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Follow-up after treatment for childhood brain and spinal cord cancer
Childhood brain and spinal cord cancer behaves differently in each child and the many different types of brain tumours react differently to treatment. Therefore, a standard follow-up schedule would not work for all children. Parents of children with brain and spinal cord cancer should talk to their child’s doctor about a follow-up plan that suits their child’s individual situation. Follow-up care is often shared among the cancer specialists (oncologists) and the family doctor.
After treatment has ended, new symptoms or symptoms that don’t go away should be reported to the doctor without waiting for the next scheduled appointment. These may include:
- a return of symptoms the child had before diagnosis, including:
- nausea and vomiting
- appearance of late symptoms or side effects of treatment, such as:
- slowed growth
- trouble learning at school
- problems with fine motor skills
- vision or hearing problems
- personality changes
The chance of brain and spinal cord cancer recurring is greatest within the first several years after therapy, so close follow-up is needed during this time. However, because a tumour can recur many years after initial treatment, long-term follow-up care is very important.
Follow-up after brain and spinal cord cancer treatment varies depending on the type of tumour, its location, the child’s age and the type of treatment given. Generally speaking, follow-up visits are usually scheduled:
- every 3 months during the first year after diagnosis
- every 4 months during the second year
- every 6 months during the third and fourth year
- every year after the fourth year
During a follow-up visit, the doctor usually asks questions about the side effects of treatment, and how the child and family are coping. The doctor may do a complete physical and neurologic examination, including:
- hearing and vision testing
- checking if the thyroid is enlarged
- checking the pupils of the child’s eyes and how they respond to light
- checking the child’s reflexes and grip strength
- checking the child’s fine motor skills
- checking the child’s growth, physical development and sexual development
- screening for learning disabilities
Tests may be ordered as part of follow-up or if the doctor suspects the cancer has come back (has recurred).
- Blood tests are done to check:
- blood cell counts
- thyroid function
- growth hormone (GH), luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels
- liver and kidney function
- MRI is done on a regular frequent basis to check for tumour recurrence. MRI scans are usually scheduled to happen close to the same time as each follow-up visit.
If a recurrence is found during follow-up, the oncology team will assess the child to determine the best treatment options.