Brain tumors in children

Brain tumors are relatively common cancers among children, just as they are among adults. Unlike the tumors of adults, however, they have a predilection for the posterior fossa. The most common types of tumors among children are astrocytomas, ependymomas, and medulloblastomas. The definitive diagnosis of these lesions can usually be made with relative ease by CT scans of the brain. Treatment typically consists of the surgical removal of all or as much tumor as possible, followed by radiation therapy, and occasionally also by chemotherapy with one of the nitrosoureas combined with vincristine and/or other antitumor drugs. Recurrence-free survival may be expected for about half of the children past infancy who develop brain tumors. The substantial progress recently made in both the diagnosis and treatment of brain tumors in childhood has heightened, not diminished, the clinical responsibilities of primary care clinicians throughout the management of this disease. Since tumor-free survival so heavily depends upon an early diagnosis, a high index of suspicion must be maintained for commonplace non-specific symptomatology. The primary physician must pursue critical aspects of the medical history at the first suggestion of an atypical course. A skillful physical examination is then needed to detect subtle clinical signs that are indicators for the prompt performance of definitive diagnostic tests. Further, since there are now so many therapeutic modalities that can be brought into the comprehensive management of children with brain tumors, the primary clinician should maintain close contact with the patient not only to provide medical and psychological support, but also to monitor the clinical response or side effects of therapeutic agents and to serve as the patient advocate at times of great personal and family need.