Although brain tumours are rare in childhood, they are now the commonset solid cancer see in children in the UK. There are 300 new case in the UK every year.

Types of Brain Tumours

• Medulloblastoma (PNET)
• Ependymoma
• Piloctic Astrocytomas
• Other rare tumours (DNET, Ganglioglimoas)

Presentation of Tumours

• Headaches, usually early morning and often settle by afternoon
• Nausea and vomiting
• Fits or seizures
• Focal neurological deficit (weakness of limb or numbness)
• Balance problems (falling to one side or shaky hand)
• Increasing head size (babies from 0-18 mths)
• Failure to put on weight
• Regression of milestones

Investigation

If there is any question of a neurological problem in a child then a CT and MRI is mandatory. For babies the scan can be done under oral sedation. Beyond 6 months children will need a GA for a scan and from 6-12 years old one may be able to MRI the child without any sedation or GA.

Scan results 

The scan will reveal the tumour, it location, its size and any associated hydrocephalus.

Treatment  (see specific management below)

• Admission to a neurosurgical unit
• All children must have a BRAIN and SPINE MRI on diagnosis
• Blood should be sent for tumour markers (AFP, bHCG, Plac ALK Phos)
• Commence dexamethasone (steriod to decrease swelling around brain)
• Urgent treatment of hydrocephalus (shunt or ventriculostomy or removal of tumour)
• The case should be discussed with the oncologist
• A plan should be made for excision or biopsy if appropriate
• Some tumours may be treated with chemotherapy or radiotherapy as a first line

MEDULLOBLASTOMA (PNET)