Find out about gliomas in children and their treatment.
Gliomas are brain tumours starting in the glial cells in the brain.
What it is
There are 3 main types of glioma:
Astrocytomas are the most common type of glioma in both adults and children. The develop from the cells called astrocytes. Astrocytes are the cells of the brain that support the nerve cells (neurones)
Astrocytomas can be low grade (slow growing) or high grade (fast growing). Some are very localised (focal). This means it is easy to see the border between the tumour and normal brain tissue on a scan or during an operation. Focal astrocytomas are often diagnosed in children and are not common in adults.
Other astrocytomas are called diffuse. These do not have a clear boundary between the tumour and normal brain tissue.
Where in the brain
Childhood gliomas can be in:
- the cerebrum (forebrain)
- the cerebellum (hindbrain)
- the brain stem
- the eyesight nerve pathways (optic nerves)
Diagnosing glioma in children
Your doctor will examine your child and they may have blood tests to check their general health. Other tests include:
- CT or MRI scan
- lumbar puncture
Factors in deciding treatment
Treatment for glioma in children depends on:
- whether the tumour is slow or fast growing (grade)
- where in the brain the tumour is growing
- whether it is possible to remove it
- the age of the child
Treatment options for children
The main treatment for most childhood gliomas is surgery to remove as much of the tumour as possible. But it isn't possible to remove tumours in some areas of the brain.
For example, surgery to remove tumours in the brain stem can cause too much damage to the surrounding normal brain tissue.
Low grade tumours are generally easier to remove than high grade tumours because they are less invasive. Low grade tumours don't spread out into the surrounding brain tissue in the way that some high grade tumours do.
Surgery might be the only treatment your child needs, particularly if it is a slow growing tumour.
Radiotherapy and chemotherapy
The specialist might suggest your child have radiotherapy or chemotherapy if it was not possible to remove all of the tumour. Or they might have radiotherapy and chemotherapy together.
Radiotherapy is not usually used for children under the age of 3 because it can cause severe long term side effects.
Proton beam treatment
This is a type of radiotherapy. Instead of using x-rays, it aims proton beams at the cancer. This type of treatment is not suitable for everyone. Your specialist will discuss this with you if they think it is suitable for your child.
High dose proton beam treatment is not available in the UK at the moment. So if necessary, they would arrange for your child to have treatment abroad.
Gliomas in the cerebrum
Surgery is the main treatment for tumours in this cerebrum. This might be the only treatment your child needs if all of the tumour has been removed.
Your child might also have radiotherapy or chemotherapy, depending on their situation.
Gliomas in the cerebellum
Gliomas in the cerebellum are nearly all low grade. The main treatment is surgery. About 9 out of 10 can be completely removed.
if the surgeon can't remove all of your child's tumour, they might
- monitor the tumour with scans and delay further treatment until it is growing again
- recommend radiotherapy or chemotherapy straight away
- carry out further surgery to try to remove the tumour
Gliomas in the brain stem
The brain stem is a very delicate area that controls many vital body functions such as breathing, swallowing and eye movements. So it is not always possible to operate safely in this area. These tumours can be difficult to treat.
Gliomas in the brain stem can be slow growing and just in one area. These are called focal tumours.
Your child might have an operation if the surgeon thinks this is possible. They remove as much of the tumour as possible.
Or the specialist might recommend delaying surgery. Some tumours in the brain stem grow so slowly that they don't really need treatment if they are not causing symptoms. The specialist monitors the tumour with regualr scans.
Tumours that are fast growing tend to grow into the surrounding brain tissue. These are called diffuse tumours.
Depending on their age, your child might have radiotherapy for a diffuse type glioma in the brain stem. Your specialist might recommend your child have chemotherapy if they are very young. Chemotherapy can work well for diffuse tumours in young children.
Gliomas of the eyesight (optic) nerves
The eyesight nerves are also called the visual nerves or the optic pathway. Gliomas in this area are most often quite slow growing (low grade).
The specialist might recommend that your child does not have treatment straight away. Some of these tumours grow so slowly that they may not cause any symptoms or problems for years. This is most often the case with tumours in children who have the genetic condition neurofibromatosis.
Your child would have immediate treatment if there is a risk that they might lose their eyesight. In this situation, the surgeon will try to remove as much of the tumour as possible.
Surgery can be difficult in this area. If your child's tumour cannot be completely removed, the specialist might suggest radiotherapy or chemotherapy. The choice would depend on your child's age and symptoms.
Glioma that comes back
Unfortunately childhood gliomas can come back some time after they have first been treated. The treatment for a brain tumour that has come back depends on the treatment that your child had first time round.
Your child's surgeon may be able to operate again. If your child didn't have radiotherapy before, then your specialist may suggest it now. If your child has had radiotherapy, they may still be able to have it again. Or their doctor may suggest chemotherapy instead.
Radiotherapy in young children
If at all possible, children under 3 years of age with a tumour in the front part of the brain are not treated with radiotherapy. This is because their young age makes radiotherapy more likely to affect their brain development. This can cause long term side effects.
Chemotherapy can work very well for some types of glioma in babies and young children. The exact combination of drugs and the timing varies. But generally chemotherapy is given every 2 to 6 weeks.
Children under 2 years of age when diagnosed usually have chemotherapy for about 2 years. After that, your child might have a course of radiotherapy to help stop the glioma from coming back.
Unfortunately, some brain tumours come back during chemotherapy. If this happens, your child might have radiotherapy to treat the tumour.
Coping with a glioma
Coping with a diagnosis of cancer can be difficult, both practically and emotionally. It can be especially difficult if your child has a rare cancer. Being well informed about their cancer and its treatment can make it easier to make decisions and cope with what happens.
Your child will have regular check ups once they finish your treatment. Your doctor will examine your child and ask about their general health.
This is your chance to ask questions and to tell your doctor if anything is worrying you.
How often your child will have check ups depends on their individual situation.
Research and clinical trials
There may be fewer clinical trials for rare types of cancer than for more common types.
It is hard to organise and run trials for rare cancers. Getting enough patients is critical to the success of a trial. The results won't be strong enough to prove that one type of treatment is better than another if the trial is too small.
The International Rare Cancers Initiative (IRCI) aims to develop more research into new treatments for rare cancers. They are designing trials that involve several countries so that more people will be available to enter trials.