Brain Tumors in Children
A brain tumor is an abnormal growth
of tissue in the brain. The brain is part of the central nervous system (CNS). The
also includes the spinal cord. The main parts of the brain are:
Cerebrum. This is the front of the brain. The cerebrum has
two halves, the right and left hemispheres. It controls thoughts, emotions, speech,
and movement. It also helps with understanding information from the senses. This
includes seeing, hearing, smelling, touching, and feeling pain.
Cerebellum. This is the back of the brain. It organizes
muscle movement and helps to maintain posture, balance, and equilibrium.
Brainstem. This is the base of the brain. It includes the
midbrain, the pons, and the medulla. It's the part of the brain that connects to the
spinal cord. It plays a part in controlling muscles and sensations from the body.
Part of the brainstem helps control breathing and the heartbeat. Many of the cranial
nerves start in the brainstem. The cranial nerves carry messages between different
parts of the upper body to the brain. These parts include the muscles in the face,
mouth, and around the eyes.
Brain tumors start in the cells of
the brain. They can be either of the following:
Benign. This kind of tumor is not cancer. In most cases,
once a benign tumor is removed, it doesn’t grow back. Most benign brain tumors don’t
grow into nearby tissue. These tumors can cause symptoms depending on how big they
are and where they are in the brain.
Malignant. This kind of tumor is cancer. These brain
tumors tend to grow fast, and grow into nearby tissue. Malignant brain tumors can
spread to other parts of the brain or to the spinal cord but don’t usually spread
other parts of the body. They may grow back after treatment.
Brain tumors can happen at any age.
Brain tumors in infants and children are very different from adult brain tumors.
Types of brain tumors
The most common type of brain
tumor is a
glioma. Gliomas start in
glial cells, which make up the tissue that supports the brain. There are different
types of glioma:
Astrocytoma. This type of tumor starts in glial cells
called astrocytes. It's the most common brain tumor in children. It can start
anywhere in the brain or spinal cord.
Brainstem glioma. This tumor is found in the brainstem.
Most brainstem tumors can’t be removed with surgery.
Oligodendroglioma. This tumor grows in the cells called
oligodendrocytes. They make the fatty covering of nerve cells. The tumor usually
grows slowly. But it tends to grow into brain tissue. This makes it very difficult
to remove with surgery.
Ependymoma. This tumor grows in the lining of the
ventricles that hold cerebrospinal fluid (CSF), or in the spinal cord. In
children, they're most often near the cerebellum. They can block the flow of the
CSF, the fluid that surrounds the brain and spinal cord. This may
cause increased pressure in the skull.
Optic nerve glioma. This kind of tumor is found in or
around the nerves that send messages from the eyes to the brain. It often affects
vision. It can also affect hormones since it’s usually at the base of the brain
where hormone control is located.
Other less common types of brain
Embryonal tumors. These tumors are found more often in
children than in adults. The most common type in children is called a
medulloblastoma. It starts in the cerebellum.
These tumors tend to grow and spread quickly.
Craniopharyngioma. This rare benign tumor starts near
the pituitary gland. It's usually slow growing. But it can cause symptoms if it
presses on the pituitary gland or nearby nerves.
Mixed glial and neuronal tumors. These tumors are made
up of glial and nerve cells. They're slow growing and are found in the
Choroid plexus tumor. This is a rare tumor that starts
in the ventricles of the brain. Most are benign.
Schwannoma. This kind of tumor starts in myelin-making
cells that cover nerves. It’s most common in the nerve in the inner ear that helps
with balance. If it grows there, the tumor is called a vestibular schwannoma or
an acoustic neuroma. This type of tumor is usually benign.
Healthcare providers don’t know why
certain children develop a brain tumor. Rarely, brain tumors are the result of exposure
to radiation or linked to a familial cancer syndrome.
Children with certain genetic
conditions have an increased risk for tumors of the central nervous system. This
includes children with:
- Neurofibromatosis type 1 (von
Recklinghausen disease) and type 2
- Von Hippel-Lindau disease
- Li-Fraumeni syndrome
- Hereditary retinoblastoma
- Tuberous sclerosis
- Gorlin syndrome
- Cowden syndrome
- Turcot syndrome
- Rubinstein-Taybi syndrome
Children who have had radiation
therapy for other cancers of the head are also at an increased risk for a new brain
Symptoms vary depending on how big
the tumor is, how fast it's growing, and where it is in the brain.
