Medulloblastoma: Symptoms and Treatment
Medulloblastoma is a cancerous tumor consisting of medulloblast, which in most cases is localized in the cerebellum, but its formation in other areas of the brain is not excluded. The mechanisms and causes of such a pathology are still unclear, but clinicians identify several predisposing factors, including childhood and male gender.
The clinical picture of the disease will differ depending on the area of tumor formation and the degree of severity of cerebral syndrome. Diagnosis is based on physical examination and laboratory-instrumental examinations of the patient. The treatment is based on surgical excision of the neoplasm and chemotherapy.
To date, the pathogenesis and the main causes of the development of such a disease remain unknown. Clinicians have information only about the predisposing factors of the formation of medulloblastoma in children and adults. To them it is necessary to carry:
- the child’s age is from five to ten years. In people of older age, the disease is diagnosed from twenty to forty years old
- male sex — doctors found that this pathology is most often detected in men and boys than in women and girls
- long-term effects on the body of ionizing radiation
- exposure to carcinogens contained in food, household chemicals, and also in varnishes and paints
- the course of some viral infections that can damage the genome of cells, such as cytomegalovirus, infectious mononucleosis and HPV;
- genetic predisposition
- the presence of certain syndromes, in particular Rubinstein-Teibi, Tyurko, Gorlin, and blue nevus syndrome.
The main difference of such a malignant neoplasm from others is that it very quickly leads to the formation of metastases that affect the cerebrospinal fluidways, against which the process of circulation of cerebrospinal fluid is disrupted. This entails an increased likelihood of developing complications that affect the survival rate.
Depending on the location of the malignant tumor is divided into:
- Medulloblastoma cerebellum — is the most common area of tumor formation and is diagnosed in 80% of patients
- medulloblast hemisphere of the brain — can be detected in a child over the age of six.
According to the histological structure, there are the following varieties of cancers:
- classical undifferentiated medulloblastoma;
- Medulloblastoma, consisting of fibers of muscle tissue
- formation with glial or neuronal differentiation
- melanotic tumor — includes neuroepithelial cells, which in turn are composed of melanin;
- desmoplastic medulloblastoma;
- lipomatous formation — is one if it contains fat cells. This kind of neoplasm has the most favorable prognosis.
The classification based on the fact that tumor volumes are taken into account, the presence or absence of metastases, as well as the level of infiltration, helps to determine the survival rate for each patient with a similar diagnosis.
Medulloblastoma of the brain has a large number of clinical manifestations, which will differ depending on the focus of education.
If the tumor is localized in the cerebellum, which happens most often, then the person will develop cerebellar ataxia, which has the following clinical signs:
- «cerebellar gait» is a condition in which the patient tries not to lose balance, why he walks with widely spaced lower extremities and balances his hands
- the unsteadiness of a gait — the person «throws» from side to side
- susceptibility to frequent injuries — this is due to the fact that the patient often falls, especially when cornering
- impaired swallowing
- a breathing disorder — such a symptom indicates that the tumor has spread to the brain stem;
- spontaneous involuntary movements with eyes, whose frequency can reach several hundred per minute;
- paralysis and a decrease in the sensitivity of the limbs — suggests that the spinal cord is involved in the pathological process.
Medulloblastoma of one of the cerebral hemispheres is expressed in such manifestations:
- psychomotor agitation
- excessive irritability
- violation of orientation in space and time
- convulsive seizures
- a person does not recognize himself;
- nausea, which often results in vomiting,
- intense headaches that appear in the morning.
The appearance of metastases significantly worsens a person’s condition. This is due to one of the features that distinguishes medulloblastoma from other neoplasms in the brain.
It is a question that often primary neoplasms do not give metastasis beyond the central nervous system, however, medulloblastoma is capable of metastasizing into such internal organs:
This occurs in about 5% of all cases of detection of such a neoplasm. Depending on which area is affected by metastases, there will be an additional symptomatology. For example, the involvement of the liver in the liver is indicated by jaundice and pain in the area under the right ribs, if the lungs are affected, then the pain syndrome will be noted in the sternum.
