Expert: Claes-Gustaf Nordquist, M.D. - 5/22/2009

Question
My 5 1/2 year old nephew has been diagnosed this week.  On Tuesday May 19, 2009 an MRI was done on my nephew Braeden in Sheboygan, WI.  They recommended my sister and Braeden to go down Childrens Hospital in Milwaukee, WI.  That day they drove down there and he was diagnosed with a tumor on his 4th and 5th vertebrae in his neck 2cm x 2cm in size.  On Thursday they had a team together and performed surgery at 7:30 A.M.  That evening we were able to visit him in ICU.  We are still waiting on reports back from the lab, however the doctor was certain it was astroblastoma.  His tumor was located on the inside of his spinal cord which caused the surgery to be of higher risk.  As of today he will be back to normal other than losing 10%^ of his balance due to having to slit his spinal cord to get behind it to perform the surgery.  My questions are regarding this type.  The doctor believes he got 90-95% of the tumor.  The rest he is hoping to leave in the spinal cord.  He also wasn't recommending chemotherapy or radiation.  Does this seem like normal practice due to wanting to minimize the possibility of being paralyzed?  Do you believe not performing radiation and chemotherapy is beneficial at this time.  Is this a spreadable cancer, or once removed it should never return.  If they leave the remaining 5-10% will this continue to grow and how fast?  Will this ever be an issue again?  Looking for answers this is scary and very little information out there.

Thank you,
Scott Schneider

Answer
Astroblastomas are RARE tumors. To find such a tumor in the spine is also RARE! It is also not common in young children. I prefer to wait for the pathology report so that we will KNOW what this is and what to do! To evaluate the treatment options and the prognosis here BOTH the diagnosis (kind of tumor) AND its GRADE (how malignant it is) must be KNOWN with certainty. That is not the case yet. So we have to wait for the pathology report. If the diagnosis is correct and its grade is low (low malignancy) then radiation therapy may not be necessary. If the grade is high (high malignancy - very malignant) then at least radiation therapy will be necessary. If it is not an astroblastoma we are back at square one and treatment and prognosis must be evaluated based on the facts of what it really is whatever that may be. Again grade will be important as in all malignant brain tumors. As always a non radical surgery result (impossible to get it all out) is not exactly good news, but it is too early to evaluate that situation too without all facts. Please do keep me posted!