The rarely heard of condition atypical teratoid rhabdoid tumor (ATRT) recently gained some spotlight when six-year-old Avalanna Routh, or "Mrs Bieber", passed away from this disease. Famous heart throb Justin Bieber, who had spent a Valentine's Day with her playing board games, given her a kiss and called her "Mis Bieber" in his tweet, expressed his heartbreak over her death on his twitter account. Love him or hate him and his fanbase, this news certainly garnered a lot of sympathy for the little one.

What is ATRT, and why do such young children fall victim to it?

ATRT is a type of brain cancer that strikes young children below the age of three. Survival rate is low for children aged three and below, but mortality rate increases when the child survives it past age three.

ATRT is a fast-growing tumour that grows in the brain and the spinal cord.

Anatomy of the brain, showing the cerebrum, cerebellum, brain stem, and other parts of the brain.
Anatomy of the inside of the brain, showing the pineal and pituitary glands, optic nerve, ventricles (with cerebrospinal fluid shown in blue), and other parts of the brain.
 
 
The tumour is commonly found in the cerebellum or brain stem. The cerebellum is the area that controls the movement, balance and posture of a person, the brain stem controls the nerves, breathing and heart rate. This tumour may also be found in other parts of the central nervous system which also includes the spinal cord. The top diagram shows the position of the brain stem and cerebellum.

Symptoms
As this tumour grows fast, symptoms can be seen over a short period of a few days to a few weeks.
This includes:
• Morning headache or headache that goes away after vomiting.
• Nausea and vomiting.
• Unusual sleepiness or change in activity level.
• Loss of balance, lack of coordination, or trouble walking.
• Increase in head size (in infants)

Diagnosis
There are many ways for a doctor to diagnose the patient with his tumour. This includes a physical examination, magnetic resonance imaging (MRI) scan, computerized tomography (CT) scan, biopsy, lumbar puncture, ultrasound and genetic testing.

The MRI and CT scan allows the doctor to get detailed images of the affected areas. Biopsy is where a doctor removes some tissue from the tumour for tests. Lumbar puncture removes cerebrospinal fluid to determine if the tumour cells have spread.  Ultrasound determines if there are tumours in other parts of the body and lastly, genetic testing allows the doctor to check if there is any genetic changes to the cells that may be linked to ATRT.
 
Causes for this condition are not yet documented. That's why supporting cancer research is so important as it helps to uncover the truths behind many bizarre conditions, and more importantly, find ways to minimise their fatality.
 
In Singapore, there are a few research centres and programmes dedicated to the study of cancers and their treatment methods, namely the NCC Research Fund by the National Cancer Centre Singapore, National Cancer Centre Institute of Singapore and Singhealth Foundation, just to name some. If you're up for some philantrophy, do consider cancer as a cause to donate for. There are always new cancer-related issues requiring discovery and further research on a daily basis!
 
Sources:
http://www.childrenshospital.org/az/Site3168/mainpageS3168P3.html

http://www.cancer.gov/cancertopics/pdq/treatment/child-CNS-ATRT/patient/page1
http://www.cancer.umn.edu/cancerinfo/NCI/CDR574573.html
http://www.childrenshospital.org/az/Site3168/mainpageS3168P0.html
http://www.childrenshospital.org/az/Site3168/mainpageS3168P3.html


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