Childhood Brain Tumors

Brain and spine tumors are the second most common cancers in children after leukemia. Brain tumors affect nearly 2,500 children in the United States every year, accounting for 20% of childhood cancers.

The brain controls many important facets of everyday life, including emotions, thought, speech, vision, hearing and movement. The brain sends messages throughout the body via the spinal cord and cranial nerves in the head. The network of the brain and spinal cord is called the central nervous system (CNS). Tumors can develop in the spinal cord and cranial nerves.

The hard, bony skull protects the brain, and the bones (vertebrae) of the spine protect the spinal cord. A liquid  called cerebrospinal fluid (CSF) surrounds both the brain and the spinal cord.

The brain has four main parts:

Basal ganglia: Found deeper inside the brain, these play a part in muscle movement.

Brain stem: Located at the base of the brain, the brain stem has nerve fibers that carry messages between the cerebrum and the rest of the body. A small but important area, the brain stem plays a part in breathing and heartbeat.

Cerebellum: At the back of the brain, this section helps control and coordinate movement, such as walking and swallowing.

Cerebrum: The outer and largest part of the brain. It has two halves called hemispheres and is responsible for emotions, reasoning, language, movement and the senses of seeing, hearing, smelling and touch; and the perception of pain.

Childhood brain tumor types

Because the brain and spinal cord are made up of many kinds of tissues and cells, many types of tumors – both benign and malignant– can develop in these areas. These tumors may require different treatment and have different outlooks.

Even when brain tumors are benign, they can cause serious problems. Although non-cancerous brain tumors usually grow slower than cancerous brain tumors, they may damage and press against normal brain tissue or the spine as they grow.

Childhood brain and spinal cord tumors differ from adult tumors. The location where they develop, the type of cell in which they develop, and their treatment and outlook often are different. Brain tumors are classified by the types of cells they contain. This determines how they grow and what kind of treatment they require. The brain tumors  found most often in children are the following.

Medulloblastoma: This is the most common type of malignant brain tumor in children. Learn more about medulloblastoma.

Astrocytoma: These form in the cerebrum in cells called astrocytes. They usually grow slowly, but higher-grade tumors spread more quickly. Since they mix with normal brain tissue, they can be difficult to remove surgically. They may spread along pathways of CSF but seldom spread outside the brain or spinal cord. Glioblastoma is the highest grade astrocytoma and the fastest growing.

Diffuse intrinsic pontine glioma: This dangerous tumor often has a poor prognosis. It grows in a vital area of the brain called the pons, which is in the brain stem.

Ependymomas develop in the brain lining, usually in the posterior fossa or along the spinal cord in glial cells. About five percent of childhood brain tumors are ependymomas. They begin in cells that line the ventricles or central canal of the spine. Ependymomas do not usually spread outside the brain or spinal cord, but they may block CSF, causing hydrocephalus.

Primitive neuroectodermal tumors (PNET): These aggressive tumors can develop anywhere in the brain, but they are usually in the frontal, temporal or parietal lobes.

Pineoblastomas: A type of PNET that develops in pineal gland and can be difficult to treat.

Craniopharyngiomas: These slow-growing tumors start above the pituitary gland but below the brain. They may press on the pituitary gland and hypothalamus, causing hormone problems. Since they start near the optic nerves, they can cause vision problems and be difficult to remove without damaging vision.

Mixed glial and neuronal tumors: Certain tumors that develop in children and young adults (and rarely in older adults) have both glial and neuronal cell components. They tend to have a fairly good prognosis.

• Pleomorphic xanthoastrocytoma (PXA) and dysembryoplastic neuroepithelial tumors (DNETs) look as if they could grow quickly when viewed under the microscope, but these tumors tend to be fairly benign, and most are cured by surgery alone.
• Ganglioglioma is a type of tumor that has both mature neurons and glial cells. Most can be cured by surgery alone or surgery combined with radiation therapy.

Choroid plexus tumors: These rare tumors start in the choroid plexus within the ventricles of the brain. Most are benign and can be removed by surgery.

Other tumors that start in or near the brain

Meningiomas: These tumors begin in the meninges, the tissue around the outer part of the brain and spine. They may press on the brain or spinal cord. Meningiomas are almost always benign and are usually cured by surgery. If they are near vital structures in the brain, they may need additional treatment.

Chordomas start in the bone at the base of the skull or at the lower end of the spine. They can injure the nervous system by pressing on it. They usually do not spread to other areas.

Germ cell tumors: Developing from germ cells, which normally form eggs in women and sperm in men, these are rare tumors. They form in the fetus when germ cells move to abnormal locations, including the brain. Germ cell tumors of the nervous system are usually found in children, most commonly in the pineal gland or above the pituitary gland. Learn more about childhood germ cell tumors.

