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Brain Tumors in Children: What Do We Know?

Posted Aug 24 2008 1:49pm
MARTY MOSS-COANE: Welcome to our webcast. I'm Marty Moss-Coane. When most of think of brain tumors, we probably don't think of children, but every year over 2,000 children are diagnosed with brain tumors, making them the second most common cancer in children. Not much is known about what causes pediatric brain tumors and they are hard to detect early since the symptoms can be very subtle.

Joining us today to discuss what we do know about brain tumors in children are two experts and let me introduce them to you. Dr. Fred Epstein is founding director of the Institute for Neurology and Neurosurgery at the Beth Israel Medical Center in New York. Dr. Epstein, thank you for joining us. Also with us is Dr. George Jallo and he is an attending pediatric neurosurgeon at the same Institute. Dr. Jallo, welcome as well.

Well, let's start with some very basic descriptions and perhaps I'll put this to you, Dr. Epstein, what exactly is a brain tumor?

FRED J. EPSTEIN, MD: Well, it's hard to be overly complex about it. A brain tumor is basically a lump in the brain that's getting bigger and causing symptoms as it gets larger, because, if you think about it, I mean -- the brain is within a skull which is essentially a closed box. And if one has a lump growing inside of the brain, it's going to cause some pressure and symptoms, and that's what the source of the symptoms.

MARTY MOSS-COANE: And are there certain parts of the brain where it's more common to find a brain tumor?

GEORGE JALLO, MD: In children, yes. The majority of tumors that are seen in children, if I can illustrate --


GEORGE JALLO, MD: Are in the posterior fossa and in this region right here. It's really the smaller part of the brain. But I'd say about 70-80% of brain tumors occur in this region alone.

MARTY MOSS-COANE: And there are two kinds of brain tumors -- both the ...?

GEORGE JALLO, MD: There's benign and malignant tumors. And benign tend to be indolent and malignant tumors are more aggressive, require other forms of therapy in addition to surgery.

FRED J. EPSTEIN, MD: One of the things that's fortunate -- fortunate, maybe that's a bad word when you look at a child with a brain tumor. But most of them are benign.

MARTY MOSS-COANE: Interesting.

FRED J. EPSTEIN, MD: Most of them are benign and it's so important that most are benign, and even the ones that are not benign are potentially curable now. We've made enormous strides over the past decades.

GEORGE JALLO, MD: And that's very different from the adults.

MARTY MOSS-COANE: I wanted to ask about that.

GEORGE JALLO, MD: It's very different. I mean most adult tumors are malignant and they may come from some place else in the body.

MARTY MOSS-COANE: I know there aren't exact causes of brain tumors, but I'm interested in what some of the theories are.

FRED J. EPSTEIN, MD: I'm going to defer to Dr. Jallo on that. Because I've got to tell you the truth, I don't have a clue. I'm not sure anybody does.

GEORGE JALLO, MD: I agree with Dr. Epstein. I don't think anyone can say with any certainty that living in one area or using cell phones can cause brain tumors. As of today, I don't think we can say that there is anything that can cause a brain tumor in children.

MARTY MOSS-COANE: Is there a genetic factor? Are there any other sort of viral implications? And I realize you're not going to tell me yes or no, but in terms of just theories.

GEORGE JALLO, MD: I mean there are some children that have a genetic or chromosomal abnormality that may be predisposed to brain tumors, but as a whole, no.

FRED J. EPSTEIN, MD: They don't run in families.

MARTY MOSS-COANE: They don't run in families.

FRED J. EPSTEIN, MD: One of the things that's so important for families to understand, if a child has a brain tumor, it doesn't mean that the other children have to go out and have MRI scans. It simply does not happen. It's extraordinarily uncommon.

MARTY MOSS-COANE: We're talking about 2,000 cases a year. Is it more boys than girls, girls from boys? Does that make a difference?

GEORGE JALLO, MD: There's a slight preference to boys, but it's very small.

MARTY MOSS-COANE: Nothing significant.

GEORGE JALLO, MD: Nothing significant at all.

MARTY MOSS-COANE: What are some of the symptoms of a pediatric brain tumor? Let me start with you and --

GEORGE JALLO, MD: Children with brain tumors actually present very different than adults. You know, an adult has a little headache they're going to go see their internist right away. A child can have a headache for months, years or can have double vision. They're so nonspecific to a child, it may mean nothing to them and they may not complain about it until they become so severe. And then they may mention it to their parents and then all of a sudden the parents get concerned and bring them to the pediatrician.

MARTY MOSS-COANE: Headaches...

FRED J. EPSTEIN, MD: It's tough. It's a tough diagnosis because you know, 2,000 really isn't many. If you look at a pediatrician, a pediatrician may see 3 in a career. So these are very difficult diagnosis. You look at Dr. Jallo and I who are experts in brain tumors, neither one of us has ever diagnosed one in our life.

MARTY MOSS-COANE: Is that right?

FRED J. EPSTEIN, MD: Absolutely. They are diagnosed by the pediatricians or the pediatric neurologists so it's very easy for us to sit here and say, "You'll look for this or you'll look for that." These are tough thing to diagnose and they're extraordinarily uncommon.

