New scan technique gives children the right medulloblastoma diagnosis in minutes, not weeks

Cancers grow and spread over time, so the less time we give them, the better. With our funding, a ground-breaking study has found a way to fully diagnose medulloblastoma much faster. Here’s what that could mean for children and young people affected by brain tumours, as well as their families.

In March 2023, surgeons removed a tumour as big as a cricket ball from six-year-old Jack Bourne’s brain. Within 24 hours of spotting it, doctors took it out.

It took a month before they could decide the best thing to do next.

Jack had medulloblastoma, the most common type of brain cancer (or malignant brain tumour) in children and young people. There are four types of medulloblastoma, and each of them responds slightly differently to treatment. Until now, it’s taken surgery and weeks of tests to tell them apart.

Now, a team co-led by Professor Andrew Peet, a researcher and cancer doctor at the University of Birmingham, may have found a way to do it as soon as children arrive in hospital. That means faster, better planned treatments and less time spent trying to catch up with cancer.

Instead of surgery, the new technique works with the MRI scans doctors already use to locate tumours. It takes minutes, not weeks.

This study was funded by Children with Cancer UK, Cancer Research UK, Children’s Cancer North and a Newcastle University PhD studentship. The team’s other co-lead was Professor Steve Clifford, Chair of Molecular Paediatric Oncology at the Newcastle University Centre for Cancer.

Previously, Clifford, one of our funded researchers, helped identify the four different types of medulloblastoma. You can read more about some of his other work on medulloblastoma here.

The hardest month

As a doctor, Peet has spent decades supporting families through medulloblastoma. He knows what it means to be able to give them answers fast.

“It’s really difficult when we meet a family right at the beginning,” he says. “They’re frightened and they want information. They want to know what’s happening, but often we have very little to tell them. And, afterwards, they often say, ‘The hardest time wasn’t going through treatment; it was the uncertainty right at the beginning. It was the not knowing that was hard.’”

As a researcher, Peet has spent decades developing ways to take that uncertainty away. This is his biggest advance yet.

“Now, almost as soon as the child has had their scan, we can come along and say, ‘Yes, we know what it is’,” he explains. “And then we can start to plan.”

Surgeons already prepare for operations by looking at MRI scans, but this extra information about the type of medulloblastoma can give them a much better idea of what to expect. Then, before surgery even finishes, specialist cancer doctors like Peet can start organising the next steps. That means cancers don’t have any chance to grow or spread between surgery and the next phase of treatment.

“We can get things on the move, and that really helps – because we don’t have time to wait,” says Peet. “We need to work as quickly as we can.”

Jack’s story

“If this new research can help other families, it would make a huge difference,” says Jack’s mum Suzanna.

“Jack had surgery immediately, but it took around a month to find out what type of medulloblastoma he had. That meant we had to wait before the doctors could give him the radiotherapy they thought would work best for him.

Jack with Paul and Jackie, two of the St John's Ambulance drivers who took him to his radiotherapy appointments. — Jack was taken to every one of daily his radiotherapy appointments by the St John Ambulance drivers Becky, Jackie (right) and Paul (left). “They were a huge part of his journey,” says Suzanna.

“Jack couldn’t talk at that time due to posterior fossa syndrome, which is a condition that can happen after brain surgery. He was paralysed on one side and needed to use a wheelchair. It was like having a newborn again and we had to do everything for him. He couldn’t eat, so we had to learn how to do his feeds, and his pumps and medication. The doctors were able to treat him with chemotherapy while we waited for the results, but it was such a worrying time. We felt that we were in limbo.

“Once the results came back, the doctors were able to stop the chemotherapy, and Jack had six weeks of radiotherapy five days a week. It had been mentioned that we might need to go to another city if he needed proton beam therapy, but, thankfully, they were able to treat him at the Queen Elizabeth Hospital nearby. It was a relief to get those results and get treatment started.

The cornerstones of medulloblastoma treatment

Around 50 children in the UK are diagnosed with medulloblastoma each year. Thanks to research, doctors have got much better at treating them.