Brain metastases: Cancers that metastasize (spread) to the brain from other areas of the body are called metastases. These are treated differently than primary brain cancers.

Childhood brain tumors risk factors

Anything that increases your child’s chance of getting a brain tumor is a risk factor. While no definite risk factors have been found for childhood brain tumors, some things may put your child at increased risk, including:

• Radiation exposure, particularly if your child was treated with radiation to the brain for leukemia. This late effect usually is seen between 10 to 15 years after treatment.
• Rare inherited genetic conditions, including:
  • Tuberous sclerosis
  • Neurofibromatosis types 1 and 2
  • Von Hippel-Lindau disease
  • Li-Fraumeni syndrome
• Other diseases that run in certain families, including:
  
  • Turcot syndrome
  • Rubinstein-Taybi syndrome
  • Gorlin syndrome (basal cell nevus syndrome)

Some cases of brain cancer can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.

Childhood brain tumors frequently cause changes in hearing, memory, learning, sight, smell or emotion. Because adults or the child may notice these changes early in the development of a tumor, childhood brain tumors often are diagnosed before they have spread.

Symptoms of childhood brain tumors depend on their location in the brain. The exact symptoms change from child to child. Some signs of a possible brain tumor include:

• Frequent nausea and vomiting
• Seizures
• Headache, usually in the morning
• Later than normal growth and development milestones, such as walking or talking
• Blurred vision
• Problems speaking or swallowing
• Mood or behavior changes
• Coordination and balance problems
• Weakness or tingling in the arms or legs
• Swelling around an eye
• Weakness of facial muscles
• Problems swallowing
• Abnormal eye movement
• Abnormal tilting of head to one side
• Increase in head size (in babies)
• Pain in the back, arms or legs
• Changes in bowel or urinary habits

These symptoms do not always mean your child has a brain tumor. In fact, they usually are caused by something less serious. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

Early and accurate diagnosis of a childhood brain tumor can increase the chances for successful treatment.

At MD Anderson’s Children’s Cancer Hospital, our specialized medical team has the depth of experience and expertise that is vital to targeting childhood brain tumors. And we have the most advanced and accurate equipment to pinpoint the exact extent and location of your child’s tumor.

Childhood brain tumor diagnostic tests

If your child has symptoms of a brain tumor, the doctor will examine your child carefully and ask you questions about your child’s and family’s medical history. The doctor also may do a neurological exam to test reflexes, muscle strength, vision and other functions of the brain and spine.

If anything appears abnormal, your doctor may refer your child to a neurologist or neurosurgeon, doctors who specialize in the nervous system.

One or more diagnostic test may be used to find out if your child has a brain tumor and if it has spread. These tests also may be used to find out if treatment is working.

Imaging tests, which may include:

• CT or CAT (computed axial tomography) scans
• MRI (magnetic resonance imaging) scans
• PET (positron emission tomography) scans
• X-rays
• Angiogram to examine blood vessels
• Bone scan

Biopsy: If imaging tests show an area that may be a brain tumor, a biopsy almost always is necessary for diagnosis. In a biopsy, the doctor removes a small amount of tissue, which is then examined with a microscope. One of the following biopsy methods will be used.

Surgery: A biopsy may be done during surgery in which all or part of the brain tumor is removed. The operation is called a craniotomy. If a tumor is difficult to reach, a CT scan may be used during surgery to locate the tumor precisely. The tissue removed is examined immediately. Sometimes surgery to remove the tumor can be done during the same procedure.

Stereotactic (needle) biopsy: If a tumor is difficult to reach, a CT scan may be used for to place a hollow needle inside the tumor and remove a small amount of tissue.

Bone marrow aspiration and biopsy

Lumbar puncture or spinal tap: A small amount of CSF (cerebrospinal fluid, which is the clear liquid in and around the brain and spine) is removed with a needle and looked at with a microscope.

Blood and urine tests

Our treatment approach

A team of some of the nation’s top experts customizes your child’s brain tumor treatment at MD Anderson’s Children’s Cancer Hospital. They work together, communicating with each other and your family, to deliver the most advanced therapies with the least impact on the body, keeping a constant eye on your child’s current and future quality of life.

These highly trained physicians specialize in childhood brain tumor treatment for both malignant (cancer) and benign (non-cancer) brain tumors. Your child’s personal medical team may include renowned neurosurgeons, radiation oncologists and neuro-oncologists. They are supported by a specially trained staff, including nurses, physician’s assistants, psychologists, social workers, rehabilitation specialists, therapists and other health professionals.

