If your child has been diagnosed with a brain tumor, you are faced with difficult decisions: what is the first step? where to turn for help? which treatment methods to choose? which doctor should I contact? Specialists in the field of pediatric oncology of Maimonides Multidisciplinary Medical Center will help you solve all complex problems in the shortest possible time.
Our Pediatric Oncology Department closely cooperates with the best pediatric oncology clinics in Israel. Pediatric Oncology Project of Maimonides Medical Center is headed by Dr. Serhiy Postovsky from Israel – the chief pediatric oncologist. He oversees all cases directly from Israel. Together with the head of Pediatric Oncology Department of Maimonides Clinic, Dr. Yuri Tymoshchuk, he takes part in each individual clinical case management. Also children's oncology project in the field of brain tumors are accompanying such Israeli doctors as Professor Konstantini and Dr. Rina Dvir. Thus, in Ukrainian conditions, you can get access to all modern Israeli medicine advantages.
Features of Pediatric Oncology Department of Maimonides Medical Center:
- Using all advantages and principles of providing medical care according to Israeli model in our daily activities.
- Only modern global treatment protocols are implemented. They all based on evidence-based medicine principles.
- Possibility to receive financial assistance for treatment of a sick child, as Maimonides Clinic works under the patronage of “Keren Or for our Child” the Charitable Foundation.
- Using only modern and safe diagnostic equipment.
- If a biopsy is performed during diagnosis, all tissue samples are sent for revision to the best pathogistological laboratories in Germany, USA, and Israel. In this manner, specialists oncologists are absolutely sure of diagnosis correctness and further treatment tactics effectiveness.
- If department does not have a specific narrow specialist or specific diagnostic equipment, patient is referred to subsidiary Maimonides medical centers or to Israeli partner clinics.
- In Pediatric Oncology Department, there is a whole multidisciplinary team, which consists of children's oncologists, hematologists, neurologists, neurosurgeons, pediatricians, rehabilitators, psychologists, speech therapists and other specialists necessary for providing continuous medical care. That is, treatment process is built in such a way that the child can receive all necessary help from the beginning of diagnosis to the end of rehabilitation after treatment course within the walls of one medical institution.
- Comfortable arrangement of wards and department as a whole. There is everything necessary for children and their parents residency. The department has a buffet, a playroom, and various training courses, because oncological pathology treatment process is long and children can spend from several weeks to several months in the department.
- Only specialists who have undergone appropriate training and internships in the world's best oncology clinics work in Pediatric Oncology Department, all of them have impeccable knowledge of modern diagnostic and treatment methods in children oncological diseases.
Types of brain tumors in children
Types of brain tumors in children
Brain tumors (central nervous system) in children occur often and are the second most common childhood cancer after blood system malignant diseases. Children with brain tumors make up to 20% of all cancer patients under the age of 15.
Despite the fact that brain neoplasms are also divided into benign and malignant according to their ability to metastasize and invasive growth, the vast majority of them all have a progressive course and require treatment. First of all, this is due to the fact that skull is a closed space, and any intracranial malformation will cause symptoms of compression nearby important brain structures, regardless of whether neoplasm is benign or malignant.
Also, brain tumors can be primary – develop directly from intracranial structures, or secondary (metastatic) – which are distant metastases of malignant malformations of another location.
The most common types of primary brain tumors in children are:
- Astrocytomas (gliomas) are half of all brain neoplasms in childhood. They develop from CNS cells called astrocytomas (star-like cells). Depending on differentiation degree (maturity), several types of astrocytes are distinguished. Treatment approaches to each individual type of tumor differ, therefore it is extremely important to determine the type of tumor using modern molecular genetic methods.
- Ependymomas – these neoplasms develop from ependymal cells that normally line inside brain ventricles (cavities in brain filled with cerebrospinal fluid). Such tumors metastasize extremely rarely and mainly with cerebrospinal fluid flow.
- Medulloblastoma and other embryonic brain tumors are malignant neoplasms that develop from underdeveloped stem cells. They have a very aggressive course, but with the right approach, they are completely curable in children. Medulloblastoma treatment is usually complex and includes surgery, radiation therapy, and chemotherapy.
- Craniopharyngioma is a rare tumor in children, occurring in the age group from 5 to 14 years. This is a benign neoplasm located in pituitary gland. As the tumor grows, pituitary tissue is compressed and corresponding endocrine disorders occur, so such tumor must be surgically removed.
- Glioblastoma is a malignant neoplasm from auxiliary cells of the CNS – glial cells, which are such a framework for the main brain nerve cells, also provide nutrition for neurons and their main metabolic processes. This is a rare type of tumor for children, characterized by aggressiveness and invasiveness of growth, which complicates their surgical treatment.
- Neurinoma of auditory nerve (vestibular schwannoma) is a benign neoplasm in auditory nerve area; it is less common in children compared to adults. Schwannomas often do not grow, do not cause any symptoms, and therefore do not require treatment. But in cases where tumor increases in size and causes problems with hearing and balance apparatus, its surgical removal is indicated.
- Atypical teratoid rhabdoid tumor (ATRT) is also a tumor that originates from embryonic tissues, has a malignant and aggressive course, affects spinal cord, as well as brain in cerebellum, brain stem region. This is a rather rare pathology that affects children under 3 years old. Treatment of this pathology is complex with application of surgical intervention, chemotherapy, targeted therapy, immunotherapy, radiation therapy, bone marrow transplantation and other advanced techniques.
