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MedulloblastomasMMedulloblastomasMedulloblastomasEnglishNeurology;OncologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesAdult (19+)NA2021-12-21T05:00:00Z9.9000000000000051.70000000000002100.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Medulloblastoma is the most common form of brain cancer among children. Learn more about medulloblastoma symptoms, causes, diagnosis and treatment.</p><h2>What is a medulloblastoma?</h2><p>Medulloblastoma is the most common type of brain cancer in children. It belongs to a group of tumours called embryonal brain tumors. These tumors originate from immature brain cells. </p><p>Medulloblastoma arises from the <a href="/article?contentid=1307&language=english">cerebellum</a>, which is located at the back of the brain. This part of the brain coordinates movement, balance, and posture and participates in some of the functions of the other parts of the brain in ways that are not fully understood. It is usually diagnosed in children four to eight years of age and is more common in boys. </p><p>Recently, scientists have been able to better understand the biology of medulloblastoma. They found that a medulloblastoma belongs to one of four subtypes called molecular subgroups, based on their genetic signatures. This helps doctors understand the different behaviours of a medulloblastoma, age of presentation and outcomes seen in children with medulloblastoma. </p><h2>Key points</h2><ul><li>Medulloblastoma is the most common type of brain cancer in children. </li><li>Medulloblastoma arises in the cerebellum, located at the back of the brain.</li><li>Symptoms include headaches, vomiting, unsteadiness, double or blurry vision, and sleep difficulties.</li><li>The cause of medulloblastoma is not known. </li><li>A child suspected to have medulloblastoma will need a staging work up. </li><li>Curative therapy for medulloblastoma includes surgery, radiation therapy, and chemotherapy. </li><li>The treatment team may include a neurosurgeon, a neuro-oncologist, radiation oncologist, a nurse practitioner or nurse, and a social worker. </li><li>Before you agree to the treatment offered, it is important that you understand what to expect and feel comfortable with your decision. </li></ul><h2>What are the symptoms of medulloblastoma? </h2><p>Symptoms of medulloblastoma include: </p><ul><li>headaches</li><li>vomiting</li><li>unsteadiness (loss of balance)</li><li>double or blurry vision</li><li>neck pain or stiffness</li><li>sleep difficulties </li></ul><p>Children with this tumour may also have <a href="/article?contentid=1408&language=english">problems in school</a> because tasks such as writing become more difficult. There may also be changes in their personality or <a href="/article?contentid=1341&language=english">behaviour</a>. </p><p>Sometimes medulloblastomas block the flow of cerebrospinal fluid (CSF) through the pathways, or hollow channels, that drain CSF from the ventricles in the brain. This can lead to a condition called <a href="/article?contentid=858&language=english">hydrocephalus</a>.</p><p>Symptoms may not be obvious early on and may take time to become clearer. If the symptoms are dramatic, the diagnosis may happen quickly. If they are milder, it can take months. This is why some children are seen by a health-care provider after a few weeks of symptoms, while others with more mild symptoms can take a few months before they are seen. The diagnosis of any brain tumour can be a long and difficult process. However, your primary care team will be available to help guide you through every step. </p><h2>What causes medulloblastoma?</h2><p>It is not known what causes medulloblastoma. There is growing evidence that medulloblastoma is the result of a mistake that occurred in the early development of the brain’s cells. These cells will then grow uncontrollably to form what is called a tumor. </p><p>There is no way to predict that a child will develop a medulloblastoma and nobody is to blame if a child develops a tumour. </p><p>Researchers have been studying whether environmental factors, such as radiation, food, or chemicals, can cause brain cancer. At the moment, there is no definite proof that there is a connection.</p><p>Certain medical conditions are connected to medulloblastoma. If a child has Turcot syndrome or Gorlin syndrome, there is a slightly greater chance of developing a medulloblastoma. Your child’s primary care team will assess the need to do genetic testing. They may recommend a genetic test depending on the initial assessments and other tests, but this may not be needed for every child. </p><h3>Medulloblastoma biology </h3><p>Medulloblastoma is now divided into four subtypes called molecular subgroups, based on their genetic signatures. These groups differ in terms of their age of presentation, and behaviour. Researchers are still learning about the differences between these groups as there are still some unknowns, such as how these subgroups can be treated differently. The molecular subgroup testing is done on the tumor once it is removed, and results may take some time. Your primary care team will provide you with the results and explain what they mean. </p><h2>How many children have medulloblastoma?</h2><p>Medulloblastoma accounts for about 20% of all brain cancers in children. </p><p>In Canada, about 40 to 50 children are diagnosed with a medulloblastoma each year.</p><h2>How is a medulloblastoma diagnosed?