Growing tumors may cause
increased pressure on the brain in the limited space inside the skull. This is called
increased intracranial pressure (ICP). But this isn’t usually the case in babies because
their skull bones haven’t fully grown together.
Pressure on the brain may
cause symptoms like:
- Enlarged head in infants
- Nausea and vomiting
- Personality changes
- Vision, hearing, and speech
Symptoms of brain tumors in the
cerebrum can include:
- Changes in vision or hearing
- Trouble talking or understanding
- Weakness or paralysis in part of the
body (often just one side)
- Mood changes, such as feeling
Symptoms of brain tumors in the
cerebellum can include:
- Trouble swallowing
- Trouble with eye movement
- Changes in speech
- Clumsy movements of the hands, arms,
feet, or legs
- Problems walking (ataxia)
Symptoms of brain tumors in the
brainstem can include:
- Balance problems
- Trouble walking (ataxia)
- Muscle stiffness
- Trouble with eye or other facial
- Trouble swallowing
- Double vision
- Hearing loss
- Bowel or bladder problems
The symptoms of a brain tumor can
be like many other health conditions. Make sure your child sees a healthcare provider
for a diagnosis.
Your child's healthcare provider
will ask about your child's health history and symptoms. An exam will be done. It
include a neurological exam. This tests reflexes, muscle strength, eye and mouth
movement, and coordination. Your child's healthcare provider may refer your child
healthcare provider specializing in the nervous system (neurologist or neurosurgeon)
to a cancer specialist (oncologist). Your child may need tests such as:
MRI. An MRI
uses magnets, radio waves, and a computer to make detailed pictures of the inside
of the body. Contrast dye may be put into your child's blood through a vein. It
helps to show the tumor more clearly.
CT scan. A CT scan uses a series of X-rays
and a computer to make detailed pictures of the inside of the body. It might be used
if an MRI can't be done or in some emergencies.
Lumbar puncture. A special needle is put into the lower
back, into the spinal canal. This is the area around the spinal cord. A small amount
of cerebrospinal fluid (CSF) is removed and sent for testing. CSF is the fluid around
the brain and spinal cord. This test is done to check the spinal fluid for cancer
Positron emission tomography (PET) scan. For this test, a
radioactive sugar is put into the bloodstream. Cancer cells use more sugar than
normal cells, so the sugar will collect in cancer cells. A special camera is then
used to see where the radioactive sugar collects in the body. A PET scan can
sometimes find cancer cells in other parts of the body, even when they don’t show
on other tests. This test is often used in combination with a CT scan. This is called
a PET/CT scan.
Biopsy. Tumor cells are removed and sent to a lab for
testing. A biopsy is done to find out the type of tumor and how quickly it's likely
Blood tests. Blood tests may be done to check for
substances that are released by some tumors. These are called tumor markers.
These tests will show where the
tumor is, how big it is, and if it's cancer (malignant) or not cancer (benign). If
child has cancer, these tests provide important information when deciding how to best
treat the cancer and what outcomes to expect. Some types of cancer use standard staging
systems of numbers and letters to note this information and whether the cancer has
spread. Brain tumors are not staged this way because they usually don't spread. Instead,
when planning treatment and predicting outcomes, your child's healthcare providers
look at things like:
- The exact type of tumor
- The location and size of the
- Whether the cancer has spread to the
CSF, spinal cord, more than one part of the brain, or beyond the brain
- How the tumor is affecting your
- Your child's age
- Whether the tumor can be removed with
The healthcare provider will also
consider the grade of the cancer cells. This is a measure of how quickly the cells
likely to grow and spread. It's based on how much the cancer cells look like normal
cells. High-grade cancer cells look very different from normal cells and are more
to grow and spread quickly.
Your child's healthcare provider
will talk to you about these things and recommend treatment for your child. These
long and complex discussions. Be sure to ask questions and have the healthcare provider
explain things to you in a way you understand so you can make the best decisions for
Since brain tumors in children are
rare, it's important to find a healthcare team that has experience and skill in treating
children with brain tumors.
