The brain and spinal cord make up the central nervous system. Tumors of the central nervous system are the second most common cancer in children under 15 years of age (after leukemia) and the leading cause of death in children from cancer.
The most common central nervous system tumors in children are (in order) astrocytomas, medulloblastomas, and ependymomas.
Brain tumors can cause various symptoms, including headaches, nausea, vomiting, vision problems, listlessness, and loss of coordination or balance.
The diagnosis is usually based on results of magnetic resonance imaging and a biopsy.
Treatment may involve surgery, radiation therapy, chemotherapy, targeted therapy, or a combination.
The cause of central nervous system tumors is usually unknown. However, high doses of radiation to the brain and spinal cord and certain genetic disorders (for example, neurofibromatosis) are known to cause central nervous system tumors.
(See also brain tumors in adults.)
Symptoms of Brain and Spinal Cord Tumors in Children
The first brain tumor symptoms may result from increased pressure within the skull (intracranial pressure). Pressure may be increased because the tumor blocks the flow of cerebrospinal fluid within the brain (a condition called hydrocephalus) or because the tumor takes up space. Increased pressure can cause the following symptoms:
An enlarged head (macrocephaly) in infants and very young children
Headaches
Nausea and vomiting (often when the child first awakens)
Vision problems, such as double vision or vision loss
Difficulty turning the eyes upward
Changes in behavior or consciousness level, making the child irritable, listless, confused, or drowsy
Seizures
When the tumor involves the spinal cord, symptoms can include the following:
Back pain
Muscle weakness in arms or legs
Loss of sensation in arms or legs
Loss of bladder or bowel control
Difficulty walking
Other symptoms vary depending on where the tumor is located in the brain or the spine.
Diagnosis of Brain and Spinal Cord Tumors in Children
Imaging tests
Usually biopsy or sometimes surgery to remove the entire tumor
Sometimes a spinal tap
Doctors suspect a brain or spinal cord tumor based on symptoms.
Doctors typically do an imaging test such as magnetic resonance imaging (MRI) of the brain, which can usually detect a tumor. Computed tomography (CT) may also be done. Before MRI or CT is done, a contrast agent is usually injected into a vein (intravenously). Contrast agents are substances that make organs and other structures clearer to see on imaging tests.
If a brain or spinal cord tumor is suspected, doctors usually remove a small piece of tissue (biopsy) to confirm the diagnosis. Sometimes, instead of removing a small piece, doctors surgically remove as much of the tumor as possible.
Sometimes a spinal tap (lumbar puncture) is done to obtain cerebrospinal fluid for examination under a microscope. This procedure is done routinely to determine whether tumor cells have spread to the cerebrospinal fluid or when the diagnosis is unclear.
Treatment of Brain and Spinal Cord Tumors in Children
Surgical removal of the tumor
Chemotherapy, radiation therapy, targeted therapy, or a combination
Drainage of cerebrospinal fluid
(See also Cancer Treatment Principles.)
Usually, treatment of brain and spinal cord tumors involves surgically removing the tumor. Then, chemotherapy, radiation therapy, targeted therapy, or a combination is used.
Treatment should be planned by a team of experts who have experience treating these tumors in children. The care team may include doctors who specialize in the care and treatment of babies, children, and adolescents such as pediatric cancer specialists (oncologists), pediatric neurologists, pediatric neurosurgeons, and radiation oncologists.
When possible, the tumor is removed surgically. Brain tumors are removed by opening the skull (called a craniotomy). Some brain tumors can be removed with little or no damage to the brain. After surgery, MRI is done to determine whether any of the tumor is left and, if so, how much.
After surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of these treatments may be required. In children younger than 5 years of age, depending on the tumor type, chemotherapy may be used first because radiation therapy can interfere with growth and brain development. If needed, radiation therapy may be added when children are older. Chemotherapy may also have serious side effects.
If the tumor is blocking the flow of cerebrospinal fluid, a small tube (catheter) may be used to drain the cerebrospinal fluid before the tumor is surgically removed. After a local or general anesthetic is given, the tube is inserted through a tiny opening drilled in the skull, and fluid is withdrawn to reduce the pressure within the skull. The tube is connected to a gauge that measures the pressure within the skull. After a few days, the tube is removed or may be converted to a permanent drain called a shunt (see Treatment of Hydrocephalus).
Because cancer is relatively rare in children, the doctor may speak with the parents about entry into a clinical trial, if available. In such trials, some children receive the standard treatment, and others receive the treatment being tested (called experimental treatment). The experimental treatment may involve new chemotherapies, new combinations of older medications, or new surgical or radiation techniques. However, experimental treatments are not always effective, and side effects or complications may not be known.
More Information
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
American Cancer Society: If Your Child Is Diagnosed With Cancer: A resource for parents and loved ones of a child who has cancer that provides information about how to cope with some of the problems and questions that come up just after a child is diagnosed
The brain tumors organizations here provide information about types of and treatments for brain tumors as well as information for caregivers about support resources:
