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Cancer Units

Brain Tumors pediatric

    • Consultants Responsible for the Program

      Dr. Mahmoud Motaz Elzembely

      • Head of Pediatric Oncology and Malignant Hematology Department, Shefa Al-Orman Oncology Hospitals
      • Assistant Professor of Pediatric Oncology, Malignant Hematology & Stem Cell Transplant, South Egypt Cancer Institute, Assiut University

        Dr. Yousra Sayed Abdel-Rahma

      • Consultant of Pediatric Oncology and Malignant Hematology, Shefa Al-Orman Oncology Hospitals
      • Lecturer of Pediatric Oncology, Malignant Hematology, South Egypt Cancer Institute, Assiut University

      Dr. Mohamed Zakaria

      • Consultant of Pediatric Oncology and Malignant Hematology, Shefa Al-Orman Oncology Hospitals
      • Lecturer of Pediatric Oncology, Malignant Hematology, South Egypt Cancer Institute, Assiut University

      Dr. Mohamed Elbeltagy

      • Professor of neurosurgery, Cairo University

      Dr Hossam Ahmed Abd Elkader

      • Consultant of Rheumatology, Physical medicine and rehabilitation

       

      Brain and Spinal Cord Tumor

       

      What are brain and spinal cord tumors?

      The brain and spinal cord make up the central nervous system (CNS). CNS tumors may be benign (not cancer) or malignant (cancer). But even benign CNS tumors can cause severe problems or death.

      Tumors that begin in the brain are called primary brain tumors. They may spread to other areas of the brain or spinal cord, but they do not usually spread to other parts of the body.

      Brain tumors may also come from tumor cells that have spread from other parts of the body. These are called metastatic or secondary brain tumors. These tumors are named for the part of the body where they began. Secondary brain tumors are rare in children.

    • Types of brain tumors

      About half of all pediatric brain tumors are gliomas or astrocytomas. They form from glial cells. These cells make up the supportive tissue of the brain. Gliomas may be benign or malignant and can occur in different areas of the brain and the spinal cord.

      The most common malignant brain tumor in children is medulloblastoma. This cancer forms in the cerebellum, in a region of the brain known as the posterior fossa.

      Other types of childhood brain tumors include:

      • Astrocytoma
      • Atypical Teratoid / Rhabdoid Tumor (AT/RT)
      • Choroid Plexus Tumor
      • Craniopharyngioma
      • Diffuse Intrinsic Pontine Glioma (DIPG)
      • Ependymoma
      • Ganglioglioma
      • Germ Cell Tumors of the Brain and Spinal Cord
      • Gliomatosis Cerebri
      • Medulloblastoma
      • Oligodendroglioma
      • Optic Pathway Glioma
      • Pineoblastoma

      Symptoms of brain and spinal tumors

      Many types of tumors form in the brain and spinal cord. Symptoms can vary widely. The symptoms depend on where the tumor is located, its size, how fast it grows, and the child’s age and stage of development.

      Many childhood CNS tumors grow slowly. The symptoms may be mild. They may come and go. They might not follow a typical or predictable pattern.

      Symptoms of brain tumors include:

      • Headaches, especially in the morning
      • Nausea and vomiting, especially in the morning
      • Vision problems
      • Crossed-eyes (strabismus or squint)
      • Problems in speech or hearing
      • Loss of balance, coordination problems, or difficulty walking
      • Weakness in the arms or legs
      • Seizures
      • Feeling tired or changes in activity level
      • Unexplained weight gain or loss
      • Symptoms related to endocrine problems or changes in hormones such as increased thirst or early puberty
      • Personality changes
      • Changes in school performance
      • Problems with thinking or memory
      • Weakness, numbness, tingling, or changes in feeling on one side of the body (arm or leg or both)
      • Chronic back pain (spinal cord tumors)
      • Tilting the head to one side
      • Increased head size in infants

      Symptoms of spinal cord tumors include:

      • Scoliosis (curving of the backbone)
      • Back or neck pain
      • Weakness in arms or legs
      • Difficulty walking
      • Problems going to the bathroom

      In some cases, a child with a brain or spinal cord tumor may have problems reaching early developmental milestones for their age. Talk to your child’s care team if you have questions about your child’s development.

      Diagnosis of brain and spinal tumors

      Symptoms of brain and spinal cord tumors can be mild and hard to recognize at first. Early symptoms are often similar to other childhood illnesses. Depending on the type of tumor and how fast it grows, diagnosis can sometimes take a while. Diagnosis usually includes:

      • Physical exam and medical history to learn about symptoms, general health, past illnesses, and risk factors 
      • Neurological exam to look at brain and nervous system function
      • Imaging tests such as magnetic resonance imaging (MRI) and computerized tomography (CT)
      • Biopsy of the tumor to look at a tissue sample under a microscope
      • Lumbar puncture to get a sample of spinal fluid to check for signs of cancer

      Treatment of brain and spinal tumors

      Surgery is a main treatment for brain and spinal cord tumors. Other treatments include chemotherapy, radiation therapy, and targeted therapy.

      Treatments depend on the tumor type and location, the child’s age, and how much of the tumor can be removed with surgery.

      Most patients who have brain surgery take steroid medicines to reduce brain swelling. Some patients may take anti-seizure medicines.

      In some cases, surgeons place a shunt in the brain to prevent fluid build-up (hydrocephalus). The shunt may be temporary or permanent.

      Your child may need services to help with recovery after surgery. These may include rehabilitation and supportive care including help with vision, speech, hearing, strength, and movement. Psychology and school support services can help with emotional, social, developmental, and learning needs.

