain tumours can be either benign (non-cancerous) or malignant (cancerous). Benign brain tumours These remain in the part of the brain that they started in and do not usually spread into other areas. Sometimes it may be difficult to remove a benign tumour, because of where it is and, in this situation, other treatments may be needed. The most common tumour of this type is a low-grade astrocytoma (also called low-grade glioma). Malignant primary brain tumours These are most likely to cause problems by causing pressure and damage to the areas around them and possibly by spreading to the normal brain tissue close by. High-grade astrocytoma and ependymoma These tumours develop from the supporting cells of the brain known as glial cells, and are sometimes also called gliomas. Medulloblastomas These usually develop in the lower part of the brain, the cerebellum. They may spread to other parts of the brain or into the spinal cord, and treatment must include the whole of this. Treatment Because there are different types of brain tumours, treatment will not be the same for everyone. The doctors will look at the type of brain tumour, its size and where it is in the brain before deciding on the best treatment. These are the main treatments used to treat brain tumours. Your child may have one treatment or a combination of treatments. Surgery Usually, a neurosurgeon will operate to remove as much of the tumour as possible. Operations can be very long. Its not uncommon for these to be more than 6 or 8 hours. Sometimes, the fluid in and around the brain does not flow freely, as a result of the tumour or brain swelling. In this case, it may be necessary to place a fine tube (shunt) to drain excess fluid from the brain and into the lining of the tummy area (abdomen). You cannot see the shunt outside the body. Another way of treating this is to create another drainage route for the fluid around the obstruction (called a ventriculostomy). After the operation, your child may spend some time in an intensive care ward or high dependency unit, so the nurses and doctors can keep a very close eye on them. Once a diagnosis is known, a plan to treat any tumour left behind can be made. For benign tumours, there may be no further treatment, but for some, radiotherapy or chemotherapy will be required. Radiotherapy Radiotherapy treats cancer by using high energy radiation beams. These are exactly the same as visible light, but instead of reflecting from the surface, the energy passes inside the body, where it causes damage to tumour cells. Radiotherapy is delivered extremely carefully, using machines linked to the MRI scans of your childs brain. The process usually takes a few minutes each time, but often needs to continue for 5 or 6 weeks. Sometimes more specialised types of radiotherapy may be used. Your childs oncologist will explain more about this. Chemotherapy Chemotherapy uses drugs to get rid of cancer cells. Chemotherapy is given into the veins, and sometimes as a liquid or tablets by mouth. Treatment is often quite prolonged, with periods of time in hospital and gaps when you will be able to return home. This part of the treatment is planned by an oncologist. The specialist doctor and nurse will explain your childs treatment and answer your questions so that you understand what is involved. Other medicines your child may need to take Your child may need to take medicines for a while to reduce or control the symptoms of the brain tumour: Steroids These are medicines that reduce swelling and inflammation in the brain and can help with symptoms. Anticonvulsants These are medicines that help prevent fits, which can be a problem before or after operations on the brain. They may only be necessary for a short period, but sometimes are needed for longer. Side effects of treatment Your childs doctor and specialist nurse will explain more about what to expect. Always let them know about any side effects your child is having. Many side effects can be well controlled or made easier. Hair loss Both radiotherapy and chemotherapy can cause hair loss . Your childs hair will usually grow back again after chemotherapy, although it may not after radiotherapy. Tiredness Tiredness is very common with both treatments and may continue for weeks after chemotherapy or radiotherapy finishes. Feeling sick Radiotherapy and chemotherapy may make your child feel sick. This can usually be controlled well with anti-sickness drugs, which the oncologist will prescribe for your child. Increased risk of an infection Chemotherapy can increase the risk of infection. Itsimportant to contact the oncologist or specialist nurse straight away if your child has a temperature, any signs of infection or suddenly feels unwell. Skin changes in the treated area if your child is having radiotherapy Radiotherapy can cause a mild form of sunburn. The skin may become red, flaky or sore if your child has fair skin and may become darker and flaky if your child has dark skin. Youll be given advice on looking after the skin in the treated area. Clinical trials Trials aim to improve our understanding of the best way to treat an illness, usually by comparing the standard treatment with a new or modified version. Its important to realise that a clinical trial is not an experiment, and your doctor will always offer you what is believed to be the best available treatment. Clinical trials are usually offered to explore ways of making new improvements to treatment, beyond what is already known. Specialist doctors carry out many trials for brain tumours. If appropriate, your childs medical team will talk to you about taking part in a clinical trial, and will answer any questions you have. Written information is often provided to help explain things. Taking part in a research trial is completely voluntary, and youll be given plenty of time to decide if it is right for your child. You can also join a trial, and then withdraw if you change your mind at a later date. Treatment guidelines Sometimes, clinical trials are not available for your childs tumour. This may be because a recent trial has just finished, or because the tumour is very rare. In these cases, you can expect your doctors and nurses to offer treatment which is agreed to be the most appropriate, using guidelines which have been prepared by experts across the country. The Childrens Cancer and Leukaemia Group (CCLG) is an important organisation which helps to produce these guidelines. Follow-up care After treatment is over, your child will be seen regularly by specialists. This is to check their progress and how well theyre recovering from treatment. It is also to check that they dont have any long-term problems from treatment. You can contact your childs specialist doctor or nurse at any time if you have any worries about their health. Long-term side effects Sometimes treatments may cause possible long-term side effects that may develop later. Your childs oncologist or specialist nurse will explain the possible risk of any long-term effects in your childs situation. Children are monitored for any long-term problems following treatment so that they can be picked up and managed early on. Your feelings As a parent, the fact that your child has cancer is one of the worst situations you can be faced with. You may have many emotions, such as fear, guilt, sadness, anger and uncertainty. These are all normal reactions and are part of the process that many parents go through at such a difficult time. Its not possible to address here all of the feelings you may have. However, the CCLG booklet Children & Young Peoples Cancer; A Parents Guide talks about the emotional impact of caring for a child with cancer and suggests sources of help and support. Your child may have a variety of powerful emotions throughout their experience of cancer. The Parents Guide discusses these further and talks about how you can support your child.