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  • 1. Pediatric Brain Tumors<br />Michelle Bovee<br />MSB College<br />Anatomy & Physiology<br />Meredith Butulis<br />November 28, 2008<br />Pediatric Brain Tumors<br />Brain tumors can occur at any age and are most common in children. Seventy-six percent of children with brain tumors are under the age of 15 years old and each year there are approximately 3400 new cases diagnosed.<br /> There are 120 different types of brain tumors so it is hard to find treatment for all of the different ones there are. Sixty percent of childhood tumors are located in the posterior fossa (the back of the brain). The posterior fossa includes the cerebellum, brainstem and the fourth ventricle. The different kinds of tumors in this area are called medulloblastomas, cerebellar astrocytomas, brainstem gliomas, and ependymomas.<br />The remaining forty percent of tumors occur within the two cerebral hemispheres or the spinal cord. The most common tumors that occur in the spinal cord are astrocytomas and ependymomas.<br />Causes<br />The cause of most brain tumors is not known, researchers are looking into environmental and genetic factors for clues. Doctors believe that the majority of the tumors are caused by abnormal, uncontrolled cell growth.<br />Tumors, also called Neoplasms, are made up of primary cells. Brain and spinal tumors in children are primary cells or secondary cells. Primary means that they start at the central nervous system (CNS) and usually never spread beyond the brain and spinal cord. Secondary tumors spread to the brain from somewhere else in the body.<br />The central nervous system consists of the brain and the spinal cord. The brain controls thought, memory, respirations, temperature, hunger, emotions, touch, vision and motor skills<br /> There are benign and malignant tumors. Benign do not spread at all, are slow-growing, and usually non-cancerous. Malignant tend to be cancerous, fast-growing, can invade surrounding tissues and can recur anytime after treatment. <br />Effects<br />Benign tumors can be very critical if it is growing in the brain stem or if it is a large enough mass to put pressure on areas of the brain. Some circumstances, benign tumors may change and turn into malignant tumors.<br />.The brain and spinal cord are located in the skull and spine; tumors are noticed more likely because the limited amount of space. As the tumor begins to grow and expand, it will put intracranial pressure on the head or spine due to blockage of cerebrospinal fluid. The blockage of the fluid is called hydrocephalus, excess fluid on the brain, which then leads to many types of noticeable symptoms or effects<br />Some of the many signs and symptoms of intracranial pressure are, headaches, which are most likely in the morning time, vomiting or nausea, balance difficulty or body weakness, blurred or changes in vision, seizures ,memory loss, behavior or mood changes and speech difficulties.<br />Spinal cord tumor symptoms may have pain sensations, which is more noticeable at nighttime while the child is at rest, tingling or weakness of legs and arms and urinary incontinence.<br />A physician or any caregiver that suspects a brain tumor will have the patient undergo either a CT scan or MRI of the brain or undergo both procedures. Using these two different procedures, doctors can pinpoint the exact location of the tumor. <br />Often medical professionals will order the child to be sedated during an MRI, they are required to be very still for a long time, and any type of movement can cause the film to be blurred, making it difficult to review the image.<br />After the imaging scans are complete, a specialist will look over the scans and if a tumor is present, the next steps would be removal of the tumor. Other tests that may be performed are an EEG and an examination of the cerebral spinal fluid.<br />Treatments<br />The typical treatments for primary pediatric brain tumors are surgery, removal of the brain tumor or part of the tumor, also called resection. After surgery, the patient within two days will have a follow-up MRI to provide a baseline to compare future MRI scans. Some tumors after surgery will not require any other type of treatment, while tumors that are more aggressive, other types of treatment are used. <br />Common treatments that are used are: Radiation therapy- the use of high-energy light rays to kill dividing or multiplying cells. Chemotherapy- the use of drugs to kill cancer cells through an IV catheter. Chemotherapy has less long-term effects than radiation does. <br />Medications that are used after surgery are Corticosteroids, which help to reduce swelling and intracranial pressure. Diuretics are used to reduce the buildup of excess fluid in the brain. Anti-convulsants are used to reduce or prevent seizures. Also pain medications are used to help control pain that may be associated after the surgery.<br />Other treatments that are typically used would be physical therapy, occupational therapy, neurological testing, vision and auditory testing.<br /> Also, MRI scans done every few months to keep track of any new tumor growth, regularly scheduled visits with a Pediatric Oncologist, Pediatric Neurologist and Pediatric Psychologist just to name a few.<br />Physical & Mental Affects<br />There are many changes and effects to the patient after the removal of the tumor and all the treatments that have been done. Some of the effects are changes in the physical appearance. For children, changes in appearance may lead to a negative self-image.<br /> Some of the changes or effects are, hair loss due to chemotherapy or radiation therapy, hair loss can be permanent if the patient received whole- brain radiation. Other effects from radiation, chemotherapy, and brain surgery are the cognitive and/or sensory problems that may result in learning difficulties.<br />Learning difficulties may result in being easily fatigued, hearing or vision problems and coordination problems. These types of difficulties make learning much harder for the patient and may need special education services while attending school.<br />Neurocognitive problems are the other effects that result from brain tumors. The areas that are affected are usually decreased intellectual ability, memory and attention difficulties and poor academic performance. Children under the age of 7 are usually the ones at risk for these changes. <br />A small number of tumor survivors can develop heart, kidney, lung and skeletal problems or even new tumors may develop.<br />It is critical that the patient works with a long-term provider that deals with his or her condition to monitor any possible future tumor re-growth. By doing so, the patient can then live life knowing their condition is somewhat controlled.<br />The reason I chose to do this report is that I went through all of this with my son and am very familiar with it all and would like others to know the signs and symptoms of these tumors.<br /> November, 2005, my son’s eye was crossing over so I brought him to an eye doctor Dec 2, 2008, which right away they ordered a MRI to see what the cause was of his sudden eye crossing. The MRI showed there was intracranial pressure on his head which put pressure on his eye to make it cross over. My son was rushed to the U of M neurosurgeons, and had an Ependymoma brain tumor removed December 5, 2005. My son still currently gets check-ups, MRI’s every 4 four months, vision and hearing tests every 6 months. He is currently still dealing with the alopecia as a result of the radiation therapy that he had to undergo for 2 months back in January-February 2006. So far he has not had any reoccurrences and is going to his appointments and is doing fine.<br />References<br />Children’s Brain Tumor Foundation (2003) Pediatric Brain Tumors: A Resource <br />Guide For Parents of Children with Brain or Spinal Cord Tumors,<br /> P.1-99.<br />Buckner JC, Brown PD, O'Neill BP, Meyer FB, Wetmore CJ, Uhm JH. Central <br /> nervous system tumors. Mayo Clin Proc. Oct 2007;82(10):1271-86.<br />Retrieved on November 15, 2008, from http://www.nlm.nih.gov/medicineplus/ency/article/000768.htm <br />Detailed Guide: Brain/CNS Tumors in Children: What Are Brain and Spinal Cord<br />Tumors in Children? , Revised 04/07/2008. Retrieved on November 15, 2008 from The American Cancer Society, http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_childrens_brain_and_spinal_cord_tumors_4.asp?sitearea=<br />