       

      Prognosis for brain and spinal tumors

       

      The prognosis for brain and spinal cord tumors depends on many factors. These include:

      • Tumor type and grade
      • Molecular features of the tumor
      • The child’s age
      • Whether the tumor is new or has returned
      • Whether the cancer has spread to other areas
      • If the tumor can be removed with surgery
      • How well the tumor responds to treatments

      The average survival rate for pediatric cancers of the brain and spinal cord is about 75% in the United States. But the prognosis can vary widely based on cancer type. Talk to your child's care team about your child’s prognosis.

      Support for patients with brain and spinal tumors

      The impact of a brain tumor on a child’s quality of life varies widely. Some patients have few lasting effects on health and function after treatment. Other children may have long-term problems in physical, cognitive, and emotional functioning. These problems may be due to the tumor or the late effects of treatment.

      Rehabilitation services and supportive care

      Rehabilitation services can help improve daily living skills after a brain tumor. These services may include physical therapy, occupational therapy, speech therapy, vision assistance, and hearing care.

      Simple lifestyle habits can help brain health and improve overall health.

      • Eat healthy
      • Be physically active
      • Get enough sleep
      • Manage stress

       

      Late effects of treatment

      Childhood cancer survivors should get long-term follow-up health care. Some treatments can cause late effects. These are health problems that happen months or years after treatment has ended.

      It is important to have regular checkups and screenings by a primary health care provider. Your child should get a survivorship care plan after completing treatment. This plan includes guidance on health screenings, disease risk factors, and how to improve health. Survivors should share this plan with their health care providers.

      Diagnostics of Brain Tumors

      The program includes:

      • Initial presentation in the clinic
      • clinical history taking
      • review of medical records
      • physical examination
      • laboratory tests:
      • complete blood count
      • biochemical analysis of blood
      • inflammation markers (CRP, ESR)
      • indicators of blood coagulation
      • tumor markers
      • MRI brain with contrast
      • CSF examination
      • Echocardiography
      • Renal scan
      • nursing services
      • consultation of related specialists
      • treatment by chief physician and all leading experts
      • explanation of individual treatment plan (the cost of medicines is not included)

      Required documents

      • Medical records
      • MRI/CT scan (not older than 3 months)
      • Biopsy results (if available)

      Type of program : Outpatient

      Expected duration of the program: 5 days

       

      Neuro-Surgical intervention 

       

      The program includes:

      • Initial presentation in the clinic
      • clinical history taking
      • physical examination
      • review of medical records
      • laboratory tests:
      • complete blood count
      • general urine analysis
      • biochemical analysis of blood
      • tumor markers
      • indicators of inflammation
      • indicators blood coagulation
      • MRI brain with contrast
      • preoperative care
      • tumor resection
      • histologically and immunohistochemically examination
        of the remote tissues
      • symptomatic treatment
      • control examinations
      • the cost of essential medicines and materials
      • nursing services
      • full hospital accommodation
      • explanation of future recommendations

      Required documents

      • Medical records
      • MRI/CT scan (not older than 3 months)

      Type of program : Inpatient

      Expected duration of the program: 10 days

       

      Radiotherapy of Brain Tumors 

      To be decided by treating physician according to the type of Brain tumors

      The program includes:

      • Initial presentation in the clinic
      • clinical history taking
      • review of medical records
      • physical examination
      • laboratory tests:
      • complete blood count
      • general urine analysis
      • biochemical analysis of blood
      • tumor markers
      • CT / MRI of local tumor
      • full curse of radiotherapy
      • nursing services
      • consultations of related specialists
      • explanation of individual treatment plan

      How program is carried out

      During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including complete blood count, laboratory assessment of liver and kidney function. Based on the received results, the physician will conduct radiotherapy planning with the help of CT or MRI, make the permanent tattoo marks on the skin and conduct CT simulation in order to assess the accuracy of the rays and the radiation dose. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

      Radiation therapy is carried out as the day hospital procedure, without mandatory admission to the hospital. At each visit, the physician will assess your general condition and the marks on the skin. After that, you will be placed in a shielded radiation therapy room, on a special table.

      Each radiation therapy session lasts less than half an hour (including preparation). All this time, doctors and nurses are monitoring your condition, you can communicate with them through a loudspeaker. The procedure is completely painless. Depending on the planned course of treatment, you will visit the hospital from 1 to 3-5 times a week.

      After the completion of the radiation therapy course, you will undergo control examinations aimed at assessing your condition and efficacy of treatment. After that you will receive the medical report with detailed recommendations regarding further follow-up and treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of treatment, if necessary.

      Required documents

      • Medical records
      • MRI/CT scan (not older than 3 months)

      Type of program: outpatient

       

      Chemotherapy of brain tumors

      To be decided by treating physician according to the type of brain tumor and residual tumor post-operative

      The program includes:

      • Initial presentation in the clinic
      • clinical history taking
      • review of medical records
      • physical examination
      • laboratory tests:
      • complete blood count
      • general urine analysis
      • biochemical analysis of blood
      • TSH-basal, fT3, fT4
      • tumor markers
      • inflammation indicators
      • indicators of blood coagulation
      • courses of chemotherapy
      • nursing services
      • consultations of related specialists
      • treatment by head doctor and leading experts
      • explanation of individual treatment plan

      How program is carried out

      During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

      Chemotherapy is carried out as the inpatient procedure, with mandatory admission to the hospital. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

      After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. After the completion of the chemotherapy course you will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

      Required documents

      • Medical records
      • MRI/CT scan (not older than 3 months)
      • Biopsy results (if available)

      Type of program : Inpatient

      Duration: 7 days



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