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Pediatric Brain Tumors & Neuro-Oncology Chat Transcript: Tanya M Tekautz MD

Introduction

Cleveland_Clinic_Host: Today's Live Web Chat with Tanya M. Tekautz, MD who will be answering a variety of questions about treatment options for children diagnosed with brain tumors and the challenges faced by the child and family when diagnosed.

Dr. Tekautz is a Pediatric and Young Adult Neuro-Oncologist, board-certified in general pediatrics and pediatric hematology/oncology. Her clinical interests include treatments for pediatric and young adult high-grade brain tumors, atypical teratoid/rhabdoid tumors, low grade-glioma and designing therapeutic clinical trials for relapsed brain tumors in children and young adults.

Dr. Tekautz is a graduate of the University of Minnesota Medical School and completed her extensive training at Baylor College of Medicine Affiliated Hospitals in Houston, TX as well as two Fellowships at Saint Jude Children's Research Hospital, in Memphis, TN for Pediatric Hematology/Oncology and Pediatric Neurology/Oncology.

Cleveland_Clinic_Host: Welcome Dr. Tekautz and thank you for joining us today. Before we get started with questions that people have submitted, let's discuss some basics about pediatric brain tumors.

The prognosis for children with brain tumors is improving. Eighty percent of children and young adults with malignant brain tumors now go into remission, compared to 10 to 20 percent only 20 years ago. Nonetheless, treatment of pediatric brain tumors poses significant challenges to the child and family, and the team at Cleveland Clinic uses a comprehensive treatment approach.

The first question deals with the terminology Neuro-Oncology.


Neuro-Oncology

newtonm: What is Neuro-Oncology?

Speaker_-_Tanya_Tekautz: Neuro-Oncology is the management & treatment of patients with brain and spinal cord tumors. It is important to be evaluated by a Neuro-Oncologist for brain and spinal cord tumors because we are dealing with a disease that not only impacts ones functioning but may affect ones personality and the ability to think/interact with the environment such as friends, colleagues or fellow students. Pediatric Neuro-oncology is the diagnosis and treatment of children with brain or spinal cord tumors with the expertise in types of cancer unique to pediatric patients.


Symptoms

ballyhoo: What symptoms does a child have that may cause one to suspect a brain tumor? Are the symptoms different than adult symptoms?

Speaker_-_Tanya_Tekautz: That is a great question. Unfortunately, the symptoms one sees are often non-specific. Symptoms in younger children vary from those in older children and adults. In a young child (infants) symptoms may include irritability, sleepiness, difficulty feeding and/or lack of normal infant developmental milestones.

The child may also have developmental regression such as no longer being able to sit up, crawl or decreased babbling/speaking. In younger school age children, school difficulties and/or changes in mood or personality can be seen. Children may also complain of headaches in this age group.

One may also see cranial nerve weakness such as abnormal gaze or double vision, occasional difficulty speaking or voice changes and asymmetric (one side) facial movement. Occasionally the initial presenting sign may be a seizure.


Treatment Options

markwilsby: What are some options available for treatment of pediatric brain tumors?

Speaker_-_Tanya_Tekautz: Surgery, chemotherapy and/or radiation. The type of treatment(s) depends on the type of tumor, location of the tumor and the age of the child.

athome: Are treatment options the same or are they different for pediatric brain tumors?

Speaker_-_Tanya_Tekautz: Many of the same general approaches to diagnosis and treatment of pediatric brain tumors are the same as those in adults. Differences exist: radiation affects the developing brain and has been shown to, in addition to other things, be associated with the development of learning disabilities when administered to infants and young children.

In infants and young children we intensify the chemotherapy administered in order to decrease the dose of radiation that is necessary.

worriedmom: Is radiation advisable for a 2-year-old who was diagnosed with Anaplastic ganglioglioma?

Speaker_-_Tanya_Tekautz: Anaplastic ganglioglioma is a tumor that is frequently fast growing and is often treated with focal radiation to slow or stop the growth. There is less success in controlling the growth of this type of tumor with chemotherapy. Therefore focal radiation, to the site of the tumor, would be very appropriate.


Diagnosis Specific Questions

cooperstown: My 7-year-old niece has just been diagnosed with a brain tumor behind her right eye. It appears to be calcified. What does this mean hand and what should we expect?

Speaker_-_Tanya_Tekautz: Calcification is a non-specific feature of a variety of conditions. It certainly can be associated with tumor growth, but also with infection or a history of bleeding in the area. In order to determine the cause and treatment options, further evaluation would be necessary.

carrp: My son had a JPA the about size of an orange on his cerebellum. It was resected in June, 2007. Since then, he has been having major issues with a pseudomeningocele around the main resection area. It isn't going away. It has been recommended that he have a VP shunt inserted to help. Any suggestions?

Speaker_-_Tanya_Tekautz: It appears as though the surgery to address the tumor was successful. As you may know, post-operatively other issues may evolve which need to be addressed surgically. At this point, your neurosurgeon would be the best person to answer this question.


Dealing with School after Surgery

pattycake: Do you have any suggestions how to talk to your child’s school (both staff and students) about brain tumors and surgery? Once she returns to school – how difficult is it going to be for her to get back to normal?

Speaker_-_Tanya_Tekautz: Children diagnosed and treated for brain tumors can have life-long residual issues related to the tumor treatment even when the tumor is cured. It is important to recognize ongoing Neuro-cognitive and physical effects and have your child involved with a multi-disciplinary follow-up program that acknowledges and addresses many of the unique needs of children who have been treated for brain and spinal cord tumors.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Tekautz is now over. Thank you again Dr. Tekautz, for taking the time to answer our questions today.

Speaker_-_Tanya_Tekautz: Thank you for your time participating in this health chat. Please look for future chats from Cleveland Clinic’s Neurological Institute.


More Information

  • If you would like more information regarding the diagnosis or treatment of pediatric brain tumors or would like to make an appointment, please call to schedule your child with a member of the Pediatric Hematology/Oncology Team at Cleveland Clinic's Children's Hospital, 216.444.3608, or (toll-free) 800.223.2273, ext. 4-3608.
  • A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult website. To request a remote second opinion, visit www.eclevelandclinic.org/myConsult
  • If you need more information, contact us, chat online or call the Center for Consumer Health Information at 216.44.3771 or toll-free at 800.223.2272 ext. 4-3771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!
  • Go to current/upcoming chat page to register for future chats and/or log in.

This chat occurred in December 2008.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.