"I am truly sorry, but your child has a brain tumor..."
The World of Childhood Brain Tumors has no "Welcome" sign leading into it.
No matter what anyone says to minimize the situation, this statement is the most painful sentence a human can hear. The combination of fear, shock, pain is much to bear.
"To see such innocence, so roughly shaken by this terrible trial, at such a young age, is nothing short of incomprehensible." I still hear this sentence, uttered by a visibly shaken parent. Instead of my becoming more routine and distant, the visceral terror that it engendered in me (the supposed all- knowing physician/advisor), the delivery of such information has grown more and more difficult, even personal. I watch my own small children grow and develop. As a physician, one realizes more than ever, there is no place for impersonal behavior when caring for the children who are afflicted by a brain tumor, benign or otherwise--their families as well. No amount of experience or training can help one to ease or minimize the situation.
When we discuss special areas such as:
Most frequently, they come from "young" cells. These are cells that are still developing ("immature" or "primitive" cells) and have not reached full maturity. They are developing at the same time as the child is developing. If one looks at the way a normal cell matures from its very beginning as a "primitive" brain cell (a precursor) through its stages of normal development, towards becoming an adult cell type, one can start to understand the logic of the progression of tumor types in children.
A diagrammatic representation of the manner in which brain cells develop from the embryo to the adult is under constructiion. It will be posted soon.
For every normal cell type, there is a corresponding tumor that can arise from it. Thus, there is the primitive neurectodermal tumor (PNET), the medulloblastoma, the astroblastoma, the neuroblastoma, the astrocytoma, the gangliocytoma/neurocytoma, the ependymoma and so on.
There are also other unusual tumors such as the teratoma, the pinealblastoma, the esthesioneuroblastoma, etc. There are also other tumors thay come from non-brain origins such as the pituitary tumors, teratomas, meningiomas, the skull bone tumors, and blood vessel tumors such as the hemangioblastoma or cavernous angioma.
Children commonly have brain tumors such as the PNET, medulloblastoma, various embryonic tumors and unusual tumors of the developing brainstem, hypothalamus and optic nerves (juvenile pilocytic astrocytomas, teratomas, etc.) There are variations of these tumors and they are rare as well as difficult to understand.
Parents and children should ask as many questions as possible. The questions can help reach level of comfort confident that the problem is clearly comprehended. Knowledge of the expected and the potentially unexpected will allow you to guide your child through the process of battle against their brain tumor. No matter how harried, tired or busy your surgeon and doctors might seem, it is important to understand the problem at hand fully. This will make the efforts of all involved more effective. More often than not, knowledge helps us cope with the developing situation better.
The most important point is that some of these tumors hold the promise for a true and complete cure! There is nothing more satisfactory than the complete removal of a dreadful sounding cerebellar microcystic astrocytoma or a hemangioblastoma. Families soar from the depths of despair to the heights of sublime elation when the smiling surgeon comes to the waiting room after a difficult surgery. The surgeon may not look tired at all. The smile-on-his-face says that he has just had the privilege of completely removing a tumor!
These tumors are rare. They are usually found on the internal surfaces of the brain and spinal cord, such as the fourth ventricle of the brain (in the back, inside) and within the central canal of the spinal cord. Occasionally they grow just beneath the surface of the lateral ventricles (called "subependymoma").
Although these tumors are capable of malignant behavior, they are almost always benign. Surgical removal often leads to a cure, especially when the tumor arises right from the surface to the fluid spaces of the brain and grows into the ventricles, an "exophytic" growth, allowing for complete removal.
If you or yours has this tumor, be confident that your future holds promise.
When the tumor is the more aggressive type, the outcome deplends on the grade/size of the tumor.
The treatment of these tumors usually include a combination of approaches, each tailored to deal with the problems that children are presented with:
The Good News is that REAL HOPE exists. Long term results are becoming more and more common, some children surviving fifty years and beyond. This has become especially true with the wonderful improvements in chemotherapy and surgical techniques. The promise of cures for difficult tumors is becoming a reality to more families than ever before.