By Lilly Su, MD Candidate, Class of 2023, Penn State College of Medicine
Brain tumors
Cancer is a diagnosis that nobody wants to hear come out of their physician’s mouth, even more so, out of the mouth of their child’s pediatrician. In an ideal world, we would never have to deal with cancer and its impact on not just the patient, but also on the patient’s loved ones, however, we do not live in an ideal world. According to the NCI Surveillance, Epidemiology, and End Results (SEER) program, for the years 2014-2018, there were 17.8 cancer diagnoses per 100,000 children ages younger than 15 years, 77.4 cancer diagnoses per 100,000 adolescents and young adults ages 15-39 years, and 548.9 cancer diagnoses per 100,000 adults ages 40-64 years [1]. While the hunt for a cure for cancer is still rapidly undergoing, there are many treatments readily available, ranging from radiation to surgical removal. In this article, we will explore specific, surgical treatment options for pediatric patients, and compare them to surgical treatment options for adult patients.
Brain and spinal cord tumors account for roughly 26% of childhood cancers, and are the second most common cancers in children, after leukemia [2]. These tumors can be further divided into cancerous or noncancerous, with cancerous ones having the potential to infiltrate other parts of the central nervous system. Tumors are typically categorized based on the type of cell the tumor originates from such as gliomas, meningiomas, and craniopharyngiomas, which are just a few examples. As nearly half of all brain and spinal cord tumors are gliomas in children, this article will focus on the group of tumors that start in glial cells, cells that play a major supportive role for brain cells.
Astrocytomas
Astrocytes are star-shaped cells responsible for regulatory roles of brain functions that include neurogenesis, synaptogenesis, control of blood-brain barrier permeability, and maintaining extracellular homeostasis [3]. Hence, astrocytomas are tumors that originate from astrocytes. Astrocytomas may be low-grade or high-grade. Low-grade astrocytomas are tumors that grow and press on surrounding areas of the brain, rarely spreading into other tissues. On the other hand, high-grade tumors not only grow at a much quicker pace but also tend to spread into other brain tissue.
To diagnose astrocytomas, a biopsy is done where a sample of the tissue is removed and will undergo either immunohistochemistry or molecular testing. Immunohistochemistry uses antibodies to check for the presence of certain antigens in the tissue sample and is used to help diagnose cancer as well as differentiate one type of cancer from another type, whereas molecular testing checks for certain genes, proteins, or other molecules in the tissue sample and is used to help plan treatment [4].
There are a variety of treatments that are commonly used in astrocytoma – they can be stand-alone or in combination with others – it depends entirely on a factor of things like the age of the child, grade of tumor, and where the remaining cancer cells are. Surgery, which surgically removes the tumor, is typically the first and sometimes the only treatment necessary for astrocytoma. However, sometimes chemotherapy or radiation therapy may be utilized after surgery to get rid of any cancer cells that are left. When multiple treatment methods are used in conjunction, it is called adjuvant therapy. Radiation therapy uses either high-energy x-rays or other types of radiation to kill the cancerous cells and prevent them from continuing to proliferate. Similarly, chemotherapy, which uses drugs either in oral form or IV form, also kills cells. Radiation therapy and chemotherapy are typically used after surgical removal of the tumor, as they can get rid of the remainder of the cancer cells [5].
Click here to learn about other types of pediatric cancers.
References:
- https://www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet#:~:text=17.8%20cancer%20diagnoses%20per%20100%2C000,ages%2040%20to%2064%20years
- https://www.cancer.org/cancer/cancer-in-children/types-of-childhood-cancers.html#:~:text=Brain%20and%20spinal%20cord%20tumors%20are%20the%20second%20most%20common,outlook%20for%20each%20is%20different
- https://www.frontiersin.org/articles/10.3389/fphar.2019.01114/full
- https://www.cancer.org/cancer/brain-spinal-cord-tumors-children/detection-diagnosis-staging/how-diagnosed.html
- https://www.mayoclinic.org/diseases-conditions/astrocytoma/cdc-20350132#:~:text=Astrocytoma%20treatments%20include%3A,that%20makes%20that%20too%20risky.