Brain Tumor
What’s in this section?
Overview
Brain tumors are the most common solid tumors in children. Approximately 4,000 children and adolescents in the U.S. are diagnosed with primary brain tumors (tumors that originate in the brain) each year. Some pediatric brain tumors are similar to those in adults. However, several brain tumors are distinct to the pediatric age group.
Pediatric brain tumors may be benign (slow growing, non-aggressive) or malignant (cancerous). Some may invade (spread through) the normal surrounding brain tissue.
Some of the more common types of brain tumors in the pediatric population include:
- Gliomas These tumors arise from glial cells which support the nerve cells in the brain.
- Low-grade astrocytomas (grade I-II). These are slower growing, but can become more aggressive over the span of years.
- SEGA (subependymal giant cell astrocytomas) are mostly seen in patients who have a condition called tuberous sclerosis. They are not cancerous, but some can grow rapidly. They occur in the walls of the ventricles (the cavities that make and contain CSF).
- Pilocytic astrocytoma is the most benign form of astrocytoma. In children, there is a high chance for cure with surgical removal.
- Pleomorphic xanthoastrocytoma is another slower growing tumor that rarely becomes more aggressive.
- High-grade astrocytoma (grade III-IV). These aggressive tumors include anaplastic astrocytoma and glioblastoma. They are more common in adults.
- Ependymoma
- Brain stem glioma is mainly a pediatric tumor. Focal brainstem glioma occurs outside the pons (a section of brainstem) and is slower growing. Diffuse intrinsic brainstem gliomas occur in the pons. They are more common than focal brainstem gliomas, more difficult to treat and have a poor long-term outlook.
- Optic glioma is a slow-growing glioma that involves the optic nerve (the nerve that connects the brain to the eye). It can occur with some frequency in patients with NF1 (neurofibromatosis type 1). It may affect vision or hormone function.
- Low-grade astrocytomas (grade I-II). These are slower growing, but can become more aggressive over the span of years.
- Embryonal tumors occur in infants and young children. There are several types of embryonal tumors. These tumors are malignant. They develop from embryonic (fetal) brain cells. They tend to grow quickly and may spread through the CSF to other parts of the brain or spinal cord. Medulloblastoma is the most common type of embryonal tumor. It typically starts in the cerebellum . Tumors previously called Primitive Neuroectodermal Tumors (PNET) are now also considered to be embryonal tumors.
- Choroid plexus papilloma/carcinoma These tumors generally occur in the ventricles (fluid spaces deep inside the brain). They may be benign or malignant. These are most often seen in the first decade of life. Hydrocephalus is commonly seen with these tumors.
- Ganglioglioma is an uncommon tumor that affects children or young adults. It is a slower growing tumor.
- Pineal tumors
- Germ Cell tumors These usually occur in the region of the pineal gland or the area above the sella turcica (the bony cave for the pituitary gland). Some of these tumors can be aggressive.
Signs and Symptoms
Symptoms of a brain tumor depend on its size, type and location. Symptoms may be caused by a tumor pressing on or irritating the brain, blocking the flow of CSF in the ventricles and around the brain, or producing swelling of the brain.
Some of the most common symptoms of brain tumors include:
- Frequent headaches
- Seizures
- Nausea and vomiting
- Loss of balance or trouble walking
- Weakness in the legs or arms
- Blurry vision
- Confusion or irritability
Potential Causes
The exact cause of brain tumors is not fully understood. Research is focusing on abnormalities in genes that control the cell cycle (when cells grow, divide and die). Such abnormalities can lead to uncontrolled cell growth.
Diagnosis
Diagnosis of a pediatric brain tumor usually starts with a medical history and neurological examination. Tests and procedures that confirm the diagnosis and help guide management include: computed tomography ( CT ), magnetic resonance imaging ( MRI ), lumbar puncture/ spinal tap or cranial ultrasound .
Treatment Options
A customized treatment plan is put together for your child based on:
- The type of brain tumor
- The tumor’s location and size
- Family preferences
Treatment for a pediatric brain tumor may include one or a combination of the following options:
- Surgery Surgery to remove tumor is often the first step in establishing the definite diagnosis and treatment. This may involve an open craniotomy or endoscopic approach.
- Stereotactic biopsy This specialized surgical procedure is done to confirm the diagnosis, especially when the suspected tumor is in a deep or critically important area of the brain, which may make the risk of surgical removal too high.
- Radiation treatment High-energy particles are directed at the tumor to destroy the cancer cells by damaging their DNA.
- Chemotherapy These medications are used to shrink or destroy fast growing cells like cancer cells.
- Targeted therapy These medications specifically target genes and proteins involved with the cancer cells. They affect the cancer cells’ ability to grow and survive.
- Immunotherapy This therapy uses the immune system or its products to attack the cancer cells.
- Steroids These medicines may improve or even provide temporary relief of symptoms from edema (swelling) around the tumor.
- Anti-seizure medicine This type of medicine is used to prevent further seizures. Sometimes, anti-seizure medication may be used for a short period around the time of surgery.
- Ventriculoperitoneal (VP) shunt This surgical procedure relieves increased pressure caused by hydrocephalus (excess fluid within the ventricles of the brain). A shunt is a thin tube that channels excess CSF in the brain ventricles to another area of the body.
- Rehabilitation therapies Speech-language, occupational and physical therapies, as well as support services may play an important role along with the other treatments.
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