MARTY MOSS-COANE: Well, I don't want to be alarmist, but at the same time I think it would be helpful to know what some of the symptoms might be. And you mentioned headaches. What are some of the other symptoms? I'm thinking nausea. Would that be associated?

GEORGE JALLO, MD: I wouldn't say you have any specific symptom to diagnosis a brain tumor.

FRED J. EPSTEIN, MD: I'll tell you one of the things that I think about sometimes when ... headache. A headache that wakes one from sleep, that's quite an uncommon sort of thing. That's a headache that I always worry about. Another type of symptom that we see in children, unlike adults, not so much now as we used, is recurrent vomiting without a cause to the point where one may have a GI investigation and all sorts of things. We don't know why it occurs. But occasionally children can just prolonged vomiting. I don't mean just occasional. I mean intractable with weight loss and simply not being able to figure it out. That's another thing that we see.

Other things can be a little obvious. If a child gets weak on one side or complains of double vision, those are red flags that everybody recognizes.

MARTY MOSS-COANE: But I would assume that you want to talk to parents -- as you say, children will probably play their way through any kind of symptom until they collapse. It's important, I guess, for parents to notice a change in behavior. Would that be significant?

FRED J. EPSTEIN, MD: Sure. Anything -- it's significant. It's important for parents. It's important for pediatricians. It's a tough, tough thing to make this diagnosis. On the one hand, yes, you want somebody to be aware of it. On the other hand, you don't want to look at a child under a microscope. It's a very -- it's a tightrope.

MARTY MOSS-COANE: I'm interested in once you do though suspect that there might be a brain tumor, what the various kind of diagnoses are or certainly some of the various tests that you might perform to try to figure out what you're dealing with.

GEORGE JALLO, MD: Tests that we would perform -- we do a physical examination. The best study that we would do now is an imaging study, an MRI. It's very sensitive to diagnosing most, if not all, the brain tumors that are seen in children today.

MARTY MOSS-COANE: MRI. Anything else in terms of the kinds of tests that you might run?

GEORGE JALLO, MD: No. I think the first test you'd want to do is an MRI. I think that's the most sensitive. I mean there're are cat-scans that -- it's an old technology now.

MARTY MOSS-COANE: Yeah, what is an MRI?

GEORGE JALLO, MD: It's -- it’s not an X-ray. It's a machine where the child has to sit still for about 30 minutes and they take some pictures of the brain. You get to see it in three different planes.

FRED J. EPSTEIN, MD: What's amazing about it, an MRI scan, is you're looking at a brain. You would recognize -- you saw a child, a scan of a child with a big tumor, you would see it. You would see it. It looks just like the model.

MARTY MOSS-COANE: I wanted to ask you. In a sense, if we're talking then about an MRI, what would it look like and would it look obviously different from the rest of the brain.

GEORGE JALLO, MD: Yes, a tumor looks very different from the rest of the brain. It stands right out in an MRI scan. I mean the technology is absolutely incredible in terms of being able to visualize it. And it looks just like the model that is right by your side. It looks exactly the same way.

When you look at an MRI scan, you would recognize every structure that you see there.

MARTY MOSS-COANE: And when you look at an MRI scan, can you see if it's one kind of a tumor or another kind of tumor -- if it's benign or malignant or anything else?

GEORGE JALLO, MD: There are certain characteristics that you might -- we might lean toward one diagnosis or the other -- but no. Without obtaining tissue we can't be certain whether it's benign or malignant. But again, most tumors in children are going to be benign.

MARTY MOSS-COANE: And there are different kinds of tumors? Yes?

GEORGE JALLO, MD: There are many different types of tumors in children.

MARTY MOSS-COANE: And explain that for us.

GEORGE JALLO, MD: There are many families of tumors -- astrocytomas, they tend to be benign. There are some pendemomas, medulloblastomas. They're all from different types of cells that arise -- that grow in the brain themselves.

FRED J. EPSTEIN, MD: And you know, I tell you -- look there are a lot of different types of tumors, but the point that I like to keep making is the bulk of them are curable. The bulk of them can be removed when properly diagnosed and properly taken care of.

MARTY MOSS-COANE: We have almost no time left. Any final comments from you, Dr. Epstein?

FRED J. EPSTEIN, MD: My final comments are that we've come an enormous way in the last ten years and I suspect ten years from now, we will be curing the overwhelming majority of children with brain tumors.

MARTY MOSS-COANE: And that's the good news.

FRED J. EPSTEIN, MD: That's wonderful news.

MARTY MOSS-COANE: Anything you want to add to that?

GEORGE JALLO, MD: I agree. I mean I think what we're able to see with brain tumors and diagnose them today, we didn't have that ability years ago.

MARTY MOSS-COANE: Well, I thank you both so much for joining us today on our webcast. Thank you very much.

FRED J. EPSTEIN, MD: Thank you.

MARTY MOSS-COANE: And thank you for joining us as well. I'm Marty Moss-Coane.

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