Skip to main content

Advertisement

SpringerLink
Log in

Presentation and symptom interval in children with central nervous system tumors. A single-center experience

  • Original Paper
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to describe the symptoms and signs of central nervous system (CNS) tumors in a pediatric population and to assess the time interval between the onset of the disease and the time of the diagnosis.

Methods

A retrospective observational study was conducted at our Oncology Pediatric Unit between January 2000 and November 2011. We included 75 children between 5 months and 16 years (mean age of 7.8 ± 4.7 years), with male to female ratio of 3:2. The tumor localization was supratentorial in 51% of cases, and the most frequent histological type was low-grade astrocytoma (48%).

Results

Presenting symptoms were headache (31%), vomiting (31%), seizures (21%), and behavioral change (11%). The most common symptoms at diagnosis were headache (51%), vomiting (51%), visual difficulties (37%), seizures (24%), and behavioral change (21%). By the time of diagnosis, neurologic examination was altered in 68% of our patients. Vomiting (44%) and behavioral change (44%) were the most frequent symptoms in children under 4 years of age, headache (61%) and vomiting (54%) in children older than 4 years. The median interval between symptoms’ onset and diagnosis was 4 weeks (range 0 to 314 weeks). A longer symptom interval was associated with younger age, infratentorial localization and low-grade tumors. The differences in symptom intervals between the different age, location, and grade groups were not statistically significant. Survival probability was influenced by tumor grade but not by diagnostic delay or age of the child.

Conclusions

Headache and vomiting are the earliest and commonest symptoms in children with brain tumors. Visual symptoms and signs and behavioral change are often present. Abnormalities in neurological examination are reported in most of the children. Intracranial hypertension symptoms suggest the need for a neurological clinical examination and an ophthalmological assessment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Peris-Bonet R, Martinez-Garcia C, Lacour B, Petrovich S, Giner-Ripoll B, Navajas A, Steliarova-Foucher E (2006) Childhood central nervous system tumours—incidence and survival in Europe (1978-1997): report from Automated Childhood Cancer Information System project. Eur J Cancer 42:2064–2080

    Article  PubMed  Google Scholar 

  2. Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D (2007) Presentation of childhood CNS tumours: a systematic review and meta-analysis. Lancet Oncol 8:685–695

    Article  PubMed  Google Scholar 

  3. Mehta V, Chapman A, McNeely PD, Walling S, Howes WJ (2002) Latency between symptom onset and diagnosis of pediatric brain tumors: an Eastern Canadian geographic study. Neurosurgery 51:365–372 discussion 372-363

    Article  PubMed  Google Scholar 

  4. Shay V, Fattal-Valevski A, Beni-Adani L, Constantini S (2012) Diagnostic delay of pediatric brain tumors in Israel: a retrospective risk factor analysis. Childs Nerv Syst 28:93–100

    Article  PubMed  Google Scholar 

  5. Dobrovoljac M, Hengartner H, Boltshauser E, Grotzer MA (2002) Delay in the diagnosis of paediatric brain tumours. Eur J Pediatr 161:663–667

    Article  PubMed  Google Scholar 

  6. Dixon-Woods M, Findlay M, Young B, Cox H, Heney D (2001) Parents’ accounts of obtaining a diagnosis of childhood cancer. Lancet 357:670–674

    Article  CAS  PubMed  Google Scholar 

  7. Wilne S, Koller K, Collier J, Kennedy C, Grundy R, Walker D (2010) The diagnosis of brain tumours in children: a guideline to assist healthcare professionals in the assessment of children who may have a brain tumour. Arch Dis Child 95:534–539

    Article  PubMed  Google Scholar 

  8. Smith MA, Freidlin B, Ries LA, Simon R (1998) Trends in reported incidence of primary malignant brain tumors in children in the United States. J Natl Cancer Inst 90:1269–1277

    Article  CAS  PubMed  Google Scholar 

  9. Dreifaldt AC, Carlberg M, Hardell L (2004) Increasing incidence rates of childhood malignant diseases in Sweden during the period 1960-1998. Eur J Cancer 40:1351–1360

