Central Nervous System Tumors

Abstract

CNS tumors are least likely to present during adolescence, when they do, their clinical presentation is enmeshed with the young person’s physical, psychological, educational, and social development. The population incidence of the different tumor types highlights the transition from “childhood type” to “adult type” and identifies those driven by adolescent development itself – intracranial germ cell tumors. While all brain tumors in this age group are undoubtedly a product of brain development, genetic and environmental factors also play a key role and highlight the complexity of tumorigenesis in the brain. Symptomatology is determined by anatomical factors and influence pathways to diagnosis which can be prolonged and are currently the focus of population interventions, seeking to accelerate diagnosis. Awareness of genetic predisposing conditions can contribute to enhanced awareness of risk and complex genetic factors that in the future can be expected to be therapeutic targets. Once diagnosed, the AYA multidisciplinary and multiprofessional teams are in development across health systems, frequently organized differently in pediatric versus adult settings. The neurosurgical options are determined by anatomy and surgical feasibility seeking to maximize resection rates while minimizing neurosurgical toxicity. Acute neurological syndromes of raised intracranial pressure, epilepsy, and acute neurological problems associated with radiotherapy and chemotherapy require an integrated approach to care and rehabilitation. Adjuvant therapies with chemotherapy and radiotherapy are tumor-type-specific and driven by trial programs, which we anticipate to be focused increasingly upon molecularly targeted therapies as they come available, although targeting drug therapies to the brain remains an outstanding challenge to their effectiveness. Intracranial germ cell tumors peak during the AYA age groups and have reached a new level of consensus, regarding all aspects of their care as a result of global research collaboration. Late consequences of childhood brain tumors and AYA tumors are a major challenge for current health systems, as survival rates rise and the neurological, cognitive, endocrine, and psychological consequences of brain tumor color the lives of the adult survivors. Future improvements in outcome are dependent on coordinated research programs seeking to answer questions prioritized by successful public engagement.