Rise In Paediatric Brain Tumor: Causes, Diagnosis, Management & Treatment

Dr. NK Venkataramana, Founder Chairman & Chief Neurosurgeon, Brains HospitalWith over three decades of experience in the field of neurosurgery, Dr. Venkataramana is an internationally acclaimed neurosurgeon, researcher and academician, who has worked with top notch hospitals and even received a number of prestigious awards & citations.

In the recent years there has been an increased incidence of paediatric brain tumors and have doubled as documented by many countries. These children who had radiation in younger age group have been shown to develop tumors later on. There has been a temporal time co-relation and with the increase to the introduction of mobile systems, suggests that there is a possibility of electromagnetic waves associated with mobiles to be influencing the new occurrence of brain tumors. In addition, nutritional factors have also been contributing. Overall the awareness and diagnostic facilities have also increased parallelly across the globe contribution to the detection and diagnosis.

Pediatric brain tumor is the second most common malignant tumor in children after blood cancer. According to a study, neuro oncology cases stands at 8.2 cases for every 1 lakh population in the world. In this, 15-20 percent of the brain tumor cases occur in children. These tumors can arise while the baby is in the womb called congenital brain tumors in the first year of the life called as infantile brain tumors, between 2-5 years called early childhood brain tumors and between 6-18 years as the brain tumor in children.

In general younger the age the more malignant the tumor is with a worst outcome. Surprisingly, majority of the brain tumor in children are in the posterior fossa affecting the small brain. In infants and older children these tumors are equally distributed.
Younger the child more are the clinical as well as management challenges such as difficulty in diagnosis, immaturity of the brain and a completely different physiology making absolutely narrow therapeutic window.

Younger children often cannot express the symptoms so the tumors remain undiagnosed or missed for a long time. They cannot complain about the headache so most of the times they are suspected by the keen and meticulous observation by mother or by teachers in the schools. These subtle changes include excessive crying, not accepting feeds properly, enlarging head and projectile vomiting in infants. Younger children often present with abnormality of walking, frequent falling, neck tilt to compensate double vision, change in behaviour or sudden drop in the scholastic performance.

Technology has advanced enough to provide a very good neurosurgical care to remove the tumors completely in majority of the locations and provide reasonable comfort with quality and cure wherever possible

Brain tumors are known to occur due to various reasons, though a lot of research is still going on. The current research clearly indicates genetic variations and mutations strongly associated with these tumors. The molecular biology now clearly indicates presence of tumor suppressors and tumor activator genes. Depending on the type of mutation, there can be tumors with different grades of malignancy and biological aggression.

Similarly, familial occurrence of some tumors, as well as many genetic symptoms with a predicition for a variety of brain tumors have been discovered in the recent years. However, the facilitating genes seem to be getting activated by many ecological and environmental influencers which are broadly termed as epigenetic factors. These include many toxins, environmental factors, ionizing radiation, drugs or certain medications, chemicals and selective viral infections. Overall management of these tumors is still a major challenge. Primarily, the brain tumor in children can be missed-out very easily; so enormous amount of observation and notification by the people around should play a major role.

Once diagnosed, surgery, chemotherapy and radiotherapy have to be meticulously planned to suit the delicacy and sensitivity of such young brains. Fortunately, the technology has advanced enough to provide a very good neurosurgical care where we can remove the tumors completely in majority of the locations to provide reasonable comfort with quality and cure wherever possible. However, all these children need to be followed up for long term to look at various complications, intellectual development, apart from the chances for recurrence. Children are totally different from the adults, they are playful in nature, enthusiastic and moreover the absence of brooding behaviour in children will make them recover much better and faster.