Brain tumors are the second most common cancer in children, following leukemia. There are many types of brain tumors, and they require different treatments. Brain tumors in children are most often located at the bottom and back of the brain. The symptoms usually depend on the location. The most common symptom is imbalance and vomiting.

In small children, where the skull bones are not fused, enlargement of the head is often the only symptom initially. Many brain tumors are benign, meaning they do not form so-called metastases. However, they still need to be removed due to the symptoms they cause when they press on healthy brain tissue.

Research

The most important investigations are CT scans and MRI of the brain and spinal cord, often with the injection of contrast agents into a vein. Other general examinations of the nervous system may be necessary.

Treatment

Often, the tumor can be removed surgically without damaging other parts of the brain. In some children, the tumor or the surgery may disrupt the normal flow of fluids from the brain's cavities. In such cases, a shunt may need to be placed to reduce pressure before or after the surgery on the tumor. If the tumor cannot be completely removed or if there is a risk of the tumor returning, the child receives chemotherapy and/or radiation therapy after the surgery. The success of the treatment depends on the tumor's location in the brain and its type.

Example

Medulloblastoma is one type of brain tumor in children. The tumor is malignant when it can form metastases elsewhere in the nervous system. Therefore, it is important to assess the spread of the disease right from the start. Even if the tumor cannot be surgically removed, the chances of a cure are fairly good with radiation and chemotherapy.

Neuroblastoma is a malignant tumor that originates in the autonomic nervous system, which is located on either side of the spinal column. Part of this system includes the adrenal glands, and most neuroblastomas originate in the adrenal glands. Neuroblastomas can also occur in other locations along the spinal column.

The symptoms of the disease depend on the location and extent of the disease.

Research

It is important to assess the spread of the disease, which is done through CT scans, MRI, and isotope scans.

A sample from the tumor must be taken, and a bone marrow aspiration is performed since the disease can be present in the bone marrow.

The tumor releases substances that can be measured in urine, so urine from the child is collected over a 24-hour period. This is an important test that is also used for monitoring after treatment.

Treatment

The treatment consists of chemotherapy, radiation therapy, and surgery. The success of the treatment varies depending on the child's age; however, the youngest children diagnosed before the age of one can often be cured.

It is more challenging to cure older children, especially since the disease often spreads before any symptoms become apparent.

The two most common bone cancers are Ewing's sarcoma and Osteogenic sarcoma.

They can form metastases in the form of very small or invisible tumors. Therefore, chemotherapy is very important even though the tumor can be removed surgically.

Ewing's sarcoma

Ewing's sarcoma is an unusual disease. It can occur anywhere in the skeleton, and occasionally it starts elsewhere than in the bone. The children are usually of school age.

Research

To diagnose the disease, a sample must be taken from the tumor either during surgery or with a needle biopsy.

CT scans, MRI, isotope studies, and bone marrow examinations are performed to look for metastases.

Treatment

Chemotherapy is always administered, and then its effectiveness is assessed. After that, surgery and/or radiation therapy follows.

The success of the treatment is often good, and an increasing number of children are cured.

Osteogenic sarcoma

Osteogenic sarcoma is also an unusual disease, but it primarily affects boys at puberty. The tumor is usually found in the long bones around the knee or upper arm. The symptoms are often pain.

Research

To diagnose the disease, a sample must be taken from the tumor either during surgery or with a needle biopsy.

CT scans, MRI, isotope studies, and bone marrow examinations are used to look for metastases.

Treatment

Chemotherapy is always given, and then the tumor is removed. Sometimes, it is necessary to amputate a limb. Children quickly learn to use prosthetics.

However, sometimes it is possible to save the limb by using bone from elsewhere in the body or from a bone bank.

Chemotherapy is also given after the surgery.

The success of the treatment is usually good.

A soft tissue tumor refers to a tumor in connective tissues such as fibrous tissue and muscles. These tumors are rare in children.

Rhabdomyosarcoma

Rhabdomyosarcoma can begin in many places in the body, but it most often occurs in the head or neck and can also be found in the abdominal cavity.

Research

A sample must be taken from the tumor to confirm the diagnosis. CT scans, MRI, and isotope scans are important for assessing the spread of the disease. Sometimes it can be difficult to locate the primary tumor.

Treatment

Chemotherapy and radiation therapy are the most important, but sometimes surgery is also necessary.

The lymphatic system transports fluid from various parts of the body to the heart. It consists of a network of vessels and lymph nodes. The lymph nodes are part of the body's defense system, where lymphocytes, a type of white blood cell, work against infections.

Two Different Types of Tumors Can Occur in the Lymph Nodes:

Hodgkin's Disease and Non-Hodgkin's Disease

Hodgkin's Disease

Hodgkin's disease usually starts in one lymph node and spreads through the lymphatic system. It can also spread to the liver, spleen, and bone marrow. Symptoms of the disease include localized swollen lymph nodes and general symptoms such as fatigue, loss of appetite, fever, and night sweats.

Research

To diagnose the disease, one or more lymph nodes must always be removed surgically. The spread of the disease also needs to be assessed using a CT scan and a bone marrow biopsy. The disease is then classified into different stages based on its spread.

Treatment

The treatment depends on the extent of the disease and the results of the tissue examination of the lymph nodes. The treatment can be solely radiation therapy, solely chemotherapy, or a combination of both. The patient is closely monitored to detect early if the disease recurs and to manage any potential side effects of the treatment.