It should be noted that the severity of the course of the disease also depends on the age of the patient — the younger the child, the higher the malignancy of the tumor. This is due to the fact that the brain stem is much more involved in the pathological process than in adults.
The diagnosis is made by the neurologist on the basis of the revealed signs of the clinical picture and the data of laboratory and instrumental studies.
However, it is worth noting that the diagnosis of such an ailment in a child is much more difficult. This is due to such factors:
- features of the structure of the skull of children
- increased volumes of the intracranial box
- plasticity of the brain;
- the elasticity of regional blood vessels
Despite this, the first stage of diagnostic activities should include:
- the doctor’s study of the medical history and anamnesis of the patient’s life — quite often such a measure indicates the most characteristic etiologic factor
- A thorough physical examination of the patient — to search for characteristics that may indicate tumor localization
- a detailed survey of the patient or his relatives — to determine the first time of the onset of symptoms and the intensity of their severity. This will enable the clinician to understand the degree of severity of the disease.
Among the laboratory studies it is worth highlighting:
- clinical analysis and blood biochemistry
- general urine analysis
- detection of oncological markers in the blood.
The most informative, especially in children, methods of diagnosis are:
- Neurosonography — the procedure is applied to infants with unclosed fontanelles
- CT and MRI — to identify the exact location and volume of the tumor, and to assess the degree of infiltration
- PET — this survey provides information on the number of metastases and allows you to detect even the smallest structural changes in the brain
- biopsy — to establish the course of the pathological process and to make the final diagnosis.
In addition, consultation and examination of the ophthalmologist and neurosurgeon will be required.
At the heart of the disease is:
- surgical excision of malignant formation — if the patient’s condition is satisfactory, then surgeons perform complete excision of the tumor
- chemotherapy — appointed after therapy by medical intervention or radiotherapy
- radiotherapy — after the operation, low doses of radiation are necessary, but with incomplete excision of the tumor, and also in the presence of metastases, high doses are indicated. Such treatment tactics are prohibited for patients under the age of three
- Radiation therapy — is necessary to reduce the size of the tumor, which will facilitate the operation.
The newest method of elimination of malignant education was offered by American scientists. Innovation is to use the measles virus in complex treatment, which is previously subjected to genetic modifications. Experiments on laboratory small rodents confirm that such a vaccine can kill pathological cells of medulloblastoma in only four days.
In the postoperative period, patients need to maintain a gentle diet, the basic rules of which include:
- frequent but fractional food intake
- refusal of compulsory feeding
- enriching the menu with citrus fruit
- Pay attention to the patient’s taste preferences, which may change after treatment.
In addition, there are folk recipes that help to normalize the patient’s condition after surgery. The most effective ones are:
- aloe juice
- decoction based on dried apricots
- walnuts and lemon
- figs and honey
- Nettles and white mistletoe
- sorrel and dill
- Tansy and celandine
Another integral part of complex therapy is the rehabilitation of the patient, which is developed individually for each patient.
The most common complication of medulloblastoma is hydrocephalus — a condition characterized by fluid accumulation in the brain (dropsy).
The formation of this effect occurs against the backdrop of the growing tumor complicating and eventually blocking the outflow of liquor.
Clinical manifestations of hydrocephalus are:
- persistent severe headaches;
- Regular head tilting
- nystagmus (pendulum movements of the eyes with high frequency)
- the shifting of the eyeballs
- Increased skull volume — this is the most common symptom in children
Prevention and Forecast
Against the background of the fact that the mechanism and causes of the formation of medulloblastoma remain unknown to specific preventive measures preventing the development of such a disease does not exist.
Women during pregnancy are encouraged to lead a healthy lifestyle and take vitamins. Adult people are best avoided exposing the body.
It is not possible to determine an unambiguous prediction of the disease. Mortality after the operation is approximately 5%, and five-year survival is observed in 20-30% of all diagnoses of such a disease.
Five-year survival rate in boys is more than 20%, and in girls — 10%.
The most unfavorable prognosis are those patients who faced such a problem as the recurrence of medulloblastoma after surgical excision.