</h2><p>Doctors and other health-care professionals will use well-established diagnostic tests to see if a brain tumour is causing your child’s symptoms. These tests will include a physical examination and brain scans such as <a href="/article?contentid=1270&language=english">magnetic resonance imaging (MRI)</a> or <a href="/article?contentid=1272&language=english">computerized tomography (CT)</a>, which will identify the presence of a tumour. If medulloblastoma is suspected, you will meet with the neurosurgeons to discuss a plan for <a href="/article?contentid=1351&language=english">surgery</a>. </p> <figure class="asset-c-100"> <span class="asset-anim-title">Medulloblastoma MRI</span> <div class="asset-animation asset-cv-animation"> <iframe src="https://www.aboutkidshealth.ca/Style%20Library/akh/animation/Medulloblastoma-vert%20-%20Storyline%20output/story.html"></iframe>  </div> </figure> <p>A biopsy will be done at the time of surgery to confirm the diagnosis. During a biopsy, a sample of tissue from the tumour will be removed. This small piece of tumour will be sent to a doctor called a pathologist. They will look at the tumour under a microscope to learn the exact type of tumour. </p><p>The doctors may ask permission to study the sample tumour cells further to learn more about their biology. At the moment, the results of these tests do not influence treatment.</p><h3>What is staging?</h3> <figure> <span class="asset-image-title">Metastasized tumour cells</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/Spine_metastasis_MEDIMG_PHO_EN.jpg" alt="A scan showing the vertebra and spinal cord with metastases" /><figcaption class="asset-image-caption">Cancer cells from a brain tumor can sometimes spread to other parts of the body, such as the spinal cord. This is called metastasis.</figcaption></figure> <p>Staging determines if the tumor has metastasized (spread) to the spine or the CSF. To stage the tumour, the following diagnostic tools are used: CT scans, MRI of the brain and spine, and <a href="/article?contentid=3380&language=english">lumbar puncture</a>. </p><p>To choose the type of treatment that is most appropriate, all the available information including the child’s age, staging and the biological characteristics of the tumor are used to match the best treatments to each tumor. Medulloblastomas are stratified into two groups, called "average risk" or "high risk", the group stratification determines the "intensity of the treatment" they will receive.</p><p>A medulloblastoma is called average risk if all of the following are true:</p><ol><li>All or most of the tumour was removed during surgery.</li><li>The tumour cells have not spread to other parts of the brain or into the cerebrospinal fluid (CSF). This is seen from a lumbar puncture and MRI scan.</li></ol><p>A medulloblastoma is called high risk if any of the following are true:</p><ol><li>Some of the tumour was not removed by surgery.</li><li>The tumour cells have spread to other parts of the brain or into the CSF.</li></ol><p>Before starting treatment, other tests such as blood tests and a hearing test are also done as a baseline to compare to during treatment.</p><h2>How is medulloblastoma treated?</h2><p>Once the health-care team has a clear understanding of what is causing your child’s symptoms — usually after <a href="/article?contentid=1351&language=english">surgery</a> — a meeting with the team will be set up to talk about results and the treatment plan. Remember that it is helpful to bring paper and a pen or laptop to take notes at each meeting with this team. It is important to have the child’s primary caregivers in this meeting, for example both parents. </p><p>The treatment team may include a neurosurgeon, a neuro-oncologist, radiation oncologist, a nurse practitioner or nurse, and a social worker. During the meeting, they will explain which doctor is responsible for your child’s treatment, and the roles of everyone who is there. Other team members may be involved such as a dietician, pharmacists, occupational therapist, and physiotherapist, depending on your child’s needs. Every team member has their role in your child’s care, and everyone works together to make your child feel better. </p><p>The doctor will explain the type of tumour that your child has, based on what the team has learned through diagnostic testing. You will learn the expected effect this tumour will have on your child in the upcoming months and years, based on what is known about the tumour. This is called the prognosis. </p><p>The team may talk about placing your child on a protocol, which is a treatment plan for medulloblastoma. You will need to <a href="/article?contentid=1346&language=english">consent</a> (agree) to the plan for the treatment to begin. Teenaged patients may be asked for their consent as well. </p><p>Your team will also talk to you about placing an IV line called a <a href="/article?contentid=52&language=english">central line</a>, this will help doctors give the treatments in a safer way and avoid multiple pokes for blood tests. You will get more information about the line insertion in details during the meeting. </p><p>There are three main modalities of treatment for medulloblastoma in children: <a href="/article?contentid=1351&language=english">surgery</a>, <a href="/article?contentid=1353&language=english">radiation</a>, and <a href="/Article?contentid=1357&language=english">chemotherapy</a>. For medulloblastoma, all three modalities are needed at different timelines to have the best results. </p><h3>Surgery </h3><p>Once a tumor is seen on the brain scans, the surgeons will assess your child for <a href="/article?contentid=1351&language=english">surgery</a>. The surgeons will decide on the timing and approach for surgery. In some situations, the surgeons will need to relieve the pressure in the brain caused by hydrocephalus before the tumor removal surgery. This is done by placing a shunt to relieve the pressure. </p><p>To reduce some of the symptoms of the tumour and the swelling in the brain, your child will likely take <a href="/article?contentid=1354&language=english">steroids</a> (an anti-inflammatory medication) to help reduce the swelling and improve the symptoms. This is usually done after the scans and around the time of surgery. Once your child is feeling better, the surgeons may stop the steroids.