"Proton Beam Therapy is ideally suited to treat brain tumours and is the global benchmark of excellence in treating paediatric brain tumours."

Overview

Paediatric brain tumours

Paediatric brain tumours are masses or growths of abnormal cells that occur in a child's brain or the tissue and structures that are near it. Many different types of paediatric brain tumours exist — some are noncancerous (benign) and some are cancerous (malignant).


Treatment and chance of recovery (prognosis) depend on the type of tumour, its location within the brain, whether it has spread, and your child's age and general health. Because new treatments and technologies are continually being developed, several options may be available at different points in treatment.


Treatment for brain tumours in children is typically quite different from treatment for adult brain tumours, so it's very important to enlist the expertise and experience of paediatric specialists in neurology and cancer.

Some common types of brain tumours

Astrocytoma


Astrocytoma is a type of cancer that can form in the brain or spinal cord. Astrocytoma begins in cells called astrocytes that support nerve cells.


Astrocytoma signs and symptoms depend on the location of your tumour. Astrocytomas that occur in the brain can cause seizures, headaches and nausea. Astrocytomas that occur in the spinal cord can cause weakness and disability in the area affected by the growing tumour.


Astrocytoma can be a slow-growing tumour, or it can be an aggressive cancer that grows quickly. The aggressiveness (grade) of your astrocytoma determines your prognosis and treatment options.


Glioblastoma


Glioblastoma is an aggressive type of cancer that can occur in the brain or spinal cord. Glioblastoma forms from cells called astrocytes that support nerve cells.


Glioblastoma can occur at any age, but tends to occur more often in older adults. It can cause worsening headaches, nausea, vomiting and seizures.


Glioblastoma, can be very difficult to treat and a cure is often not possible. Treatments may slow the progression of cancer and reduce signs and symptoms.


Ependymoma


Ependymoma is a type of tumour that can form in the brain or spinal cord. Ependymoma begins in the ependymal cells in the brain and spinal cord that line the passageways where the fluid (cerebrospinal fluid) that nourishes your brain flows.


Ependymoma can occur at any age, but most often occurs in young children. Children with ependymoma may experience headaches and seizures. Ependymoma that occurs in adults is more likely to form in the spinal cord and may cause weakness in the part of the body controlled by the nerves that are affected by the tumour.


Surgery is the primary treatment for ependymoma. For more aggressive tumours or for tumours that can't be removed completely with surgery, additional treatments, such as radiation therapy or chemotherapy, may be recommended.


Oligodendroglioma


Oligodendroglioma is a tumour that can occur in the brain or spinal cord. Oligodendroglioma forms from oligodendrocytes — cells in the brain and spinal cord that produce a substance that protects nerve cells.


Oligodendroglioma can occur at any age, but most often affects adults. Signs and symptoms can include seizures and headaches. Weakness or disability can occur in the part of the body that's controlled by the nerve cells affected by the tumour.


Oligodendroglioma treatment usually involves surgery to remove the tumour. Additional treatments may be necessary if the tumour is aggressive or is more likely to recur.


Meningioma


A meningioma is a tumour that arises from the meninges — the membranes that surround your brain and spinal cord. Although not technically a brain tumour, it is included in this category because it may compress or squeeze the adjacent brain, nerves and vessels. Meningioma is the most common type of tumour that forms in the head.


Most meningiomas grow very slowly, often over many years without causing symptoms. But sometimes, their effects on nearby brain tissue, nerves or vessels may cause serious disability.


Meningiomas occur more commonly in women and are often discovered at older ages, but may occur at any age.


Because most meningiomas grow slowly, often without any significant signs and symptoms, they do not always require immediate treatment and may be monitored over time.


Pituitary tumours


Pituitary tumours are abnormal growths that develop in your pituitary gland. Some pituitary tumours result in too many of the hormones that regulate important functions of your body. Some pituitary tumours can cause your pituitary gland to produce lower levels of hormones.


