General Approaches and Considerations for Pediatric Brain Tumors
This chapter provides a reference for practicing clinicians regarding the important clinical, diagnostic, and treatment considerations for children with brain tumors. Pediatric brain tumors remain the most common solid tumors diagnosed in childhood. They account for one-third of all childhood cancer diagnoses and result in the highest overall mortality. CNS malignancies in childhood differ vastly from those seen in adulthood in both histology and location. The differences have significant implications for their diagnosis, treatment, and prognosis. It is clear that early diagnosis is paramount to improving the chance for long-term cure. Achieving them, however, can prove to be challenging, as many of the symptoms are nonspecific and present in many common non-life-threatening alternative diagnoses. Pediatricians are often faced with managing the investigative process of a sick child in an orthograde fashion and must identify the dangerously sick child from the child with a self-limiting common childhood illness. The investigating physician should search for “red flag” symptoms, such as the triad consisting of morning headaches, associated vomiting without abdominal complaint, and neurological symptoms. If identified, prompt imaging should be performed to rule out CNS pathology. Once a diagnosis has been made, treatment must begin. Treatment algorithms have changed dramatically over the past several decades. Although the steadfast roles of surgery, chemotherapy, and radiation therapy remain vital, alternative therapies are extensively being pursued. They include molecular and immune-modulating therapies, in hopes of not only improving survival but also reducing the long-term risks associated with traditional therapies. Diagnosis and treatment often have lasting effects physically, emotionally and socially, on the patient and the family. Having a strong foundation of physicians participating in the care of the child can have tremendous positive influences.
