Tumors of the central nervous system. Improvement in outcome through a multimodality approach

Central nervous system tumors in children

OBJECTIVES

To examine how pediatric and adult central nervous system (CNS) tumors differ and to discuss the unique aspects of diagnosis, treatment, and long-term effects of brain tumors in children.

DATA SOURCES

Research, review articles, book chapters, and abstracts.

CONCLUSIONS

A child's growing and developing body and brain place him or her at great risk for permanent damage as a result of traditional treatment methods. A family-centered nursing approach assists the child and family in coping with the impact of a brain tumor.

IMPLICATIONS FOR NURSING PRACTICE

Children have unique needs during and following treatment for CNS tumors. All oncology nurses need to be fully informed about and help monitor for intellectual, endocrinologic, and oncogenic late effects from the disease and treatment.

Posterior fossa tumors in children: a case study

Brain tumors are the second most common malignancy to occur during childhood and the posterior fossa is the most common region of the brain affected. Diagnosis and treatment are complex and challenging. Once a child suffering from a posterior fossa tumor is identified, a multidisciplinary team must be assembled to provide comprehensive care through all phases of treatment. The nursing staff is vital to this team because they are often the individuals who coordinate services involved in the care of the child with a posterior fossa tumor. This case study illustrates the phases of diagnosis and treatment of a child with a medulloblastoma and highlights critical care nursing challenges. Following the case study presentation, a summary describes posterior fossa tumors including epidemiology, pathophysiology, clinical manifestations, and outcome. The case study is integrated throughout this review to highlight key issues for critical care nurses to explore.

Chromosome 17 abnormalities and lack of TP53 mutations in paediatric central nervous system tumours

Central nervous system (CNS) tumours are the most common solid tumours in children. Cytogenetic and molecular genetic studies of these neoplasms have previously shown abnormalities of chromosome 17, implicating genes on this autosome in tumorigenesis. To identify mutations in the TP53 tumour suppressor gene (17p13.1), we have sequenced the five highly conserved regions of this gene in 29 mixed paediatric CNS tumors. No mutations were detected by this analysis. In order to identify other candidate disease loci on chromosome 17, we have carried out a detailed deletion mapping analysis using 16 polymorphic DNA markers on 19 of the above tumours and an additional four cases. Abnormalities of chromosome 17 occurred in nine cases (39%), six of which were primitive neuroectodermal tumour (PNET)-medulloblastomas. These findings suggest that it is unlikely that the TP53 gene is directly involved in the development of common paediatric brain tumours. This is in contrast to findings from adult brain and other tumour types. Moreover, the frequency of chromosome 17 aberrations, especially in PNET-medulloblastomas, suggests that other genes on this chromosome contribute to tumourigenesis.