    Article  PubMed  Google Scholar 

  10. Pisani P, Mosso ML, Buzzoni C, Crosignani P, Michiara M, Tumino R, AIRTUM Working Group (2011) Good news for Italian children. Since 2000 malignant CNS cancer has stopped increasing. Epidemiol Prev 35:245

    PubMed  Google Scholar 

  11. Wilne S, Collier J, Kennedy C, Jenkins A, Grout J, Mackie S, Koller K, Grundy R, Walker D (2012) Progression from first symptom to diagnosis in childhood brain tumours. Eur J Pediatr 171:87–93

    Article  PubMed  Google Scholar 

  12. Ansell P, Johnston T, Simpson J, Crouch S, Roman E, Picton S (2010) Brain tumor signs and symptoms: analysis of primary health care records from the UKCCS. Pediatrics 125:112–119

    Article  PubMed  Google Scholar 

  13. Wilne SH, Ferris RC, Nathwani A, Kennedy CR (2006) The presenting features of brain tumours: a review of 200 cases. Arch Dis Child 91:502–506

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Magnani C, Aareleid T, Viscomi S, Pastore G, Berrino F, EUROCARE Working Group (2001) Variation in survival of children with central nervous system (CNS) malignancies diagnosed in Europe between 1978 and 1992: the EUROCARE study. Eur J Cancer 37:711–772

    Article  CAS  PubMed  Google Scholar 

  15. Lannering B, Sandstrom PE, Holm S, Lundgren J, Pfeifer S, Samuelsson U, Stromberg B, Gustafsson G, Swedish Childhood CNSTWG (2009) Classification, incidence and survival analyses of children with CNS tumours diagnosed in Sweden 1984-2005. Acta Paediatr 98:1620–1627

    Article  PubMed  Google Scholar 

  16. Edgeworth J, Bullock P, Bailey A, Gallagher A, Crouchman M (1996) Why are brain tumours still being missed? Arch Dis Child 74:148–151

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Abu-Arefeh I, Russell G (1994) Prevalence of headache and migraine in schoolchildren. BMJ 309:765–769

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Raieli V, Eliseo M, Pandolfi E, La Vecchia M, La Franca G, Puma D, Ragusa D (2005) Recurrent and chronic headaches in children below 6 years of age. J Headache Pain 6:135–142

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lewis DW, Dorbad D (2000) The utility of neuroimaging in the evaluation of children with migraine or chronic daily headache who have normal neurological examinations. Headache 40:629–632

    Article  CAS  PubMed  Google Scholar 

  20. Hayashi N, Kidokoro H, Miyajima Y, Fukazawa T, Natsume J, Kubota T, Kojima S (2010) How do the clinical features of brain tumours in childhood progress before diagnosis? Brain and Development 32:636–641

    Article  PubMed  Google Scholar 

  21. Pinho RS, Andreoni S, Silva NS, Cappellano AM, Masruha MR, Cavalheiro S, Vilanova LC (2011) Pediatric central nervous system tumors: a single-center experience from 1989 to 2009. J Pediatr Hematol Oncol 33:605–609

    Article  PubMed  Google Scholar 

  22. Nunes VD, Sawyer L, Neilson J, Sarri G, Cross JH (2012) Diagnosis and management of the epilepsies in adults and children: summary of updated NICE guidance. BMJ 344:e281

    Article  PubMed  Google Scholar 

  23. Coserria Sanchez JF, Garrido Ocana AI, Quiroga Cantero E, Reina Gonzalez AM, Amadeu Da Costa AP, Garcia Zarza N (2007) Presenting signs and symptoms of central nervous system tumors according to age. An Pediatr (Barc) 66:115–120

    Article  CAS  Google Scholar 

  24. Saha V, Love S, Eden T, Micallef-Eynaud P, MacKinlay G (1993) Determinants of symptom interval in childhood cancer. Arch Dis Child 68:771–774

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Kukal K, Dobrovoljac M, Boltshauser E, Ammann RA, Grotzer MA (2009) Does diagnostic delay result in decreased survival in paediatric brain tumours? Eur J Pediatr 168:303–310

    Article  PubMed  Google Scholar 

  26. Klitbo DM, Nielsen R, Illum NO, Wehner PS, Carlsen N (2011) Symptoms and time to diagnosis in children with brain tumours. Dan Med Bull 58:A4285

