Brain Tumors in Children
Brain tumors are the most common solid tumors in children. Approximately 1,500 children in the U.S. are diagnosed with a brain tumor each year. Brain tumors, either malignant or benign, are tumors that originate in brain cells. A tumor is an abnormal growth of tissue.
A benign tumor does not contain cancer cells and usually, once removed, does not recur. Most benign brain tumors have clear borders, meaning they do not invade or spread to surrounding tissue. These tumors can, however, cause symptoms similar to cancerous tumors because of their size and location in the brain.
Malignant brain tumors contain cancer cells and usually grow quickly, invading the surrounding tissue. They rarely spread to other areas of the body, but may recur after treatment. Sometimes brain tumors that are not cancerous are called malignant because of their size and location, and the damage they can do to vital functions of the brain.
Brain tumors can occur at any age. Those that occur in infants and children are very different from adult brain tumors, both in terms of the type of cells and the responsiveness to treatment.
The central nervous system (CNS) consists of the brain and spinal cord. The brain is an important organ that controls thought, memory, emotion, touch, motor skills, vision, respirations, temperature, hunger and every process that regulates our body.
The brain can be divided into the cerebrum, the brainstem and the cerebellum:
Cerebrum (supratentorial, or front of brain)
The cerebrum is composed of the right and left hemispheres. Functions of the cerebrum include initiation of movement, coordination of movement, temperature, touch, vision, hearing, judgment, reasoning, problem solving, emotions and learning.
Brainstem (midline, or middle of brain)
This includes the midbrain, the pons and the medulla. Functions of this area include movement of the eyes and mouth, relaying sensory messages (e.g. hot, pain, loud), hunger, respirations, consciousness, cardiac function, body temperature, involuntary muscle movements, sneezing, coughing, vomiting and swallowing.
Cerebellum (infratentorial, or back of brain)
The cerebellum is located at the back of the head; its function is to coordinate voluntary muscle movements and to maintain posture, balance and equilibrium.
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The majority of brain tumors have abnormalities of genes involved in cell cycle control, causing uncontrolled cell growth. These abnormalities are caused by alterations directly in the genes or by chromosome rearrangements that change the function of a gene.
Patients with certain genetic conditions (such as neurofibromatosis, von Hippel-Lindau disease, Li-Frameni syndrome and retinoblastoma) also have an increased risk to develop tumors of the central nervous system. There have also been some reports of children in the same family who do not have any of these genetic syndromes but also develop brain tumors.
Researchers have been investigating parents of children with brain tumors and their past exposure to certain chemicals. Some chemicals may change the structure of a gene that protects the body from diseases and cancer. Workers in oil refining, rubber manufacturing and chemists have a higher incidence of certain types of tumors. Which, if any, chemical toxin is related to this increase in tumors is currently unknown.
Children who have received radiation therapy to the head as part of prior treatment for other malignancies are also at an increased risk for new brain tumors.
Diagnosis & Treatment
In addition to a complete medical history and physical examination of your child, diagnostic procedures for a brain tumor may include:
Your child’s physician tests reflexes, muscle strength, eye and mouth movement, coordination and alertness.
Computed Tomography Scan (also called a CT or CAT scan)
This diagnostic imaging procedure uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs. CT scans are more detailed than general x-rays. Learn more about CT scans.
Magnetic Resonance Imaging (MRI)
An MRI is diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. Learn more about MRI.
An x-ray is a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film. Learn more about x-rays.
Bone scans are pictures or x-rays taken of the bone after a dye has been injected and absorbed by bone tissue. These are used to detect tumors and bone abnormalities.
A dye is used to visualize all the blood vessels in the brain in order to detect certain types of tumors.
Similar to an angiogram, a myelogram is an x-ray of the spine.
Lumbar Puncture/Spinal Tap
A special needle is placed into the lower back into the spinal canal, the area around the spinal cord. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing. CSF is the fluid that bathes the brain and spinal cord. Diagnosis of a brain tumor depends mostly on the types of cells in which the tumor begins and the tumor location.