</p><h3>Radiation therapy </h3><p><a href="/article?contentid=1353&language=english">Radiation therapy</a> is high energy X-rays that kill tumor cells. You will meet with the radiation oncologist for a consultation to talk about how radiation therapy is given, side effects and how many treatment sessions are needed. This takes place after your child has had time to recover from surgery. In very young children, radiation therapy may be avoided due to the severe neurological side effects observed when given to the young developing brain. Your doctor will explain different therapies available to avoid or delay the use of radiation.</p><h3>Chemotherapy </h3><p><a href="/Article?contentid=1357&language=english">Chemotherapy</a> is a type of medication that will kill cells that are dividing fast. This includes the tumor cells. Chemotherapy can be given by intravenous (IV) line or by mouth depending on what type of chemotherapy is needed. Your child’s neuro-oncologist and pharmacists will explain to you how and when chemotherapy is given. For children with medulloblastoma it is given after radiation therapy. </p><h3>Clinical trials</h3><p>Many doctors are trying to make cancer treatments more successful. They can do this by studying different types of treatment, in clinical trials. Your child’s doctor may ask if you would like your child to participate in a clinical trial. You will have to sign an informed consent form for your child to participate in a trial. The health-care team will explain the differences between being on a clinical trial and getting the standard treatment. </p><h3>Additional supports</h3><p>When you meet with the treatment team, you may also be told about resources available to support your child, you and your other children during treatment and recovery. You will be encouraged to think about any questions concerning the diagnosis and the treatment plan.</p><p>Before you agree to the treatment offered, it is important that you understand what to expect and feel comfortable with your decision. <br></p>
MédulloblastomesMMédulloblastomesMedulloblastomasFrenchNeurology;OncologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesAdult (19+)NA2021-12-21T05:00:00Z9.9000000000000051.70000000000002100.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Le médulloblastome est la forme la plus fréquente de cancer du cerveau chez les enfants. Elle apparaît dans le cervelet. En savoir plus sur le médulloblastome.</p><p>Le médulloblastome est la forme la plus fréquente de cancer du cerveau chez les enfants. Il appartient à un groupe de tumeurs appelées tumeurs cérébrales embryonnaires. Ces tumeurs proviennent de cellules cérébrales immatures.</p><p>Le médulloblastome se développe dans le <a href="/article?contentid=1307&language=french">cervelet</a>, situé à l’arrière du cerveau. Cette partie du cerveau coordonne le mouvement, l’équilibre et la posture et participe également à certaines fonctions des autres parties du cerveau d’une manière encore difficile à comprendre. On le diagnostique généralement chez les enfants âgés de quatre à huit ans et il est plus fréquent chez les garçons.</p><p>Récemment, les scientifiques ont pu mieux comprendre la biologie du médulloblastome. Ils ont découvert qu’un médulloblastome appartient à l’un des quatre sous-types appelés sous-groupes moléculaires, sur la base de leurs signatures génétiques. Cela aide les médecins à comprendre les différents comportements d’un médulloblastome, l’âge de son arrivée et les résultats observés chez les enfants atteints de médulloblastome.</p><h2>À retenir</h2><ul><li>Le médulloblastome est la forme la plus fréquente de cancer du cerveau chez les enfants.</li><li>Le médulloblastome se développe dans le cervelet, situé à l’arrière du cerveau.</li><li>Les symptômes comprennent des céphalées, des vomissements, de l’instabilité, une vision double ou floue et des troubles du sommeil.</li><li>Les causes du médulloblastome sont inconnues.</li><li>Un enfant suspecté d’être atteint d’un médulloblastome devra subir un examen de stadification.</li><li>Le traitement curatif du médulloblastome comprend la chirurgie, la radiothérapie et la chimiothérapie.</li><li>L’équipe soignante peut comprendre un neurochirurgien, un neuro-oncologue, un radio-oncologue, une infirmière praticienne, et un travailleur social.</li><li>Avant d’accepter le traitement offert, il est important que vous compreniez à quoi vous attendre et que vous soyez à l’aise avec votre décision. </li></ul><h2>Quels sont les symptômes médicaux du médulloblastome?</h2><p>Les symptômes comprennent des: </p><ul><li>céphalées;</li><li>vomissements;</li><li>l’instabilité;</li> vision double ou floue; <li>troubles du sommeil.</li></ul><p>Les enfants atteints de cette tumeur peuvent également avoir des <a href="/article?contentid=1408&language=french">problèmes à l’école</a>, car les tâches comme l’écriture deviennent plus difficiles. Il peut également y avoir des changements dans leur personnalité ou leur <a href="/article?contentid=1341&language=french">comportement</a>. </p><p>Parfois, ces tumeurs bloquent l’écoulement du liquide céphalorachidien (LCR) par les voies qui drainent le LCR des ventricules, ou canaux creux, dans le cerveau. Cela peut provoquer une affection que l’on appelle <a href="/article?contentid=858&language=french">hydrocéphalie</a>.