World Brain Tumor Day: New-age treatments are boosting survival rates in youngest victims of brain cancer

Brain tumors are relatively uncommon in adults. However, in children, they contribute to a higher share of all tumors. Brain tumors are the second most common type of cancer after leukemia affecting children below 12 years of age according to Brain Tumor Foundation of India. There is also a difference in the site of origin, type of tumor as well as the behaviour of brain tumors among adults and children. In adults, metastasis from a tumor in the other parts of the body, or secondary tumor is quite common, whereas children most often develop primary brain tumors originating in the brain itself. Even primary brain tumors of adults and children differ: adults get more tumors in the upper brain affecting memory, behavior etc. whereas children get more tumors in lower brain and back of the brain which affect their movement, coordination capabilities and vision etc. Luckily, the survival rates in children are better than those in adults for this dreaded disease. In the adults, 5-year survival rate with brain metastasis is less than 5 percent and for primary brain tumors, it is around 30 percent. In comparison, more than 50 percent of children with a brain tumor are cured of it with current age treatment protocols in developed countries. Of course, tumor characteristics such as cells of origin and grade of aggressiveness as well as the stage at diagnosis affect survival. For example, Gliomas, which account for almost 50 percent of all CNS tumors in children and adolescents have survival rates of 75-85 percent at 5 years, whereas the most aggressive tumors in children such as glioblastoma have a survival rate of 20-25 percent only. [caption id=“attachment_5134401” align=“alignnone” width=“1280”] Representational image. Image courtesy: MaxPixel[/caption]

What are the risk factors for brain tumors in children?

Brain tumors do not have a specific cause or any lifestyle-related risk factors. But having a family history of brain tumors may put children at higher risk. Also, children who suffer from genetic conditions such as neurofibromatosis or tuberous sclerosis are at a greater risk of developing brain tumors. Frequent physical exams and diagnostic tests are often recommended to ensure that a tumor can be detected at a very early stage.

What are the red flags for a brain tumor in children?

As early diagnosis helps in better survival, the logical question is: what signs and symptoms should alert us for getting a child checked out for brain tumor. The commonest symptoms are headache, vomiting, changes in vision or swelling or growth in eyes. There are defined criteria which doctors use for getting a child investigated, by brain imaging (MRI or CT Scan usually) for example:

• A headache which has lasted for more than 4 weeks, with any one of these complaints
• Wakes a child from sleep
• Occurs upon waking
• Occurs in a child <4 years of age with confusion
• Vomiting upon waking up a few times, with no GI upset
• Movement-related problems, such as weakness of the movement in the face, arms or legs, Abnormal walk or lack of coordination
• Vision-related complaints, such as new squint, inability to see in a particular direction, roving eye etc. Getting fits for the first time, without any fever

What treatment options are there?

The mainstay of treatment of brain tumors has been surgery and radiation therapy. The adult brain tumors mostly do not respond to chemotherapy well. However, radiation, while tolerated well in adults, can really impede the normal development of a child’s brain and can lead to life long complications. Also, brain tumors in children respond better to chemotherapy. Therefore, more and more, radiation is being avoided and chemotherapy is being added to treatment protocols of childhood brain tumors. [caption id=“attachment_6778271” align=“alignnone” width=“1024”] A 5-year old boy with a brain tumour, lies on a stretcher as he arrives with his parents. Reuters[/caption]

What research and innovation are happening in the area?

Better treatment options are being explored, each focusing on a different aspect of the behavior of tumor cells, the brain itself or the surgical technique etc. While molecular research is working on identifying proteins whose supply, if broken will reduce growth or even survival of tumor cells, genetic research is trying to identify the gene sequences which get altered in tumor cells as a target for gene therapy. More refined surgical techniques such as endoscopic surgery etc. are increasing the reach and precision of surgery, whereas better identification of tumor cells is being explored with techniques such as stimulated Raman Scattering Microscopy. There is hope that in the next one or two decades we will be able to save more and more children from brain tumors, just as we have managed to enhance survival in the commonest childhood cancer, leukemia.

Dealing with the emotional turmoil

It could be heartbreaking for the parents to know that their child has been diagnosed with a brain tumor. They may find it very difficult to explain the situation to the child. However, it is imperative, to be honest, and give the child all the details as per its emotional maturity. It will help the child to understand why he or she is undergoing this treatment. One should also try to contact and talk to the parents and children who have already dealt with such a situation. This can help you to understand how to stay emotionally stable and strong during this journey of recovery. The author is a Senior consultant in the medical team at docprime.com