Pediatric glioma is a type of tumor that originates in the glial cells of a child’s brain or spinal cord. Understanding this condition is important for families and healthcare providers.
What is Pediatric Glioma?
Gliomas arise from glial cells, which are supportive cells in the central nervous system that surround and protect neurons. In children, gliomas can develop in various locations within the brain or spinal cord, with about 60% occurring in the infratentorial brain. These tumors are classified based on their histological characteristics and how quickly they grow.
Pediatric gliomas are broadly categorized into low-grade and high-grade types. Low-grade gliomas, such as pilocytic astrocytomas, diffuse astrocytomas, and oligodendrogliomas, are slow-growing and less aggressive. Pilocytic astrocytoma is the most common low-grade glioma in children, often found in the cerebellum. High-grade gliomas, including anaplastic astrocytomas and glioblastomas, are more aggressive, growing quickly and potentially spreading to other central nervous system areas. Diffuse midline gliomas, previously known as diffuse intrinsic pontine gliomas (DIPGs), are high-grade tumors located in the brainstem.
Identifying Signs and Diagnosis
The symptoms of pediatric glioma can vary significantly depending on the tumor’s location, size, and rate of growth. Common signs include headaches, particularly those that are worse in the morning or improve after vomiting. Children may also experience nausea, vomiting, vision changes such as double or blurry vision, and difficulties with balance or walking. Seizures, changes in energy levels, increased sleepiness, or alterations in behavior and personality can also indicate a glioma. In infants, an increased head size might be observed.
Diagnosing pediatric glioma involves several steps, beginning with a thorough medical history and physical examination, including a neurological assessment. Imaging techniques are then employed to visualize the tumor. Magnetic resonance imaging (MRI) is a primary tool, often supplemented by computed tomography (CT) scans to detect bone erosion or hemorrhagic features. For a definitive diagnosis, a biopsy or tissue sample of the tumor is required, allowing a pathologist to examine the cells and perform molecular tests. In certain cases, such as with diffuse intrinsic pontine gliomas, a biopsy may not be performed due to the tumor’s location, and diagnosis relies on imaging findings.
Treatment Options
Treatment for pediatric glioma is individualized, taking into account the tumor’s type, grade, location, and the child’s age. The primary goal is to remove as much of the tumor as safely possible through surgery, performed by neurosurgeons. Complete removal of the tumor, also known as gross total resection, is considered the optimal outcome, especially for high-grade gliomas, and can be a predictor of survival in low-grade gliomas.
Following surgery, other treatment modalities may be used. Radiation therapy utilizes high-energy rays to target and destroy remaining cancer cells, employed for high-grade gliomas or when complete surgical removal is not possible. Chemotherapy involves medications administered orally, intravenously, or directly into the spinal fluid to kill cancer cells, and it may be given before or after surgery. Targeted therapy, also known as precision medicine, focuses on specific genetic characteristics of the tumor to tailor treatment, offering a more precise approach. Immunotherapy, which aims to boost the body’s immune system to fight cancer, is also being explored.
Life After Treatment and Support
Life after treatment for pediatric glioma involves ongoing monitoring and support, as children may face long-term effects. Regular follow-up care is important to monitor for any tumor recurrence and to address potential late effects from the disease or its treatment. These long-term effects can include cognitive challenges, such as difficulties with memory, attention, or processing speed. Physical impairments and emotional challenges, including anxiety and uncertainty, are also common.
Multidisciplinary teams, including neuro-oncologists, neurologists, rehabilitation specialists, and psychologists, play a role in providing comprehensive care. Physical therapy can help regain strength and mobility, while cognitive rehabilitation focuses on improving memory and concentration skills. Support resources for families are available, and integrating children back into school and social activities requires careful planning to ensure their overall well-being.