</p><p>Au début, il est possible que les symptômes ne soient pas évidents et qu’il s’écoule du temps avant qu’ils se clarifient. Si les symptômes sont spectaculaires, le diagnostic peut se faire rapidement. S’ils sont plus légers, cela peut prendre des mois. C’est pourquoi certains enfants sont examinés par un fournisseur de soins de santé après quelques semaines de symptômes, alors que d’autres, présentant des symptômes plus légers, peuvent patienter plusieurs mois avant d’être examinés. Le diagnostic de n’importe quelle tumeur cérébrale peut être un processus long et difficile. Cependant, votre équipe de soins primaire sera à votre disposition pour vous guider à chaque étape.</p><h2>Quelles sont les causes du médulloblastome?</h2><p>Les causes du médulloblastome ne sont pas connues. De plus en plus de données probantes indiquent que le médulloblastome est le résultat d’une erreur survenue au début du développement des cellules cérébrales.</p><p>Il n’y a aucun moyen de prédire qu’un enfant aura un médulloblastome, et personne n’est à blâmer si un enfant développe une tumeur.</p><p>Les chercheurs ont étudié si des facteurs environnementaux, tels que les rayonnements, les aliments ou les produits chimiques, peuvent causer le cancer du cerveau. À l’heure actuelle, il n’y a pas de preuve concluante qu’il y a un lien.</p><p>Certaines affections médicales sont liées au médulloblastome. Si un enfant est atteint du syndrome de Turcot ou du syndrome de Gorlin, le risque de développer un médulloblastome est légèrement plus élevé.L’équipe de soins primaire de votre enfant évaluera la nécessité d’effectuer un test génétique. Elle peut recommander un test génétique en fonction des évaluations initiales et d’autres tests, mais cela n’est pas forcément nécessaire pour tous les enfants.</p><h3>Biologie du médulloblastome</h3><p>Le médulloblastome est aujourd’hui divisé en quatre sous-types appelés sous-groupes moléculaires, basés sur leurs signatures génétiques. Ces groupes diffèrent en termes d’âge d’arrivée et de comportement. Les chercheurs sont encore en train d’étudier les différences entre ces groupes, car il y a encore des variables inconnues, comme la manière dont ces sous-groupes peuvent être traités différemment. L’analyse des sous-groupes moléculaires est effectuée sur la tumeur une fois qu’elle a été enlevée, et l’obtention des résultats peut prendre un certain temps. Votre équipe de soins primaire vous fournira les résultats et vous expliquera ce qu’ils signifient. </p><h2>Combien d’autres enfants ont des médulloblastomes?</h2><p>Les médulloblastomes représentent environ 20 % des tumeurs cérébrales chez les enfants.</p><p>Au Canada, environ 40 à 50 enfants reçoivent un diagnostic de médulloblastome chaque année.</p><h2>Comment diagnostique-t-on un médulloblastome?</h2><p>Les médecins et autres professionnels de la santé utiliseront des tests diagnostiques bien établis pour déterminer si une tumeur cérébrale est à l’origine des symptômes de votre enfant. Ces tests comprennent un examen physique et une scintigraphie cérébrale, comme une <a href="/article?contentid=1270&language=french">imagerie par résonance magnétique (IRM)</a> ou une <a href="/article?contentid=1272&language=english">tomodensitométrie</a>, qui permettront de détecter la présence d’une tumeur. Un échantillon de tissu sera prélevé au moment de l’intervention chirurgicale pour confirmer le diagnostic. Ce petit morceau de tumeur sera retiré et envoyé à un médecin appelé pathologiste. Il examinera la tumeur au microscope pour déterminer le type exact de tumeur.</p> <figure class="asset-c-100"> <span class="asset-anim-title">IRM - Médulloblastome</span> <div class="asset-animation asset-cv-animation"> <iframe src="https://www.aboutkidshealth.ca/Style%20Library/akh/animation/FR-Medulloblastoma-vert%20-%20Storyline%20output/story.html"></iframe>  </div> </figure> <p>Les médecins peuvent demander l’autorisation d’étudier plus avant les échantillons de cellules tumorales pour en savoir plus sur leur biologie. À l’heure actuelle, les résultats de ces tests n’influencent pas le traitement.</p><h3>Qu’est-ce que la stadification?</h3> <figure> <span class="asset-image-title">Cellules tumorales métastasées</span> <img src="https://assets.aboutkidshealth.ca/AKHAssets/Spine_metastasis_MEDIMG_PHO_FR.jpg" alt="Un balayage montrant la vertèbre et la moelle épinière avec des métastases" /> <figcaption class="asset-image-caption">Les cellules cancéreuses d'une tumeur au cerveau peuvent parfois essaimer dans d'autres parties du corps comme la moelle épinière. On appelle cela des métastases.</figcaption></figure> <p>La stadification permet de déterminer si la tumeur s’est métastasée (étendue) à la colonne vertébrale ou au liquide céphalorachidien (LCR). Pour déterminer le stade de la tumeur, les outils de diagnostic suivants sont utilisés : Tomodensitométrie, IRM du cerveau et de la colonne vertébrale, et <a href="/article?contentid=3380&language=french">ponction lombaire</a>.</p><p>La stadification détermine le type de traitement le plus approprié, qui dépend de l’âge de l’enfant et des facteurs liés à la tumeur. Le médulloblastome est actuellement stadifié, ou divisé en deux groupes, appelés « risque moyen » et « risque élevé ».</p><p>Ces stades sont basés sur les résultats recueillis des traitements antérieurs des enfants dans les hôpitaux du monde entier.