Introduction

Brain tumour is one of the most common tumours in children. It can be benign or malignant. About 20-30 children develop brain tumour in Hong Kong every year.

Symptoms

The symptoms vary with different types of brain tumour and also depend on the location of the tumour. A child suffering from the disease may exhibit one or more of the symptoms described here.

The brain is normally well protected by the skull which is a closed and rigid box. A growing tumour in it will exert pressure on the brain resulting in headache, vomiting and drowsiness.

Blockage of the flow of spinal fluid will also increase the pressure on the brain. This fluid is normally produced inside the brain and flows to the surface of the brain and spinal cord. It will accumulate inside the brain if its flow is blocked by a tumour, leading to hydrocephalus (‘water’ in the brain).

The pressure of the tumour on brain substance will cause loss of balance, weakness, clumsiness, squinting, double vision, swallowing difficulty, slurred speech or convulsion. Hormone production from the pituitary gland may also be disturbed resulting in abnormal growth and pubertal development or excessive urine. Also, the child may become bad tempered or lose interest in daily activities.

Diagnostic Tests

1. Computerised tomography scan
2. Magnetic resonance imaging
3. Lumbar puncture for examination of cerebrospinal fluid
4. Blood and urine tests for hormone study
5. Examination of vision by ophthalmologist

Treatment

The treatment of brain tumour includes surgery, radiotherapy and chemotherapy. As a child's physical and intellectual development may be impaired by these types of treatment, the doctor will give careful consideration before proceeding and will also explain to the child and parents the side effects of the treatment.

In most cases, the neurosurgeon will operate to see if the tumour is benign or malignant and will remove it, if possible. In order to reduce the swelling of brain tissue around the tumour, a steroid (known as dexamethasone) will be prescribed before the operation. If hydrocephalus is present, a tube (shunt) will be inserted into the brain to drain the spinal fluid to relieve the pressure inside the skull. If the tumour cannot be removed, a permanent tube (shunt) may be put into the brain to drain the spinal fluid into the abdomen.

Children with malignant brain tumour may need radiotherapy to the brain. Sometimes, the spine also receives treatment because the tumour cells may have spilled into the spinal fluid and spread along the spine. The child may feel lethargic about 6 weeks after the treatment but this will eventually subside. Some brain tumour can be treated by chemotherapy.

Long-term Care

After undergoing treatment, the child will often need physiotherapy, play and occupational therapy, speech therapy and sometimes hormone replacement. These are usually carried out one or two weeks after the operation. As the child may have to be hospitalised for a long time for these rehabilitation therapies, provision is made by teachers of the Red Cross Hospital School to tutor the child in school work.

The child will need regular follow-up after discharge from the hospital. If there is no recurrence in 5 years after complete removal of a benign tumour, he is most likely completely cured. After a malignant tumour is removed and if the child remains well, then the tumour is considered to be under control. The symptoms of recurrence may be similar to those in the initial stage of the illness. When recurrence occurs, further treatment is then needed.

Prognosis

The success of treatment depends on the type and location of the tumour. Most brain tumours have a cure rate of about 50%. But young children with malignant tumours have a lower chance of cure.