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What is Medulloblastoma?
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Causes and Risk Factors of Medulloblastoma
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Symptoms of Medulloblastoma
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Diagnostic Methods for Medulloblastoma
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Medulloblastoma Classification and Subtypes
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Medulloblastoma Treatment in Children
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Frequently Asked Questions
Medulloblastoma is one of the most common malignant brain tumors in childhood, often affecting the cerebellar region of the brain. Tumors in this area can impact a child’s balance, coordination, and cognitive abilities. Some grow rapidly and show early signs, while others progress silently and are diagnosed in advanced stages. Early detection and a multidisciplinary treatment approach are key to improving both survival rates and long-term quality of life.
What is Medulloblastoma?
Medulloblastoma is an aggressive brain tumor that originates near the cerebellum, the part of the brain responsible for balance and coordination. It is most commonly diagnosed in children between the ages of 5 and 9, with a higher incidence in boys. Classified as a malignant pediatric brain tumor, medulloblastoma has a high rate of cell division and may spread (metastasize) to other parts of the central nervous system, including the spinal cord.
Due to its aggressive nature, medulloblastoma requires urgent diagnosis and a coordinated, multidisciplinary treatment plan. It is considered a central focus within pediatric neuro-oncology due to its prevalence and potential impact on development.
Causes and Risk Factors of Medulloblastoma
While the exact cause of medulloblastoma is still not fully understood, research suggests that both genetic mutations and environmental factors may contribute to its development.
Key medulloblastoma risk factors include:
- Genetic syndromes such as Gorlin syndrome or Turcot syndrome, which have been associated with an increased risk of developing brain tumors.
- Family history: Although most cases are sporadic (non-hereditary), children with a family history of brain tumors may have a slightly elevated risk.
- Exposure to radiation is another environmental factor that may increase the likelihood of tumor formation.
- The tumor affects both boys and girls, but it is observed more frequently in male children.
- Medulloblastoma accounts for over 20% of pediatric brain tumors, making it the most common malignant brain tumor in children.
Symptoms of Medulloblastoma
Medulloblastoma symptoms often result from increased intracranial pressure and compression of the cerebellum and surrounding brain structures. Symptom presentation may vary depending on the child’s age and tumor size, but common signs include:
Early Warning Signs
- Severe headaches, especially in the morning, are a common early symptom.
- Nausea and vomiting, often linked to increased intracranial pressure.
- Behavioral changes such as irritability, lack of motivation, or difficulty focusing at school may be subtle but significant early indicators.
Advanced Symptoms of Medulloblastoma
As medulloblastoma progresses, it can cause more noticeable and serious neurological impairments. These symptoms result from the tumor’s pressure on the cerebellum and nearby brain structures.
Common Advanced Symptoms Include:
- Balance problems and unsteady walking, caused by the tumor compressing the cerebellum.
- Double vision, loss of visual field, or involuntary eye movements (nystagmus).
- Speech difficulties, often due to disruption of cerebellar pathways.
Symptoms in Infants and Young Children
- Medulloblastoma may present differently in babies and toddlers, who are unable to express symptoms verbally. Watch for signs such as:
- Rapid head growth, bulging fontanelles (soft spots), irritability, and persistent crying.
- Changes in muscle tone—either decreased tone (hypotonia) or increased tone (spasticity)—may accompany developmental delays.
Hydrocephalus and Associated Symptoms
- When the tumor is located near the fourth ventricle, it can block cerebrospinal fluid flow, leading to hydrocephalus (fluid buildup in the brain).
- Common hydrocephalus-related symptoms include:
- Headaches, blurred vision, confusion, and lethargy.
- This condition may require emergency neurosurgical intervention to relieve pressure.
Diagnostic Methods for Medulloblastoma
Accurate diagnosis is critical for initiating the appropriate treatment plan. Medulloblastoma diagnosis involves a combination of clinical assessment and advanced imaging technologies.
Steps in Diagnosing Medulloblastoma:
- A thorough neurological examination is performed first. This includes evaluating eye movements, muscle strength, balance, and reflexes to identify affected brain regions.
- MRI (Magnetic Resonance Imaging) is the gold standard for diagnosing brain tumors. It provides detailed information about the tumor’s location, size, and its relationship to nearby structures.
Biopsy:
- Tissue samples collected during or before surgery are examined under a microscope to confirm the type and behavior of tumor cells.
- In some cases, a lumbar puncture (spinal tap) is done to check if the cancer has spread to the cerebrospinal fluid (CSF).
- Molecular profiling may also be conducted to analyze the tumor’s genetic characteristics and develop a personalized, targeted treatment plan.
