Improving diagnosis of pediatric central nervous system tumours: aiming for early detection

Central nervous system (CNS) tumours account for a quarter of all cancers in children aged 1 to 19 years, despite being relatively uncommon.1 Survival in many cases is poor, and thus the diagnosis may be devastating.2 Yet for 70% of children with CNS tumours, there is potential for effective treatment with multimodal therapy by a specialized, multidisciplinary team.1 Early detection is essential to allow the best possible treatment by an experienced team of pediatric neurosurgeons and oncologists, to optimize outcomes. However, CNS tumours in children are often initially misdiagnosed as more common pediatric conditions, such as migraine, gastroenteritis, or psychologic or behavioural problems. Headache, vomiting, lethargy and seizures are the most common symptoms associated with CNS tumours, but they are nonspecific and present more frequently with other, more benign conditions. The diagnosis of CNS tumours necessitates a comprehensive clinical history and complete examination, in addition to advanced imaging, such as computed tomography (CT) or magnetic resonance imaging (MRI) to confirm clinical suspicion. These imaging tests expose children to radiation or require preparation and sedation for young children; as such, clinicians should order these tests judiciously and only if merited. Here, we review the presenting features of and diagnostic approach to CNS tumours in children, to assist family physicians and pediatricians in the early identification of such lesions (Box 1). © 2017 Joule Inc.