Most pituitary tumours are noncancerous (benign) growths (adenomas). Adenomas remain in your pituitary gland or surrounding tissues and don't spread to other parts of your body.


There are various options for treating pituitary tumours, including removing the tumour, controlling its growth and managing your hormone levels with medications.


Craniopharyngiomas


Craniopharyngioma is a rare type of noncancerous (benign) brain tumour.


Craniopharyngioma begins near the brain's pituitary gland, which secretes hormones that control many body functions. As a craniopharyngioma slowly grows, it can affect the function of the pituitary gland and other nearby structures in the brain.


Craniopharyngioma can occur at any age, but it occurs most often in children and older adults. Symptoms include gradual changes in vision, fatigue, excessive urination and headaches. Children with craniopharyngioma may grow slowly and may be smaller than expected.


Pineal region tumours


Pineoblastoma is a rare, aggressive type of cancer that begins in the cells of the brain's pineal gland. Your pineal gland, located in the center of your brain, produces a hormone (melatonin) that plays a role in your natural sleep-wake cycle.


Pineoblastoma can occur at any age, but it tends to occur most often in young children. Pineoblastoma may cause headaches, sleepiness and subtle changes in the way the eyes move.


Medulloblastomas


Medulloblastoma is a cancerous (malignant) brain tumour that starts in the lower back part of the brain, called the cerebellum. The cerebellum is involved in muscle coordination, balance and movement.


Medulloblastoma tends to spread through cerebrospinal fluid (CSF) — the fluid that surrounds and protects your brain and spinal cord — to other areas around the brain and spinal cord. This tumour rarely spreads to other areas of the body.


Choroid plexus carcinoma


A choroid plexus carcinoma is a rare cancerous (malignant) brain tumour that occurs mainly in children.


A choroid plexus carcinoma begins near the brain tissue that secretes cerebrospinal fluid. A noncancerous tumour of this area is called a choroid plexus papilloma. As the tumour grows, it can affect the function of nearby structures in the brain, causing excess fluid in the brain (hydrocephalus), irritability, nausea or vomiting, and headaches.


Brain metastases


Brain metastases occur when cancer cells spread from their original site to the brain. Any cancer can spread to the brain, but the types most likely to cause brain metastases are lung, breast, colon, kidney and melanoma.


Skull Base Tumour


Skull base tumours are grouped by location and the type of cells in the tumour. Where a skull base tumour begins can make a difference in the type of cancer cells. The location also can influence symptoms and treatment.


Skull base tumours may start from:


  • Areas below the skull base, such as the nasal sinus or inner ear.
  • Brain tumours that grow down toward the skull base.
  • The bones of the skull base.

Skull Base Tumour Symptoms


Skull base tumours may not produce symptoms until they grow large. If they do have signs, they vary from person to person depending on where the tumour is and how fast it is growing.


Skull base tumour symptoms may include:


  • Pain or numbness in the face
  • Weakness in the face
  • Headache
  • Recurrent sinus problems
  • Stopped-up nose
  • Loss of sense of smell
  • Vision loss
  • Double vision
  • Hearing loss
  • Ringing in the ears (tinnitus)
  • Dizziness or loss of balance
  • Shortness of breath
  • Hoarseness, losing your voice
  • Difficulty swallowing and frequent choking

Having one or more of these symptoms does not mean you have a skull base tumour. But you should talk to your doctor if you have any of these signs. They may mean you have other health problems.

Questions to Ask Your Doctor about Brain Tumours
  • Are tests needed for diagnosis or to determine origin?
  • What type of tumour is it?
  • Where is its origin?
  • How serious is the condition?
  • What treatment will you recommend?
  • What are the side effects?
  • How successful is this treatment?
  • Will surgery be necessary?
  • What are the risks?
  • What can be expected after surgery?
  • Will any medication be prescribed?
  • What is the prognosis?
  • How do I live and work after a brain tumour has been detected?
  • Physiotherapy and Occupational Therapy?