The following are the most common symptoms of a brain tumor. However, each child may experience symptoms differently. Symptoms vary depending on size and location of tumor. Many symptoms are related to an increase in pressure in or around the brain. There is no spare space in the skull for anything except the delicate tissues of the brain and its fluid. Any tumor, extra tissue or fluid can cause pressure on the brain and result in the following symptoms:
- Increased Intracranial Pressure (ICP)
- Caused by extra tissue or fluid in the brain, pressure may increase when one or more of the ventricles that drain cerebrospinal fluid (CSF, the fluid that surrounds the brain and spinal cord) become blocked, causing the fluid to be trapped in the brain.
Increased ICP can cause the following:
Symptoms vary depending upon which part of the brain the tumor is found.
Symptoms of brain tumors in the cerebrum (front of brain) may include:
- Visual changes
- Slurred speech
- Paralysis or weakness on half of the body or face
- Increased intracranial pressure (ICP)
- Drowsiness and/or confusion
- Personality changes
Symptoms of brain tumors in the brainstem (middle of brain) may include:
- Endocrine problems (diabetes and/or hormone regulation)
- Visual changes or double vision
- Paralysis of nerves/muscles of the face, or half of the body
- Respiratory changes
- Increased intracranial pressure (ICP)
Symptoms of brain tumors in the cerebellum (back of brain) may include: ]
- Increased intracranial pressure (ICP)
- Vomiting (usually occurs in the morning without nausea)
- Uncoordinated muscle movements
- Problems walking (ataxia)
The symptoms of a brain tumor may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.
Specific treatment for brain tumors will be determined by your child's physician based on:
- Your child's age, overall health and medical history
- Type, location and size of the tumor
- Extent of the disease
- Your child's tolerance for specific medications, procedures or therapies
- Expectations for the course of the disease
- Your opinion or preference
Treatment may include (alone or in combination):
- Surgery is usually the first step in the treatment of brain tumors, with the goal of removing as much of the tumor as possible while maintaining neurological function. Surgery for a biopsy is also done to diagnose the type of tumor. This is frequently done if the tumor is located near sensitive brain structures that may be injured during removal.
- Radiation therapy
- Steroids to treat and prevent swelling especially in the brain
- Anti-seizure medication to treat and prevent seizures associated with intracranial pressure
- Ventriculoperitoneal shunt (also called a VP shunt)
- A VP shunt may be placed in the head to drain excess fluid from inside the brain, helping to control the pressure inside the brain.
- Lumbar puncture/spinal tap to test pressure in the central nervous system, to look for suspicious cells and give medication if needed
- Bone marrow transplantation
- Supportive care for the side effects of the tumor or treatment
- Rehabilitation to regain lost motor skills and muscle strength; speech, physical and occupational therapists may be involved in the healthcare team
- Antibiotics to treat and prevent infections
- Continuous follow-up care to manage disease, detect recurrence of the tumor and to manage late effects of treatment
Prognosis greatly depends on:
- The type of tumor
- The extent of the disease
- Size and location of the tumor
- Presence or absence of metastasis
- The tumor's response to therapy and the age and overall health of your child
- Your child's tolerance of specific medications, procedures or therapies and new developments in treatment
As with any cancer, prognosis and long-term survival can vary greatly from individual to individual. Prompt medical attention and aggressive therapy are important for the best prognosis. Continuous follow-up care is essential for a child diagnosed with a brain tumor. Side effects of radiation and chemotherapy, as well as second malignancies, can occur in survivors of brain tumors.
Rehabilitation for lost motor skill and muscle strength may be required for an extended amount of time. Speech therapists and physical and occupational therapists may be involved in some form of rehabilitation. More research is needed to improve treatment, decrease side effects of the treatment for this disease and develop a cure. New methods are continually being discovered to improve treatment and to decrease side effects.