Maimonides Medical Center works under the patronage of “Keren Or for our Child” the Charitable Foundation, so all patients who need expensive treatment, but cannot afford it, can count on partial or full payment of medical services by this foundation.
What symptoms permit to suspect a brain tumor in a child?
Brain tumor symptoms depend on tumor type, size, and location, as well as the age of the child.
The following signs are most often observed:
- persistent headache;
- dizziness, general weakness;
- nausea and vomiting that do not bring relief;
- various mental disorders;
- neurological disorders that depend on tumor location;
- memory loss;
- various visual impairments;
- numbness of various parts of body.
If you notice certain symptoms from this list in your child, seek help from our oncologists. The specialist will explain everything during face-to-face consultation, make up an individual plan for further examination and treatment in accordance with the exact diagnosis and medical care standards of the best Israeli clinics.
Modern diagnostics possibilities
To overcome the disease successfully, first of all, a quick and accurate diagnosis is needed. Specialists of Maimonides clinic have all modern diagnostic methods of brain tumors in children. The examination begins with establishing complaints characteristic of brain neoplasm, collecting medical and life anamnesis (whether there have been similar cases in family), physical and detailed neurological examination. Next, specialist will make up a detailed examination plan using modern equipment and the latest techniques for 100% accurate diagnosis.
Methods of diagnosing brain tumors in children:
- various blood and urine tests;
- Spinal puncture and examination of obtained cerebrospinal fluid;
- color dopplerography of head and neck vessels;
- Medical imaging techniques – skull CT, MRI, X-ray, PET-CT, PET-MRI, MSCT – allow us to see the neoplasm, assess its size, location, make assumptions about the type of tumor, assess metastases in distant organs presence or absence;
- angiography of head and neck arteries;
- neurophysiological diagnostic methods of brain functional state, spinal cord, peripheral nerves – EEG, EMG, Echo-EG and others;
- targeted biopsy, cytological and histological examination, immunohistochemical and immunofluorescence examination of tissue samples (for example, parts of tumor) to determine tumor subtype, to plan treatment regimen most effective for this type of neoplasm.
A modern diagnostic procedure, the Foundation One panel is a complete set of genomic profile research (molecular tests) of detected genetic changes in patient's tumor cells. It is used to select individual targeted and immunobiological therapy. This approach makes it possible to choose the most effective treatment scheme for each individual patient, taking into account malignant cells sensitivity to certain drugs. This approach is called personalized oncology, when specific drugs are created for each individual, taking into account the subtype of the tumor.
Caris Molecular Testing is a panel for molecular testing of the entire human genome. Testing includes sequencing of 22,000 genes. The Caris test evaluates protein biomarkers on tumor surface using an extensive immunohistochemical panel. In future, this analysis is used to select and manufacture individual therapy that will be effective for patient (targeted drugs, other immunobiological drugs).
Based on received data, patient is given an accurate diagnosis, indicating the type of tumor, its localization, the stage of process, and possible complications. All this is taken into account making up a plan of the most effective treatment in each specific case.
Innovations of brain tumors treatment in children
Most often, a complex approach to brain tumors treatment is used, that is, one patient receives both surgical, radiation, and chemotherapy treatment.
Planning surgical intervention on brain, neurosurgeons try to find the most optimal access, so that the intervention is minimally invasive and does not injure surrounding nerve tissue. For example, with neoplasms in pituitary gland, a transsphenoidal approach is used, that is, access through the nose without disturbing skull integrity. When neoplasm is large, a transcranial approach with trepanation of the skull and craniotomy is used.
Modern neurosurgery has reached incredible development, so patients with brain tumors have access to modern and effective surgical interventions on brain, including:
- Gamma knife stereotaxic radiosurgical unit , Cyber knife, X-knife and NanoKnife, when surgery is performed in targeted manner without a single incision with scalpel;
- Cryosurgery is a neurosurgical intervention when probes cooled by liquid nitrogen are used, which are brought directly to tumor to destroy it, while completely preserving healthy surrounding tissue.
Radiation therapy is also actively used in young patients with brain tumors. It can be preoperative, when radiation is prescribed to reduce the size of tumor so that it is easier to remove it in future. Postoperative, when patient receives radiation therapy courses to prevent disease recurrence and destroy every single malignant cell that may have remained after surgery. There is also a modern type of intraoperative radiation therapy (IORT), when radiation occurs directly during surgery, which significantly increases full recovery chances.
Chemotherapy is prescribed in complex treatment of patients with brain tumors. Oncologist selects drugs, their dosages and application regimens specifically for each child. In our practice, we use only proven, effective and safe chemotherapy drugs from leading pharmaceutical companies. This approach ensures maximum effectiveness of treatment and minimum number of side effects.
Individual immunobiological therapy drugs can be developed on molecular genetic research basis of tumor samples. Such drugs are able to attack specific malignant tumors selectively, while not harming healthy body cells.
Brain tumors are complicated disease in terms of a single tactic, because neoplasm can damage various important areas in brain, which will cause severe, sometimes even incompatible with life, disorders. For example, impaired vision, speech, breathing or swallowing center. Therefore, decision about necessity for certain treatment methods in complex is made not by one oncologist, but by a whole team of specialists – neurologists, neurosurgeons, radiologists, radiation therapists, chemotherapists and oncologists. Only joint efforts can overcome the disease and at the same time avoid serious consequences for health.
Also, all patients of Maimonides Multidisciplinary Medical Center have the opportunity to participate in clinical experimental studies absolutely free of charge. For some, this is a real chance for a full recovery, especially for those patients in whom standard treatment methods have turned out to be ineffective.