The treatment has good outcomes, and most patients are cured.

Non-Hodgkin's Disease

Non-Hodgkin's disease is a term for other tumors in the lymph nodes. These are often tumors closely related to leukemia (ALL) and can spread and become leukemia.

Research

A sample is always taken from the swollen lymph node, and a bone marrow aspiration is performed to diagnose the disease.

Treatment

The treatment is chemotherapy, similar to that used for leukemia.

The outcomes of the treatment are good, especially when the disease has not spread to the bone marrow.

• A tumour may remain in your body for some time without symptoms.

• The symptoms the child gets are usually because the tumour starts to take up space and pushes onto the free tissue.

• If the tumour is in the brain, it can cause balance problems and vomiting.

• Abdominal tumours are sometimes found at a routine medical examination by chance.

• It is unusual for tumours in children to give general symptoms such as weight gain, tiredness, fever or low blood levels.

When a tumor is diagnosed, its size and type need to be determined. It is also necessary to investigate the spread of the disease to other organs.

A medical examination is conducted in the usual manner, and blood tests are taken.

• X-ray Examinations: X-ray examinations can be used in various ways. Standard X-rays can be taken of the lungs and bones, and with the administration of contrast agents, for example, of the kidneys and digestive organs.

• CT scans, with or without contrast, can be taken of the brain, lungs, and abdominal cavity.

• MRI: MRI is a newer examination that does not use X-rays. MRI can provide very clear images, especially of the brain and spinal cord.

• Isotope Scan: By injecting a special radioactive substance (isotope) into a vein, images can be taken with a special camera of bones or organs where the isotope is visible. This helps in determining the spread of the disease.

• Ultrasound: Ultrasound can often provide good information.

• Bone Marrow Aspiration: Some tumors can spread to the bone marrow where blood cells are formed. Therefore, a bone marrow aspiration must be performed using a large needle in the iliac crest or tibia to take a sample that is examined under a microscope.

A sample is taken from the tumor to identify the type of tumor. This is a necessary part of the investigation.

Many of these examinations are performed under anesthesia, both because the child needs to lie still and to prevent pain during the procedure.

After the results of these examinations, the tumor is classified into a specific stage, usually on a scale from 1 to 4 based on size and spread, and then the treatment can be determined.

Surgery

Surgery is performed to remove the tumor and check for possible metastases. The procedure can be decisive for the choice of further treatment. The tumor is always examined in the laboratory under a microscope and with other methods to obtain the best and most accurate diagnosis.

In certain cases, it may be better to start with chemotherapy or radiation therapy to reduce the tumor before it is removed surgically. If only part of the tumor can be removed during surgery, drug or radiation therapy may still be effective.

Chemotherapy

Chemotherapy is almost always necessary. Even if the tumor has been successfully removed through surgery, there may be cancer cells that are not visible, and if they are not eliminated, they could begin to multiply again. This could cause the disease to recur. To prevent this, chemotherapy is sometimes administered both before and after the surgery.

Cancer Drugs

Cancer drugs are medications that inhibit cancer cells from dividing, thus preventing the tumor from growing and spreading to other organs. Chemotherapy can also inhibit other cells from dividing, causing side effects or undesirable effects.

Medications have different side effects. By administering more than one drug at a time, the effects of the drugs on the tumor can be enhanced, and treatment plans for different diseases have been developed. These plans are based on years of international experience, and with global collaboration, new treatment strategies are continually being developed.

Radiation Therapy

Many tumors are very sensitive to radiation, but radiation also damages healthy tissue. With modern technology, radiation can be directed very precisely so that adjacent tissues are not harmed. For this to be successful, the patient must lie still, which is why small children often need to be sedated. There is no pain associated with receiving radiation therapy, and each treatment takes only a very short time.

Radiation therapy can last from 3 to 8 weeks.

Treatment of cancerous tumors in children is a medicine for many children today.

The risk of developing the disease is highest in the first years after treatment is completed but decreases every year.

Good monitoring is important and often studies are needed to be able to diagnose the disease as soon as possible and have the possibility to re-treat the child. The child is usually considered free after 5 years, but this depends on the disease and sometimes it can be seen already after 2 years.

The child is however monitored for longer and then it is observed that it grows and develops normally.

It is unusual for the treatment to cause permanent damage in children.

Many children who have had cancer have become adults today and have had children themselves.

Many types of cancer in children can now be cured, but unfortunately, there are still certain types for which there is not yet an adequate treatment.

International collaboration is continually aimed at improving treatment options.

When testing a new treatment, it is not always certain that it is better than previous treatments. Therefore, it is necessary to treat a certain number of children with the new treatment while an equal number of other children receive the old treatment. Then, the two methods can be scientifically compared to see which one proves to be better.

To obtain reliable results from such studies, a large number of patients are needed, which is why these studies are conducted in multiple countries simultaneously. Iceland often participates in research, and parents are always asked for permission first. Many successful treatments have indeed emerged in this way.

Doctors in the Nordic countries have collaborated on the treatment of childhood cancer for many years. This has, among other things, improved the treatment of leukemia in children, and its success is among the best in the world today.

Nurses have also begun to collaborate in the same way as doctors.