Medulloblastoma

Diagnosis

The diagnosis for medulloblastoma often involves discussing the symptoms experienced by the patient, evaluating the medical history, and conducting different tests and investigations, such as:

• Neurological exam: A neurological exam is an assessment tool to identify sign of disorder affecting the brain, spinal cord, and nerve. The neurological exam has many aspect of testing including coordination, balance, vision, muscle strength, and sensation.
• Imaging tests: Computerized tomography (CT) scan or magnetic resonance imaging (MRI) are commonly used to diagnose brain tumors. In some cases, perfusion MRI and magnetic resonance spectroscopy may be used. Through high-grade X-rays and radio waves, a detailed image which can aid in determining the location and size of a brain tumor is produced. These tests are also critical for detecting pressure or obstruction in the CSF pathways.
• Biopsy: The doctor may collect a tissue sample and send it to a pathology lab for testing and analysis. A biopsy is usually not performed, but it may be advised if the imaging tests are not typical pointed for medulloblastoma or failed to confirm the condition.
• Spinal tap (lumbar puncture): This test is usually performed after the pressure in the brain has been relieved or the tumor has been removed. It involves placing a needle between two bones in the lower spine to extract cerebrospinal fluid from surrounding the spinal cord. The fluid is examined for cancer cells or other abnormalities.

Treatment

The treatment plan for medulloblastoma requires careful consideration of many factors such as tumor grade and type, cancer characteristics, the patient’s age, and health at the time of diagnosis, and potential response to treatment. Several treatment options include:

• Surgical removal of medulloblastoma: Surgery is usually the first line of treatment for medulloblastoma. During the surgery, it is important not to damage nearby tissue while the tumor is being removed. However, because medulloblastoma grows near key structures deep within the brain, it is not always possible to completely remove the tumor. The surgery may be followed by chemotherapy, radiation therapy or both.
• Surgery to relieve fluid buildup in the brain: This surgery can be done with the removal of medulloblastoma. The goal is to create a passageway for the fluid to exit the brain, typically an external ventricular drain or ventriculoperitoneal shunt, may be advised. This occurs because when a medulloblastoma grows enough to impede the flow of cerebrospinal fluid, causing an accumulation of fluid that exerts pressure on the brain.
• Radiation therapy: Surgery is usually followed by radiation to the brain and spine because the disease can spread in these areas. This treatment uses high-powered X-rays to destroy cancer cells. In some cases, a proton beam radiation therapy is recommended as it focuses on killing cancer cells while preserving healthy tissues. It minimizes the possible complication with bone marrow and nearby organs during a standard brain and spine radiation.
• Chemotherapy: Chemotherapy may be part of the post-surgery treatment plan alongside or after radiation depending on the amount of tumor left. Following chemotherapy, a stem cell transplant may be done. The drugs used in this treatment are either ingested in pill form or injected into a vein (intravenous chemotherapy) to destroy cancer cells and prevent tumor growth.
• Clinical trials: These trials allow an opportunity to explore the latest medical methods such as new chemotherapy, targeted therapy, or immunotherapy medications that may treat medulloblastoma. The patient’s medical team decides on possible treatments based on the patient’s age, remaining tumor after surgery, tumor type, tumor location and danger of unknown side effects.