Treatment may include 1 or more of
Surgery. Surgery is usually the first step in treating
brain tumors. The goal is to remove as much of the tumor as possible, while keeping
brain function. The surgery is also done to take a sample of the tumor to determine
what kind it is.
Chemotherapy. These are strong medicines that kill cancer
cells or stop them from growing. They may be given into the vein (IV), injected into
tissue, or taken by mouth.
Targeted therapy. These are medicines that focus on
specific parts of cancer cells.
Radiation therapy. These are high-energy X-rays or other
types of radiation. They're used to kill cancer cells or stop them from growing.
Stereotactic surgery is a special type of radiation therapy. It uses very focused
beams of energy that can destroy tumors with less damage to normal, surrounding
Other treatments may include:
Corticosteroids. These treat and prevent swelling in the
Antiseizure medicine. These treat and prevent
Ventriculoperitoneal (VP) shunt. A long tube called a
shunt may be put inside the brain to remove extra fluid. This helps control
Antibiotics. These treat and prevent infections.
Hormones. Medicines can be used to replace hormones if a
tumor affects natural hormone production.
Sometimes these treatments are called supportive or palliative care.
They're used to treat side effects and problems caused by the tumor, but not the tumor
itself. Medicines and other treatments can be used for pain, fever, infection,
nausea, and vomiting.
With any tumor, how well a child is
expected to recover (prognosis) varies. Keep in mind:
- Getting medical treatment right away
is important for the best outcomes.
- Ongoing follow-up care during
and after treatment is needed.
- New treatments are being tested to
improve outcomes and to lessen side effects.
A child may have complications from
the tumor or from treatment, such as:
- Damage to the brain or nervous system
that causes problems with coordination, muscle strength, speech, or eyesight
- Problems after surgery, like
infection, bleeding, and problems with general anesthesia (the medicines used to make
your child sleep during surgery)
- Infection and bleeding
- Delayed growth and development
- Learning problems
- Problems with reproduction
- Return of the cancer
- Growth of other cancers in the
A child with a brain tumor needs
ongoing care. Your child will be seen by oncologists and other healthcare providers
treat any late effects of treatment and to watch for signs or symptoms of the tumor
returning. Your child will be checked with imaging tests and other tests. And your
may see other healthcare providers for problems from the tumor or from treatment.
instance, your child may see an eye care provider (ophthalmologist) for vision problems.
Your child may need therapy to help
with movement and muscle strength. This may be done by physical and occupational
therapists. If your child's speech is affected, they may need help from a speech
therapist. Your child may also need the help of other therapists for learning or
You can help your child manage
their treatment in many ways. For instance:
- Your child may have trouble eating. A
dietitian may be able to help.
- Your child may be very tired. They
will need to balance rest and activity. Encourage your child to get some exercise.
This is good for overall health. And it may help to lessen tiredness.
- Get emotional support for your child.
A counselor, psychologist, or child support group can help.
- Make sure your child attends all
When to Call a Healthcare Provider
Call the healthcare provider if
your child has:
- Symptoms that get worse or don't get
better with treatment
- New symptoms
- Side effects from treatment
- Signs of infection, like fever or chills
- Trouble breathing
- Brain tumors start in the cells of the
- Brain tumors can grow at any age.
Those that grow in infants and children are very different from those in adults.
- The types of brain tumors are based on
the cell type and its location in the brain.
- Some common symptoms of brain tumors
are headache, nausea and vomiting, and trouble with movement.
- Most children are treated with
surgery, chemotherapy, and radiation therapy.
- Ongoing follow-up care is important to
watch for effects of tumors or treatment and the cancer growing back.
Tips to help you get the most from
a visit to your child’s healthcare provider:
- Know the reason for the visit and what
you want to happen.
- Before your visit, write down
questions you want answered.
- At the visit, write down the name of a
new diagnosis and any new medicines, treatments, or tests. Also write down any new
instructions your provider gives you for your child.
- Know why a new medicine or treatment
is prescribed and how it will help your child. Also know what the side effects
- Ask if your child’s condition can be
treated in other ways.
- Know why a test or procedure is
recommended and what the results could mean.
- Know what to expect if your child does
not take the medicine or have the test or procedure.
- If your child has a follow-up
appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s
provider after office hours. This is important if your child becomes ill and you have
questions or need advice.