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What is Medulloblastoma - Childhood ?
Medulloblastoma is a type of brain tumor. A brain tumor begins when normal cells in the brain change and grow uncontrollably, forming a mass. A tumor can be benign (noncancerous) or malignant (cancerous, meaning it can spread to other parts of the body). Medulloblastoma is a malignant tumor.
The brain and spinal column make up the central nervous system (CNS), where all vital functions are controlled, including thought, speech, and body strength. Medulloblastoma begins in granular cells in the cerebellum (back of the brain). This is the part of the brain that controls body movement and coordination.
Medulloblastoma occurs most commonly in children, and this section is about childhood medulloblastoma.
Symptoms and Signs
Children with medulloblastoma may experience the following symptoms or signs. Sometimes, children with medulloblastoma do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not a tumor. If you are concerned about a symptom or sign on this list, please talk with your child's doctor.
Headaches
Morning vomiting that gets worse over time
Clumsiness
Problems with handwriting and other motor skills that get worse over time
Problems with vision or an eye turning inwards
If the tumor spreads to the spinal cord, it may cause the following symptoms:
Back pain
Inability to control the bowels and bladder
Difficulty walking
Your child's doctor will ask you questions about the symptoms your child is experiencing to help find out the cause of the problem, called a diagnosis. This may include how long he or she has been experiencing the symptom(s) and how often.
If a tumor is diagnosed, relieving symptoms and side effects remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your child's health care team about symptoms your child experiences, including any new symptoms or a change in symptoms.
Risk Factors
A risk factor is anything that increases a person's chance of developing a tumor. Although risk factors often influence the development of a tumor, most do not directly cause a tumor. Some people with several risk factors never develop a tumor, while others with no known risk factors do.
Doctors don't know what causes most childhood cancers, including medulloblastoma. Medulloblastoma is more common in boys than in girls. It occurs most often in the first eight years of life, with about half occurring in children younger than six years old.
In rare situations, children with nevoid basal cell carcinoma syndrome (NBCCS), a hereditary condition also known as Gorlin syndrome, have an increased risk of developing medulloblastoma. People with NBCCS are more likely to develop various tumors.
Diagnosis
Doctors use many tests to diagnose a tumor and find out if it has metastasized (spread). Some tests may also determine which treatments may be the most effective. For most types of tumors, a biopsy or removal of the tumor with surgery is the only way to make a definitive diagnosis. If a biopsy or surgery to remove the tumor is not possible or medically safe, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the tumor has metastasized. Your child's doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
Type of tumor suspected
Severity of symptoms
Previous test results
In addition to a physical examination, the following tests may be used to diagnose medulloblastoma:
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but looking at the tumor tissue removed during a biopsy or surgery (see below) is the only way to make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease).
Surgical removal of the tumor. During surgery, a neurosurgeon (a doctor who specializes in removing a tumor from the brain or spine with surgery) removes as much of the tumor as possible for examination under a microscope. The sample removed during surgery is then analyzed by the pathologist.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient's vein to create a clearer picture.
Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a doctor uses a needle to take a sample of cerebral spinal fluid (CSF) to look for cancer cells, blood, or tumor markers (substances found in higher than normal amounts in the blood, urine, or body tissues of people with certain kinds of cancer). CSF is the fluid that flows around the brain and the spinal cord. The child is given an anesthetic that numbs the lower back before the procedure. For patients with medulloblastoma, doctors usually perform a lumbar puncture after the tumor is removed through surgery.
Stages
Staging is a way of describing the size of a tumor, where it is located, if it is cancerous or where it has spread, and whether it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the tumor's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
Medulloblastoma in children is classified as either standard (average) risk or high risk, depending on the following factors: the child's age, how much of the tumor remains after surgery, and whether the tumor has spread.
Standard-risk tumor. The tumor is almost completely removed during surgery, meaning that less than 1.5 cubic centimeters of the tumor remains after surgery. The tumor is in the very back part of the brain and has not spread to other areas of the brain and spinal cord.
High-risk tumor. This type of tumor has either spread to other parts of the brain or the spine, or it has not spread but more than 1.5 cubic centimeters of tumor remains after surgery.
Recurrent tumor. A recurrent tumor is a tumor that comes back after treatment. It may recur in the brain, spine, spinal fluid or very rarely elsewhere in the body. If there is a recurrence, the tumor may need to be staged again (called re-staging) using the system above.