Medulloblastoma Classification and Subtypes
Modern medulloblastoma classification relies on genetic and histological features of the tumor. Understanding the specific subtype is essential for predicting prognosis and tailoring therapy.
Molecular Subtypes of Medulloblastoma:
- WNT subtype: Associated with the best prognosis, typically diagnosed in children over age 5.
- SHH (Sonic Hedgehog) subtype: Common in infants and young adults. Some subgroups may show resistance to chemotherapy.
- Group 3: The most aggressive form, with a high likelihood of metastasis.
- Group 4: Frequently affects male children, associated with intermediate prognosis.
These subtypes are crucial for both developing an effective treatment strategy and predicting long-term survival outcomes.
Medulloblastoma Treatment Options
Treating medulloblastoma requires a multidisciplinary approach involving surgery, radiation therapy, and chemotherapy. The primary goal is to completely eliminate the tumor and prevent recurrence while preserving neurological function.
Standard Medulloblastoma Treatment Protocol:
- Once a diagnosis is confirmed, the treatment process is typically coordinated by a neurosurgical team.
- Surgical removal of the tumor is the first step. The aim is to excise as much of the tumor mass as possible. However, complete removal may not be feasible if the tumor is located near vital brain structures.
- Within the first few weeks after surgery, radiotherapy is initiated. The radiation is carefully planned to target both the brain and spinal cord, considering the potential for tumor cell spread.
- Chemotherapy is administered either concurrently with or after radiotherapy. Common medications include vincristine, cisplatin, and cyclophosphamide, which help destroy microscopic cancer cells remaining after surgery.
Medulloblastoma Treatment in Children
Treatment strategies in pediatric cases are customized based on the child’s age and the molecular subtype of the tumor.
- In children under age 3, delaying or minimizing radiation exposure is critical to avoid harming brain development.
- In such young patients, intensified chemotherapy protocols may be used to postpone or eliminate the need for radiotherapy.
- A team of specialists—including pediatric oncologists, pediatric neurosurgeons, neuropsychologists, physiotherapists, and dietitians—works together to ensure both oncological success and proper developmental progress.
- This collaborative approach significantly enhances treatment outcomes and the child's long-term quality of life.
Post-Treatment Follow-Up and Long-Term Care
Recovery after medulloblastoma treatment involves not only monitoring for cancer recurrence but also addressing the child's physical, cognitive, and emotional development.
Key Elements of Post-Treatment Management:
- After treatment, regular MRI scans are scheduled: every 3 months during the first year and every 6 months in the second year to check for recurrence.
- Children’s school performance, social integration, and psychological well-being are closely monitored.
- The first two years post-treatment are critical due to the higher risk of recurrence.
- Late effects such as hearing loss, growth retardation, and hormonal imbalances may occur. As a result, long-term care involves coordination with pediatricians, endocrinologists, and child psychiatrists.
Frequently Asked Questions
Can Medulloblastoma Be Completely Cured?
Yes, in some cases, medulloblastoma can be completely cured, especially when treatment is initiated early and the tumor belongs to a favorable subtype. Children diagnosed with the WNT molecular subtype and who undergo complete surgical resection tend to have excellent survival rates. However, long-term follow-up and monitoring are essential for sustained success.
Is Medulloblastoma a Hereditary Disease?
The majority of medulloblastoma cases are sporadic, meaning they are not inherited. However, certain genetic syndromes, such as Gorlin or Turcot syndrome, may increase the risk. In families with multiple affected members, genetic counseling is recommended. Some mutations associated with medulloblastoma may have a hereditary component.
Is Medulloblastoma Contagious?
No, medulloblastoma is not contagious. It is not caused by a virus or bacterium and cannot be transmitted from person to person.
Can Children Return to Normal Life After Treatment?
Many children are able to return to school and participate in normal social activities after treatment. However, some may require supportive programs to aid with attention, learning, and physical coordination. The involvement of pediatric oncology and rehabilitation teams is crucial during this phase.
What Should Families Focus On After a Medulloblastoma Diagnosis?
Families should carefully follow the medical team's guidance, attend all follow-up appointments, and pay close attention to the child's emotional and psychological well-being. Staying informed and maintaining open communication with healthcare providers can greatly improve treatment outcomes.
What Are the Side Effects of Medulloblastoma Treatment?
Treatment—especially radiotherapy and chemotherapy—can cause various short-term or long-term side effects, including:
- Hair loss
- Nausea
- Hearing loss
- Delayed growth and development
- Hormonal imbalances
Most of these side effects can be managed with supportive care and tend to improve over time.
* Contents of this page is for informational purposes only. Please consult your doctor for diagnosis and treatment. The content of this page does not include information on medicinal health care at Liv Hospital .
