Medulloblastoma is the most common central nervous system (CNS) embryonal tumour and the most common high grade childhood tumour, accounting for 15-20% of all childhood brain tumours. They are commonly found in children between ages of three and eight, with a higher occurrence in males.
Medulloblastomas usually develop in a part of the brain called the posterior fossa, and may sometimes spread to other parts of the brain or spinal cord, through the cerebrospinal fluid (CSF) that surrounds the brain. They are most commonly found in the cerebellum, an area of the posterior fossa that controls coordination and balance.
Due to the location of these tumours, they may block the flow of CSF leading to a condition called hydrocephalus, which raises the pressure inside the skull.
In the past few years, our understanding of medulloblastoma has advanced significantly by studying their genetic make-up and increasing our molecular understanding of this tumour type. Researchers have been able to identify that medulloblastoma can be subgrouped in to four main groups that have been defined by demographic, clinical and genetic differences.
Wnt medulloblastoma – This is the best known subgroup of all the medulloblastomas and has been identified in 10-15% of patients. The average age of occurrence is 10 years old and it is more commonly found in females. These tumours often occupy the fourth ventricle; the fluid filled space in the middle of the posterior fossa.
SHH medulloblastoma – This type of medulloblastoma frequently occurs in both infants (under three) and adults (over 16), but are less frequent in children aged three to sixteen. SHH medulloblastoma is commonly associated with a condition known as Gorlin syndrome, due to a gene mutation that causes the over-activation of cells, leading to the formation of a tumour.
Group 3 medulloblastoma – This type of medulloblastoma occurs more commonly in males than females, and are most common in young children ranging from one to ten years old. At diagnosis, these are often metastatic (already spread to other parts of the brain and spinal cord). Similar to the WNT medulloblastomas, the tumour is generally located within the fourth ventricle.
Group 4 medulloblastoma – This is the most common subgroup of medulloblastoma, making up around 35-40% of all cases. These tumours can occur in all ages but are most prevalent in mid-childhood.
The signs and symptoms of a medulloblastoma are usually caused by increased pressure in the brain. Symptoms may include:
In some cases, the tumour can spread to the spinal cord, causing another set of symptoms, such as back pain, an inability to control the bowels and bladder and difficulty walking.
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