Symptoms

 

Signs and Symptoms of Brain Tumour in general
  • Headaches
  • Seizures
  • Difficulty thinking and/or speaking
  • Changes in personality
  • Tingling on one side of the body
  • Stiffness on one side of the body
  • Loss of balance
  • Change in vision
  • Memory loss
  • Nausea
  • Disorientation
  • Fatigue and muscle weakness
  • Anxiety/depression
What are the symptoms of a brain tumour in a child?
  • Headaches, which may become more frequent and more severe
  • Feeling of increased pressure in the head
  • Unexplained nausea or vomiting
  • Abrupt onset of vision problems, such double vision
  • A fuller soft spot (fontanel) on the skull in babies
  • Seizures, especially when there's no history of seizures
  • Abnormal eye movement
  • Slurred speech
  • Trouble swallowing
  • Loss of appetite; or in babies, difficulty feeding
  • Difficulty with balance
  • Trouble walking
  • Weakness or loss of sensation in an arm or a leg
  • Weakness or drooping on one side on the face
  • Confusion, irritability
  • Memory problems
  • Personality or behaviour changes
  • Hearing problems

Risk Factors

A risk factor is anything that increases a person’s chance of developing a brain tumour. Although risk factors often influence the development of a brain tumour, most do not directly cause a brain tumour. Knowing your risk factors and talking about them with your doctor may help you make more informed decisions.


The following factors may raise a person’s risk of developing a brain tumour:


  • Age. Brain tumours are more common in children and older adults, although people of any age can develop a brain tumour.
  • Gender. In general, men are more likely than women to develop a brain tumour. However, some specific types of brain tumours, such as meningioma, are more common in women.
  • Home and work exposures. Exposure to solvents, pesticides, oil products, rubber, or vinyl chloride may increase the risk of developing a brain tumour. However, there is not yet scientific evidence that supports this possible link.
  • Family history. About 5% of brain tumours may be linked to hereditary genetic factors or conditions, including Li-Fraumeni syndrome, neurofibromatosis, nevoid basal cell carcinoma syndrome, tuberous sclerosis, Turcot syndrome, and von Hippel-Lindau disease. Scientists have also found “clusters” of brain tumours within some families without a link to these known hereditary conditions. Studies are underway to try to find a cause for these clusters.

Exposure to infections, viruses, and allergens. Infection with the Epstein-Barr virus (EBV) increases the risk of CNS lymphoma. EBV is more commonly known as the virus that causes mononucleosis or “mono.” In other research, high levels of a common virus called cytomegalovirus (CMV) have been found in brain tumour tissue. The meaning of this finding is being researched. Several types of other viruses have been shown to cause brain tumours in research on animals. More data are needed to find out if exposure to infections, other viruses, or allergens increase the risk of a brain tumour in people. Of note, studies have shown that patients with a history of allergies or skin conditions have a lower risk of glioma.


Electromagnetic fields. Most studies evaluating the role of electromagnetic fields, such as energy from power lines or from cell phone use, show no link to an increased risk of developing a brain tumour in adults. Because of conflicting information regarding risk in children, the World Health Organization (WHO) recommends limiting cell phone use and promotes the use of a hands-free headset for both adults and children.


Race and ethnicity. In the United States, white people are more likely to develop gliomas but less likely to develop meningioma than black people. Also, people from northern Europe are more than twice as likely to develop a brain tumour as people in Japan.


Ionizing radiation. Previous treatment to the brain or head with ionizing radiation, including x-rays, is a risk factor for a brain tumour.


Head injury and seizures. Serious head trauma has long been studied for its relationship to brain tumours. Some studies have shown a link between head trauma and meningioma, but not between head trauma and glioma. A history of seizures has also been linked with brain tumours, but because a brain tumour can cause seizures, it is not known if seizures increase the risk of brain tumours, if seizures occur because of the tumour, or if anti-seizure medication increases the risk.


