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Part 1 Recognising the Potential Existence of Brain Tumours in Children and the Implications From a Medical Negligence Perspective.

View profile for Kimmo Boote
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Brain tumours are the most common solid tumour in children and young people. Brain tumours account for about 25% of all childhood cancers, with an incidence of 5 per 100,000 children (aged up to 9 years of age).

The location of tumours is divided into a number of categories anatomically. For example the brain is separated by a horizontal layer of fibrous material, the ‘tentorium’, so the terms ‘above’ and ‘below’ is used. Most childhood tumours are below this separation (infra-tentorial) which effects the types of treatment that can be offered (taking the size and the type of brain tumour into account).

Although, on the whole, the outlook for children with brain tumours is better than that seen in adults; however, there may be a quite a delay between the onset of symptoms (and even signs) and when the diagnosis is reached. This is the area where many clinical negligence claims occur owing to the failure to consider a brain tumour.

There are genetic conditions which are linked to the development of a brain tumour. For example ‘astrocytoma’ (43% of all Tumours in children) is more often seen in patients with the condition Neurofibromatosis. There are other genetic conditions that are also associated with tumours, and patients with these conditions require monitoring to ensure that they remain well.

Tumours have the effect of directly compressing the surrounding brain structures. Some may be metastases from the original primary site (a tumour located elsewhere in the body that has spread)  - not so common in childhood but much more so in adults. Tumours grow at different rates, and their ‘degree of malignancy’ can relate to their histological appearance, for example, glioma grade 1 is slow growing whereas grade 4 is the fastest.

Tumours that are said to be benign (non cancerous) can still cause effects owing to their location.

Tumours in childhood can cause the following:

- Headaches - worse on waking, recurrent headaches

- Abnormal gait and co-ordination

- Nerve abnormality – such as cranial nerve malfunction, e.g. sudden onset of a squint, or visual disturbances Seizures

- For children under two the symptoms may be non-specific, e.g. with vomiting and irritability

Frontal tumours may be associated with personality changes, those affecting the pituitary gland (the main regulator of the endocrine systems of the body) can cause changes in growth, and sex hormone production (with visual changes due to upward growth on the visual pathways close by).

If you want further information about this particular topic, or wish to discuss the possibility of bringing a claim, please contact the Dutton Gregory Clinical Negligence Team on 01202 315005, or email k.marden@duttongregory.co.uk.