</p><p>On dit que le médulloblastome est de risque moyen si les deux conditions suivantes sont vraies :</p><ol><li>La totalité ou la majeure partie de la tumeur a été retirée lors de l’intervention chirurgicale.</li><li>Les cellules tumorales ne se sont pas propagées dans d’autres parties du cerveau ou dans le liquide céphalorachidien (LCR). On peut l’observer grâce à une ponction lombaire et à une IRM.</li></ol><p>On dit que le médulloblastome est de risque élevé si l’une des conditions suivantes est vraie :</p><ol><li>Une partie de la tumeur n’a pas été enlevée par chirurgie.</li><li>Les cellules tumorales se sont propagées dans d’autres parties du cerveau ou dans le liquide céphalorachidien (LCR).</li></ol><p>Avant de commencer le traitement, d’autres tests, tels que des analyses sanguines et un test auditif, sont également effectués pour servir de référence pendant le traitement.</p><h2>Comment traite-t-on les médulloblastomes? </h2><p>Une fois que les médecins auront bien compris ce qui cause les symptômes de votre enfant, généralement après l’intervention <a href="/article?contentid=1351&language=french">chirurgicale</a>, vous rencontrerez l’équipe soignante. Rappelez-vous qu’il est utile d’apporter du papier et un stylo pour prendre des notes à chaque réunion avec l’équipe. Vous pouvez également demander à un membre de la famille ou à un ami de vous accompagner et de le faire pour vous.</p><p>L’équipe soignante peut comprendre un neurochirurgien, un neuro-oncologue, une infirmière praticienne, et un travailleur social. Au cours de l’entretien, ils vous indiqueront qui est le médecin chargé du traitement de votre enfant et le rôle de chaque personne présente.</p><p>Le médecin vous expliquera le type de tumeur qu’a votre enfant, selon ce que les tests diagnostiques auront révélé à l’équipe.</p><p>L’équipe vous informera des effets attendus de cette tumeur sur votre enfant dans les mois et les années à venir, selon ce que l’on sait sur la tumeur. C’est ce qu’on appelle le pronostic.</p><p>Il se peut que l’équipe discute de la possibilité d’inscrire votre enfant à un essai clinique ou de le traiter selon la norme de soins, qui est un plan de traitement pour une tumeur particulière. Vous devrez donner votre <a href="/article?contentid=1346&language=french">consentement</a> au plan pour que le traitement puisse commencer. Les patients adolescents peuvent également être invités à donner leur consentement.</p><p>Votre équipe vous parlera également de la mise en place d’une <a href="/article?contentid=52&language=french">ligne IV appelée ligne centrale</a>. Cela permettra aux médecins d’administrer les traitements de manière plus sûre et d’éviter les piqûres multiples pour les analyses sanguines. Vous obtiendrez des renseignements détaillés sur l’insertion de la ligne lors de la rencontre.</p><p>Il existe trois options principales de traitement du médulloblastome chez l’enfant : la <a href="/article?contentid=1351&language=french">chirurgie</a>, la <a href="/article?contentid=1353&language=french">radiothérapie</a> et la <a href="/Article?contentid=1357&language=french">chimiothérapie</a>. Dans le cas du médulloblastome, les trois options sont nécessaires à des moments différents pour obtenir les meilleurs résultats.</p><h3>Opération chirurgicale</h3><p>Lorsqu’une tumeur est détectée par une scintigraphie cérébrale, les chirurgiens évaluent votre enfant en vue d’une opération chirurgicale. Les chirurgiens décideront du moment et de l’approche de l’opération <a href="/article?contentid=1351&language=french">chirurgicale</a>. Dans certains cas, les chirurgiens devront soulager la pression dans le cerveau causée par l’hydrocéphalie avant de procéder à l’ablation de la tumeur. Pour ce faire, une dérivation est mise en place afin de soulager la pression.</p><p>Pour réduire certains des symptômes de la tumeur et du gonflement du cerveau, votre enfant prendra probablement des <a href="/article?contentid=1354&language=french">stéroïdes</a> (un médicament anti-inflammatoire) pour aider à réduire le gonflement et à minimiser les symptômes. Cela se fait généralement après les scintigrammes et à peu près au moment de l’opération. Lorsque votre enfant se sentira mieux, les chirurgiens pourront lui faire cesser les stéroïdes.</p><h3>Radiothérapie</h3><p>La <a href="/article?contentid=1353&language=french">radiothérapie</a> consiste en l’utilisation de rayons X à haute énergie qui tuent les cellules tumorales. Vous rencontrerez l’oncologue radiothérapeute lors d’une consultation pour discuter de la manière dont la radiothérapie est administrée, des effets secondaires et du nombre de séances de traitement nécessaires. Cela a lieu après que votre enfant ait eu le temps de se remettre de l’opération chirurgicale. Chez les très jeunes enfants, la radiothérapie peut être évitée en raison des effets secondaires neurologiques graves observés lorsqu’elle est administrée au cerveau en développement. Votre médecin vous expliquera les différentes thérapies disponibles pour éviter ou retarder l’utilisation de la radiothérapie.</p><h3>Chimiothérapie</h3><p>La <a href="/Article?contentid=1357&language=french">chimiothérapie</a> est un type de médicament qui tue les cellules qui se divisent rapidement. Cela inclut les cellules tumorales. La chimiothérapie peut être administrée par perfusion intraveineuse (IV) ou par voie orale, selon le type de chimiothérapie nécessaire. Le neuro-oncologue et les pharmaciens de votre enfant vous expliqueront comment et quand la chimiothérapie est administrée. Pour les enfants atteints de médulloblastome, il est administré après la radiothérapie.