Facts
A childhood brain or spinal cord tumor is a disease in which abnormal cells form in the tissues of the brain or spinal cord.
There are many types of childhood brain and spinal cord tumors. The tumors are formed by the abnormal growth of cells and may begin in different areas of the brain or spinal cord.
Tumors in the brain are categorized according to several factors, including where they're located, the type of cells involved, and how quickly they're growing. They are graded on a scale from 1 to 4. A grade I being the slowest growing, a grade IV being the fastest growing.
The central nervous system (CNS) is made up of the brain and the spinal cord. Together, these important organs control functions necessary to sustain life, such as breathing, heart rate, movement, thinking and learning. Important substances produced in the brain (hormones) stimulate and control many other organs in the body. Tumors that develop in this critical area have many unique properties and symptoms.
As a group, brain tumors are the most common solid tumors in children less than 15 years of age, and account for approximately 20% of all cancers diagnosed in this population.
Tumors can arise at any age in any area of the brain and spinal cord, although some specific types of pediatric tumors tend to occur more often in certain parts of the brain.
Brain tumors are categorized by the type of malignant cell and by the area of the brain in which they develop.
The terms "benign" and "malignant" as usually applied to tumors are not as useful when describing brain tumors. Because the brain and skull comprise a "box" of a fixed size, even "benign" or slow-growing tumors can cause serious problems or eventual death if they develop in an area where complete surgical removal is not possible.
Most brain tumors tend NOT to "metastasize" or spread to distant areas to other parts of the body outside the brain and/or spinal cord (CNS).
They do, however, tend to recur locally, or spread to other areas of the CNS.
- Low Grade Glioma (includes Juvenile Pilocytic Astrocytoma (JPA), Fibrillary Astrocytoma, Ganglioglioma, Oligodendroglioma and Mixed Glioma (Astrocytoma and Oligodendroglioma)
- Medulloblastoma (also called PNET (Primitive Neuroectodermal Tumor))
- Supratentorial PNET and Pineoblastomas
- High Grade Glioma (includes Anaplastic Astrocytoma and Glioblastoma Multiforme)
- Brain Stem Glioma (includes DIPG (Diffuse Intrinsic Pontine Glioma))
- Ependymoma
- Germ Cell Tumor
- Choroid Plexus Tumor (includes Choroid Plexus Papilloma and Choroid Plexus Carcinoma)
- Craniopharyngioma
- Glioneuronal
- Optic Pathway Glioma
Typical symptoms of brain tumors are directly related to the location of the tumor, how fast it is growing, and any associated tissue swelling that occurs in conjunction with the tumor. Parents often are the first to notice symptoms related to the development of a CNS tumor. Occasionally, the child's teacher or physician may note signs and symptoms that are worrisome.
Typical symptoms of brain tumors include:
- Headaches (frequent, recurrent), especially after waking up in the morning;
- Vomiting, especially in the morning;
- Eye movement problems and/or vision changes;
- Unsteady gait or worsening balance;
- Weakness of one side of the face;
- Loss of previously acquired developmental milestones;
- Weakness in the arms or legs;
- Bulging fontanelle or increased head size in infants;
- Tilting of the head or neck to one side;
- Difficulty with speech or swallowing or drooling;
- Seizures; and/or
- Back or neck pain, often awakening the child at night.
Less common symptoms of brain tumors include:
- Changes in eating or thirst;
- Growth problems;
- Dizziness;
- Lethargy, irritability, or other behavior changes;
- Deterioration in school performance;
- Loss of consciousness, without history of injury;
- Changes in, or loss of control of, bowel or bladder;
- Loss of sensation in the arms or legs; and/or
- Hearing loss, without evidence of infection.
Many brain tumor survivors require physical, cognitive and rehabilitation services to allow them to return to tasks of everyday life.
Quality of life for survivors of pediatric brain tumors is influenced by the long-term side effects of treatments such as chemotherapy and radiation.
For many pediatric brain tumors (DIPG, AT/RT, GBM), long-term survival rates remain below 20 percent.
Pediatric brain tumors are different from those in adults and are often treated differently.
There are more than 120 different types of brain tumors, making effective treatment very complicated.
The overall mortality rate of pediatric cancer has decreased in past 20 years, but deaths from brain and spinal cord tumors have increased from 18% to 30%.
Only two new brain tumor treatments have been approved in the past 25 years.
The cause of most childhood brain and spinal cord tumors is unknown.
Brain tumors are diagnosed by computerized tomography (CT scan), magnetic resonance imaging (MRI) and tissue examination. A CT scan will reveal brain abnormalities and an MRI will detect tumors beneath the bones of the skull. Microscopic examination of tumor tissue (biopsy) will identify cancer cells. A physician may order further tests using lumbar puncture, withdrawing bone marrow, biochemistry and a bone scan to see if the tumor has spread beyond the brain. Sedation may be used for younger children who are unable to stay still for these tests.
Children with brain tumors typically have an entire team of doctors and specialists overseeing their treatment. This team usually includes:
- Neurosurgeon
- Neurologist
- Neuro-oncologist
- Neuropathologist
- Neuroradiologist
- Radiation oncologist
- Endocrinologist
- Psychologist
- Ophthalmologist
- Rehabilitation specialist
- Social worker
- Nurse specialist
Childhood brain and spinal cord tumors may cause symptoms that begin before diagnosis and continue for months or years.
Many brain tumor treatments cause side effects months or years after treatment has ended. These are called late effects. Late effects of cancer treatment may include the following:
- Physical problems.
- Changes in mood, feelings, thinking, learning, or memory.
- Second cancers (new types of cancer).
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
Radiation therapy to the brain can affect growth and development in young children. It can also cause secondary cancers to develop later in life.
Chemotherapy
Among the side effects caused by chemotherapy are hair loss, skin problems, nausea, vomiting, diarrhea, constipation, changes in taste, fatigue, mouth sores, seizures, hearing loss, kidney and liver problems, and reduction of platelets, red cells, or white cells in the blood. Some of these side effects may be temporary, while others may be permanent.
Early brain tumor symptoms in children can be vague. Therefore, it is not uncommon for a child with early symptoms to have his or her condition diagnosed as migraines, school phobia, anorexia, or other common problems. Children with possible brain tumor symptoms should see a doctor as soon as possible, because only a doctor can diagnose and treat the problem.