    PubMed  Google Scholar 

  27. Brasme JF, Chalumeau M, Doz F, Lacour B, Valteau-Couanet D, Gaillard S, Delalande O, Aghakhani N, Sainte-Rose C, Puget S, Grill J (2012) Interval between onset of symptoms and diagnosis of medulloblastoma in children: distribution and determinants in a population-based study. Eur J Pediatr 171:25–32

    Article  PubMed  Google Scholar 

  28. Suharwardy J, Elston J (1997) The clinical presentation of children with tumours affecting the anterior visual pathways. Eye (Lond) 11(Pt 6):838–844

    Article  Google Scholar 

  29. Feletti A, Marton E, Mazzucco GM, Fang S, Longatti P (2010) Amaurosis in infancy due to craniopharyngioma: a not-exceptional but often misdiagnosed symptom. Neurosurg Focus 28:E7

    Article  PubMed  Google Scholar 

  30. Harbert MJ, Yeh-Nayre LA, O'Halloran HS, Levy ML, Crawford JR (2012) Unrecognized visual field deficits in children with primary central nervous system brain tumors. J Neuro-Oncol 107:545–549

    Article  CAS  Google Scholar 

  31. Chen J, Mullen CA (2017) Patterns of diagnosis and misdiagnosis in pediatric cancer and relationship to survival. J Pediatr Hematol Oncol 39:e110–e115

    Article  PubMed  Google Scholar 

  32. Sethi RV, Marino R, Niemierko A, Tarbell NJ, Yock TI, MacDonald SM (2013) Delayed diagnosis in children with intracranial germ cell tumors. J Pediatr 163:1448–1453

    Article  PubMed  Google Scholar 

  33. Arnautovic A, Billups C, Broniscer A, Gajjar A, Boop F, Qaddoumi I (2015) Delayed diagnosis of childhood low-grade glioma: causes, consequences, and potential solutions. Childs Nerv Syst 31:1067–1077

    Article  PubMed  PubMed Central  Google Scholar 

  34. Halperin EC, Friedman HS (1996) Is there a correlation between duration of presenting symptoms and stage of medulloblastoma at the time of diagnosis? Cancer 78:874–880

    Article  CAS  PubMed  Google Scholar 

  35. Qaddoumi I, Sultan I, Gajjar A (2009) Outcome and prognostic features in pediatric gliomas: a review of 6212 cases from the surveillance, epidemiology, and end results database. Cancer 115:5761–5770

    Article  PubMed  PubMed Central  Google Scholar 

  36. Pogorzala M, Styczynski J, Wysocki M (2014) Survival and prognostic factors in children with brain tumors: long-term follow-up single center study in Poland. Anticancer Res 34:323–326

    PubMed  Google Scholar 

  37. Phi JH, Kim SK, Lee YA, Shin CH, Cheon JE, Kim IO, Yang SW, Wang KC (2013) Latency of intracranial germ cell tumors and diagnosis delay. Childs Nerv Syst 29:1871–1881

    Article  PubMed  Google Scholar 

  38. Roddy E, Mueller S (2016) Late effects of treatment of pediatric central nervous system tumors. J Child Neurol 31:237–254

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Maternal and Child Health, IRCSS Burlo Garofolo, University of Trieste, Trieste, Italy

    Chiara Stocco

  2. Department of Medical and Biological Science, University of Udine, Udine, Italy

    Chiara Pilotto & Raffaello Tosolini

  3. Department of Pediatrics, S. Maria della Misericordia University Hospital, University of Udine, Udine, Italy

    Chiara Pilotto, Eva Passone, Agostino Nocerino, Raffaello Tosolini, Anna Pusiol & Paola Cogo

Authors
  1. Chiara Stocco
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chiara Pilotto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva Passone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Agostino Nocerino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raffaello Tosolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Anna Pusiol
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paola Cogo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chiara Stocco.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stocco, C., Pilotto, C., Passone, E. et al. Presentation and symptom interval in children with central nervous system tumors. A single-center experience. Childs Nerv Syst 33, 2109–2116 (2017). https://doi.org/10.1007/s00381-017-3572-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-017-3572-1

Keywords

Search

Navigation