</p><h3>Essais cliniques</h3><p>De nombreux médecins tentent de rendre les traitements contre le cancer plus efficaces. Ils peuvent le faire en étudiant différents types de traitement, dans le cadre d’essais cliniques. Il se peut que le pédiatre vous demande si vous souhaitez que votre enfant participe à un essai clinique. Vous devrez signer un formulaire de consentement éclairé pour que votre enfant puisse participer à un essai. L’équipe de soins de santé expliquera les différences entre un essai clinique et le traitement standard.</p><p>L’équipe de soins de santé de votre enfant peut recommander des tests moléculaires pour déterminer si votre enfant est admissible à un essai clinique. Dans certains cas, les résultats des tests moléculaires peuvent également permettre à l’équipe de soins de santé de faire appel à des médicaments plus récents pour le traitement de votre enfant.</p><h3>Autres soutiens</h3><p>Lors de votre rencontre, l’équipe soignante peut également vous informer des ressources disponibles pour assurer le soutien de votre enfant, le vôtre et celui de vos autres enfants au cours du traitement et du rétablissement. Elle vous invitera à réfléchir aux questions que vous pourriez avoir sur le diagnostic et le plan de traitement.</p><p>Avant d’accepter le traitement offert, il est important que vous compreniez à quoi vous attendre et que vous soyez à l’aise avec votre décision.</p>

 

 

 

 

Medulloblastomas1314.00000000000MedulloblastomasMedulloblastomasMEnglishNeurology;OncologyChild (0-12 years);Teen (13-18 years)BrainNervous systemConditions and diseasesAdult (19+)NA2021-12-21T05:00:00Z9.9000000000000051.70000000000002100.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Medulloblastoma is the most common form of brain cancer among children. Learn more about medulloblastoma symptoms, causes, diagnosis and treatment.</p><h2>What is a medulloblastoma?</h2><p>Medulloblastoma is the most common type of brain cancer in children. It belongs to a group of tumours called embryonal brain tumors. These tumors originate from immature brain cells. </p><p>Medulloblastoma arises from the <a href="/article?contentid=1307&language=english">cerebellum</a>, which is located at the back of the brain. This part of the brain coordinates movement, balance, and posture and participates in some of the functions of the other parts of the brain in ways that are not fully understood. It is usually diagnosed in children four to eight years of age and is more common in boys. </p><p>Recently, scientists have been able to better understand the biology of medulloblastoma. They found that a medulloblastoma belongs to one of four subtypes called molecular subgroups, based on their genetic signatures. This helps doctors understand the different behaviours of a medulloblastoma, age of presentation and outcomes seen in children with medulloblastoma. </p><h2>Key points</h2><ul><li>Medulloblastoma is the most common type of brain cancer in children. </li><li>Medulloblastoma arises in the cerebellum, located at the back of the brain.</li><li>Symptoms include headaches, vomiting, unsteadiness, double or blurry vision, and sleep difficulties.</li><li>The cause of medulloblastoma is not known. </li><li>A child suspected to have medulloblastoma will need a staging work up. </li><li>Curative therapy for medulloblastoma includes surgery, radiation therapy, and chemotherapy. </li><li>The treatment team may include a neurosurgeon, a neuro-oncologist, radiation oncologist, a nurse practitioner or nurse, and a social worker. </li><li>Before you agree to the treatment offered, it is important that you understand what to expect and feel comfortable with your decision. </li></ul><h2>What are the symptoms of medulloblastoma? </h2><p>Symptoms of medulloblastoma include: </p><ul><li>headaches</li><li>vomiting</li><li>unsteadiness (loss of balance)</li><li>double or blurry vision</li><li>neck pain or stiffness</li><li>sleep difficulties </li></ul><p>Children with this tumour may also have <a href="/article?contentid=1408&language=english">problems in school</a> because tasks such as writing become more difficult. There may also be changes in their personality or <a href="/article?contentid=1341&language=english">behaviour</a>. </p><p>Sometimes medulloblastomas block the flow of cerebrospinal fluid (CSF) through the pathways, or hollow channels, that drain CSF from the ventricles in the brain. This can lead to a condition called <a href="/article?contentid=858&language=english">hydrocephalus</a>.</p><p>Symptoms may not be obvious early on and may take time to become clearer. If the symptoms are dramatic, the diagnosis may happen quickly. If they are milder, it can take months. This is why some children are seen by a health-care provider after a few weeks of symptoms, while others with more mild symptoms can take a few months before they are seen. The diagnosis of any brain tumour can be a long and difficult process. However, your primary care team will be available to help guide you through every step. </p><h2>What causes medulloblastoma?</h2><p>It is not known what causes medulloblastoma. There is growing evidence that medulloblastoma is the result of a mistake that occurred in the early development of the brain’s cells. These cells will then grow uncontrollably to form what is called a tumor. </p><p>There is no way to predict that a child will develop a medulloblastoma and nobody is to blame if a child develops a tumour. </p><p>Researchers have been studying whether environmental factors, such as radiation, food, or chemicals, can cause brain cancer. At the moment, there is no definite proof that there is a connection.