N-nitroso compounds. Some studies of diet and vitamin supplementation seem to indicate that dietary N-nitroso compounds may raise the risk of both childhood and adult brain tumours. Dietary N-nitroso compounds are formed in the body from nitrites or nitrates found in some cured meats, cigarette smoke, and cosmetics. However, additional research is necessary before a definitive link can be established.


Brain tumours can be benign or malignant:


  • Usually, benign tumours can be removed, and they seldom grow back.
  • The border or edge of a benign brain tumour can be clearly seen. Cells from benign tumours do not invade tissues around them or spread to other parts of the body. However, benign tumours can press on sensitive areas of the brain and cause serious health problems.
  • Unlike benign tumours in most other parts of the body, benign brain tumours are sometimes life threatening.
  • Very rarely, a benign brain tumour may become malignant.

Malignant brain tumours contain cancer cells:


  • Malignant brain tumours are generally more serious and often are life threatening.
  • They are likely to grow rapidly and crowd or invade the surrounding healthy brain tissue.
  • Very rarely, cancer cells may break away from a malignant brain tumour and spread to other parts of the brain, to the spinal cord, or even to other parts of the body. The spread of cancer is called metastasis.
  • Sometimes, a malignant tumour does not extend into healthy tissue. The tumour may be contained within a layer of tissue. Or the bones of the skull or another structure in the head may confine it. This kind of tumour is called encapsulated.

Winning Over Cancer

Our Medical Director Dr. Rakesh Jalali emphasises on the key steps that include comprehensive care and safety measures to be taken by the general & neuro-oncology communities for brain tumour treatments during COVID-19.

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From the desk of Medical Director. 5 tips to ensure the health & safety of patients from an oncology perspective during COVID-19. He also explains how hospital authorities can help patients and their families with the right information about treatments during this challenging time.

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Watch the exclusive session on Cancer Management during Covid-19 by Dr Rakesh Jalali, Medical Director- Radiation Oncology at Apollo Proton Cancer Centre. He elucidates on how cancer care is being affected globally and throughout the country by COVID -19 and how one should face and be prepared to protect during these tough circumstances.

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For treating a patient, more than adavnced treatment techniques, ensuring an enhanced quality of life during and after treatment is important. - Dr Rakesh Jalali, Medical Director & Head - Neuro Oncology

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Dr. V.R Roopesh Kumar, Senior Consultant & Lead, Neurosurgery talks about the journey of our international patient Mrs.Jebin who flew down from London for treating her mother who had a highly complicated block in the vessel that carries blood to the right brain.

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Mr. Abhilash from Bangalore takes us on an emotional journey of his son's treatment. Further, he explains how Dr Rakesh Jalali, Dr Roopesh and the entire team at APCC took care of his son despite the challenges due to the lockdown.

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Watch Dr. Arun Kati share his experience here, at Apollo Proton Cancer Centre.

He thanks Dr. Jalali, Dr. Srinivas Chilukuri, Dr. Anand Murgusen and the entire team for their constant support and care during the treatment.

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"Difficult roads lead to beautiful destinations."

Watch Mr Jayant Kumar Dubey as he shares his son's journey during proton therapy at Apollo Proton Cancer Centre. He thanks Dr. Jalali and the entire team at APCC for assisting them in transport needs during this lockdown period.

The joy in the kid’s parent's eyes is truly unmissable!

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Mr. Piyush from Raipur, Chhattisgarh shares his experience at Apollo Proton Cancer Centre where his grandfather was provided with proton therapy for metastatic cancer in brain.

He thanks the entire team for helping him and his grandfather with travel, accommodation and other necessary arrangements during this challenging time of lockdown.

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Here is a glimpse of Mr. Ahmed Mahmoud who fought against brain cancer with 17 operations before he approached Apollo Proton Cancer Centre where he was successfully treated through proton therapy. He said not to lose hope because every problem has a solution.

Thank you for sharing your experience with us. We wish you good health & happiness.

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