Now almost seven in every 10 – or 35 in every 50 – children with medulloblastoma will survive for at least five years after their diagnosis. But that means, on average, 15 of the children diagnosed each year won’t live to see five more.

“We’re losing three out of every 10 children who have this disease,” says Peet. “We need to do better.”

We know what better will look like. “This type of research is improving things,” Peet continues. “Knowing the disease earlier on, knowing more about it, being able to refine your treatment and getting to treatment quicker – those are the cornerstones of good cancer care.”

Decades of improvements in how we diagnose and treat cancer have shown just how strong those cornerstones are. They’re why children and young people are now more likely to survive medulloblastoma than die from it.

When Jack arrived at hospital, his doctors were able to use an MRI scan to find his tumour and guide his surgery. Testing Jack’s tumour took a long, anxious time, but it meant they could find out his medulloblastoma subtype and decide what to do next. The UK only has two proton beam therapy machines, but they are available to treat the children who need them.

The Proton Beam Therapy Centre at The Christie in Manchester

Things haven’t been lined up like that for long.

“I remember, 10 years ago, two little girls who came in and were diagnosed at almost exactly the same time,” says Peet. “Both had medulloblastoma and we treated both of them the same way.

“One of them did very well. The other one unfortunately didn’t make it.

“Nowadays, with more information, we probably wouldn’t be treating them in exactly the same way because they probably didn’t have exactly the same type of medulloblastoma.

“One maybe could have had less treatment and still done just as well. The other one may have needed more innovative ways of being treated. And knowing right from the beginning is just so important, because no two tumours are exactly the same.”

Using MRIs to see how cancers use energy

Peet’s technique works because each subtype of medulloblastoma uses energy differently. Scientifically speaking, they have different metabolisms. Every cancer needs to find food in the body to grow, and you could say the four types of medulloblastoma have different diets.

Sometimes, things are what they eat: Peet’s team found a way to actually spot signs of different cancer metabolisms on MRI scans. MRIs are normally used to look inside the body by highlighting water, but the data they produce can also reveal other chemicals.

What a cure looks like

Importantly, knowing more makes it possible to do less. Since doctors have been able to divide medulloblastomas into different groups, they’ve realised that children and young people with wingless (WNT) medulloblastoma are more likely to respond to treatment.

Because these patients already have a good chance of recovering from their cancer, doctors can focus more on minimising side effects. That’s especially important for the growing brain, our most sensitive and complicated organ, and one that’s connected to almost everything else in the body.

“It isn’t just about improving our ability to cure,” explains Peet. “It’s what does ‘cure’ look like.

“You can’t operate on a developing brain without causing some damage. You can’t give radiotherapy to a developing brain without causing damage. And the same with chemotherapy: the drugs have to get into the brain in order to work, and they’re designed to be toxic.

“So, being able to reduce the intensity of treatment, if you know people with medulloblastoma can still survive, is really important.”

Equally, quickly identifying that a child or young person has a high-risk type of medulloblastoma gives doctors more time to find innovative treatments to meet their specific needs. Today, those treatments might only be available on clinical trials, but they could soon be part of standard care too.

A new way to treat high-risk medulloblastoma

“What I’m sure of is that in the future we will have more targeted drugs to use instead of chemotherapy,” says Peet. “Chemotherapy is a bit of a blunderbuss approach. It works on any cancer cells pretty well, but it’s really quite damaging and not as effective as we’d like it to be. These techniques will allow us to work out which bits of which cancer we need to be attacking and which ways to do it.”

In fact, the study has revealed a new target for treating high-risk medulloblastoma.

While looking closely at the how the four different types of medulloblastoma consumed and used energy, the team started to notice something interesting about a chemical called glutamate.

Some of Peet’s previous work had helped show that glutamate was important in tumour metabolism. Now, though, his team is beginning to understand just how important it might be.

“When tumours had a lot of glutamate, the children did less well,” Peet explains. “So, finding ways of blocking glutamate, or changing it, could be a very important avenue for treating these tumours in the future.”

The team’s new technique means glutamate levels are visible on MRI scans today. And there are already drugs with the potential to interfere with it. This research isn’t just helping doctors match children and young people to the same treatments faster; it’s revealing even better ones.

Tim