</p><p>Certain medical conditions are connected to medulloblastoma. If a child has Turcot syndrome or Gorlin syndrome, there is a slightly greater chance of developing a medulloblastoma. Your child’s primary care team will assess the need to do genetic testing. They may recommend a genetic test depending on the initial assessments and other tests, but this may not be needed for every child. </p><h3>Medulloblastoma biology </h3><p>Medulloblastoma is now divided into four subtypes called molecular subgroups, based on their genetic signatures. These groups differ in terms of their age of presentation, and behaviour. Researchers are still learning about the differences between these groups as there are still some unknowns, such as how these subgroups can be treated differently. The molecular subgroup testing is done on the tumor once it is removed, and results may take some time. Your primary care team will provide you with the results and explain what they mean. </p><h2>How many children have medulloblastoma?</h2><p>Medulloblastoma accounts for about 20% of all brain cancers in children. </p><p>In Canada, about 40 to 50 children are diagnosed with a medulloblastoma each year.</p><h2>How is a medulloblastoma diagnosed?</h2><p>Doctors and other health-care professionals will use well-established diagnostic tests to see if a brain tumour is causing your child’s symptoms. These tests will include a physical examination and brain scans such as <a href="/article?contentid=1270&language=english">magnetic resonance imaging (MRI)</a> or <a href="/article?contentid=1272&language=english">computerized tomography (CT)</a>, which will identify the presence of a tumour. If medulloblastoma is suspected, you will meet with the neurosurgeons to discuss a plan for <a href="/article?contentid=1351&language=english">surgery</a>. </p> <figure class="asset-c-100"> <span class="asset-anim-title">Medulloblastoma MRI</span> <div class="asset-animation asset-cv-animation"> <iframe src="https://www.aboutkidshealth.ca/Style%20Library/akh/animation/Medulloblastoma-vert%20-%20Storyline%20output/story.html"></iframe>  </div> </figure> <p>A biopsy will be done at the time of surgery to confirm the diagnosis. During a biopsy, a sample of tissue from the tumour will be removed. This small piece of tumour will be sent to a doctor called a pathologist. They will look at the tumour under a microscope to learn the exact type of tumour. </p><p>The doctors may ask permission to study the sample tumour cells further to learn more about their biology. At the moment, the results of these tests do not influence treatment.</p><h3>What is staging?</h3> <figure> <span class="asset-image-title">Metastasized tumour cells</span><img src="https://assets.aboutkidshealth.ca/AKHAssets/Spine_metastasis_MEDIMG_PHO_EN.jpg" alt="A scan showing the vertebra and spinal cord with metastases" /><figcaption class="asset-image-caption">Cancer cells from a brain tumor can sometimes spread to other parts of the body, such as the spinal cord. This is called metastasis.</figcaption></figure> <p>Staging determines if the tumor has metastasized (spread) to the spine or the CSF. To stage the tumour, the following diagnostic tools are used: CT scans, MRI of the brain and spine, and <a href="/article?contentid=3380&language=english">lumbar puncture</a>. </p><p>To choose the type of treatment that is most appropriate, all the available information including the child’s age, staging and the biological characteristics of the tumor are used to match the best treatments to each tumor. Medulloblastomas are stratified into two groups, called "average risk" or "high risk", the group stratification determines the "intensity of the treatment" they will receive.</p><p>A medulloblastoma is called average risk if all of the following are true:</p><ol><li>All or most of the tumour was removed during surgery.</li><li>The tumour cells have not spread to other parts of the brain or into the cerebrospinal fluid (CSF). This is seen from a lumbar puncture and MRI scan.</li></ol><p>A medulloblastoma is called high risk if any of the following are true:</p><ol><li>Some of the tumour was not removed by surgery.</li><li>The tumour cells have spread to other parts of the brain or into the CSF.</li></ol><p>Before starting treatment, other tests such as blood tests and a hearing test are also done as a baseline to compare to during treatment.</p><h2>How is medulloblastoma treated?</h2><p>Once the health-care team has a clear understanding of what is causing your child’s symptoms — usually after <a href="/article?contentid=1351&language=english">surgery</a> — a meeting with the team will be set up to talk about results and the treatment plan. Remember that it is helpful to bring paper and a pen or laptop to take notes at each meeting with this team. It is important to have the child’s primary caregivers in this meeting, for example both parents. </p><p>The treatment team may include a neurosurgeon, a neuro-oncologist, radiation oncologist, a nurse practitioner or nurse, and a social worker. During the meeting, they will explain which doctor is responsible for your child’s treatment, and the roles of everyone who is there. Other team members may be involved such as a dietician, pharmacists, occupational therapist, and physiotherapist, depending on your child’s needs. Every team member has their role in your child’s care, and everyone works together to make your child feel better. </p><p>The doctor will explain the type of tumour that your child has, based on what the team has learned through diagnostic testing. You will learn the expected effect this tumour will have on your child in the upcoming months and years, based on what is known about the tumour. This is called the prognosis. </p><p>The team may talk about placing your child on a protocol, which is a treatment plan for medulloblastoma. You will need to <a href="/article?contentid=1346&language=english">consent</a> (agree) to the plan for the treatment to begin. Teenaged patients may be asked for their consent as well. </p><p>Your team will also talk to you about placing an IV line called a <a href="/article?contentid=52&language=english">central line</a>, this will help doctors give the treatments in a safer way and avoid multiple pokes for blood tests. You will get more information about the line insertion in details during the meeting. </p><p>There are three main modalities of treatment for medulloblastoma in children: <a href="/article?contentid=1351&language=english">surgery</a>, <a href="/article?contentid=1353&language=english">radiation</a>, and <a href="/Article?contentid=1357&language=english">chemotherapy</a>. For medulloblastoma, all three modalities are needed at different timelines to have the best results. </p><h3>Surgery </h3><p>Once a tumor is seen on the brain scans, the surgeons will assess your child for <a href="/article?contentid=1351&language=english">surgery</a>. The surgeons will decide on the timing and approach for surgery. In some situations, the surgeons will need to relieve the pressure in the brain caused by hydrocephalus before the tumor removal surgery. This is done by placing a shunt to relieve the pressure. </p><p>To reduce some of the symptoms of the tumour and the swelling in the brain, your child will likely take <a href="/article?contentid=1354&language=english">steroids</a> (an anti-inflammatory medication) to help reduce the swelling and improve the symptoms. This is usually done after the scans and around the time of surgery. Once your child is feeling better, the surgeons may stop the steroids.</p><h3>Radiation therapy </h3><p><a href="/article?contentid=1353&language=english">Radiation therapy</a> is high energy X-rays that kill tumor cells. You will meet with the radiation oncologist for a consultation to talk about how radiation therapy is given, side effects and how many treatment sessions are needed. This takes place after your child has had time to recover from surgery. In very young children, radiation therapy may be avoided due to the severe neurological side effects observed when given to the young developing brain. Your doctor will explain different therapies available to avoid or delay the use of radiation.</p><h3>Chemotherapy </h3><p><a href="/Article?contentid=1357&language=english">Chemotherapy</a> is a type of medication that will kill cells that are dividing fast. This includes the tumor cells. Chemotherapy can be given by intravenous (IV) line or by mouth depending on what type of chemotherapy is needed. Your child’s neuro-oncologist and pharmacists will explain to you how and when chemotherapy is given. For children with medulloblastoma it is given after radiation therapy. </p><h3>Clinical trials</h3><p>Many doctors are trying to make cancer treatments more successful. They can do this by studying different types of treatment, in clinical trials. Your child’s doctor may ask if you would like your child to participate in a clinical trial. You will have to sign an informed consent form for your child to participate in a trial. The health-care team will explain the differences between being on a clinical trial and getting the standard treatment. </p><h3>Additional supports</h3><p>When you meet with the treatment team, you may also be told about resources available to support your child, you and your other children during treatment and recovery. You will be encouraged to think about any questions concerning the diagnosis and the treatment plan.</p><p>Before you agree to the treatment offered, it is important that you understand what to expect and feel comfortable with your decision. <br></p><h2>What is the outcome for a child with a medulloblastoma?</h2><p>The survival rate of children with medulloblastoma has improved significantly over the past 50 years. This was achieved using multimodal therapy, meaning the use of surgery and radiation followed by chemotherapy. </p><p>However, the outcome for a child with a medulloblastoma depends on many factors, including: </p><ul><li>the child’s age<br></li><li>the biology of the tumor</li><li>whether it has spread and by how much</li><li>the type of treatment the child received </li></ul><p>For medulloblastomas, the outcome is better if the child is in the "average risk" category. In general, the tumour is more likely to come back (recurrence) if the child is in the "high risk" category. </p><p>The risk of recurrence is higher during the first two years after diagnosis. However, recurrences can also happen later in life. This has been learnt over many years and after treating many children with medulloblastoma across the world. </p><p>Five years after treatment, 60% to 80% of children with medulloblastoma will survive. For children under the age of three, 20% to 50% will survive after five years. </p><p>There is increasing evidence to show that the biology of the tumour is essential to outcome. Doctors are trying to find out how to improve treatment for the different medulloblastoma subgroups while also reducing the late effects that can happen due to treatment. </p><p>It is important to keep in mind that every child is different. Speak to your child’s primary-care team if you have any questions about outcomes for your child. </p>MedulloblastomasFalse

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