Surgical expertise

Like all surgeries, childhood brain tumor surgery is most successful when it is performed by a specialist with a great deal of experience in the particular procedure. This is especially true with brain tumors, because it is crucial to remove as much of the tumor as possible while leaving intact as much brain function as possible.

Children’s Cancer Hospital pediatric neurosurgeons are among the most skilled and recognized in the world. They perform a large number of childhood brain tumor surgeries each year, using the least-invasive and most-advanced techniques.

We have the expertise to examine each tumor carefully to determine gene-expression profiles, which then guide us toward the most advanced, effective treatment targeted to your child’s specific cancer. This personalized medicine approach sets us above and beyond most cancer centers and allows us to attack the specific causes of each cancer.  

Our childhood brain tumor treatments

If your child is diagnosed with a brain tumor, your doctor will talk to you about the best options to treat it. This depends on several factors, including the location and type of the tumor and your child's general health.

One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

Surgery usually is the first treatment for brain tumors in children. If complete removal of the tumor is not possible, the surgeon will remove as much as the tumor as possible without damaging surrounding areas.

Surgery also may help:

• Reduce the size of the tumor
• Relieve symptoms, such as headaches, nausea
• Place a shunt to drain excess CSF (cerebrospinal fluid), which may cause symptoms including headaches and blurred vision

The most common surgery for brain tumors is craniotomy, in which the skull is opened. Some brain tumors can be removed with little or no damage to the brain. However, many grow in areas that make them difficult or impossible to remove without destroying important parts of the brain.

MD Anderson's Children's Cancer Hospital has the latest, leading-edge equipment, called functional MRI or fMRI, to help map the area and make surgery more accurate. Many brain tumors in children can be treated successfully with surgery alone. If additional treatment is necessary, surgery may help by reducing the size of the tumor before radiation or chemotherapy.

Brainsuite® iMRI

When a brain tumor is in a challenging location, our neurosurgeons can use this innovative open MRI system that allows them to view the tumor during surgery. This helps them remove as much of the tumor as possible without damaging other parts of the brain. MD Anderson's Brainsuite is the first in the world of its type.

Radiation therapy

Radiation therapy may be able to stop or slow the growth of childhood brain tumors that cannot be removed with surgery. It generally is not used for children younger than 3 years. Radiation therapy may be used:

• As the main treatment if surgery is not possible
• After surgery to destroy remaining tumor cells
• To help relieve symptoms

New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target brain tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Children's Cancer Hospital uses the most advanced radiation treatment methods, including:

Gamma Knife radiosurgery delivers a pinpoint dose of radiation to the tumor from hundreds of angles. It may be used if the tumor's location makes it impossible to remove of if the child is not healthy enough for surgery.

Focused radiation therapy, which is aimed directly at the tumor and immediately surrounding area

Whole-brain radiation therapy, which may be needed if your child has two or more brain tumors

Intensity-modulated radiotherapy (IMRT), which shapes the radiation beam to the brain tumor and lessens exposure to the rest of the brain.

Proton therapy

The Proton Therapy Center at MD Anderson is one of the largest and most advanced centers in the world, offering passive-scattered and intensity-modulated proton therapy. It's the only proton therapy facility in the country within a comprehensive cancer center. This means this cutting-edge therapy is backed by all the expertise and compassionate care for which MD Anderson is famous.

The ability to precisely target tumors with radiation makes proton therapy ideal for treating certain types of childhood cancer. It provides accurate treatment of tumors near or within sensitive organs while limiting radiation exposure to healthy tissues, which is vital in children whose bodies are still  growing and developing. Studies show that proton therapy can also result in fewer late effects from treatment, a major concern among physicians and families when a child – especially a very young child – is undergoing radiation treatment. This includes potentially fewer issues with brain development for children who have been treated for brain tumors.

Proton therapy may be used to treat many types of tumors, including those in the brain, skull base and spine.

Chemotherapy

Children's Cancer Hospital offers the most up-to-date and advanced chemotherapy options for childhood brain tumors. Chemotherapy, often in conjunction with radiation and surgery, is frequently a treatment for tumors that are growing quickly. It sometimes may be used instead of radiation therapy in children under the age of three. Chemotherapy often is not as effective for brain cancer as some other types of cancer. This is because of the blood-brain barrier, small blood vessels in the brain and spinal cord that protect the brain from harmful substances, which may act as a shield against chemotherapy drugs.

Targeted therapies

These new drugs target the specific gene changes that cause cancer. MD Anderson is at the forefront of discovering these agents. Many of our brain tumor clinical trials determine the best drug for each patient based on analysis of the molecular profiles of patients' tumors.

Medications to decrease symptoms

Certain medications, including anti-seizure drugs, hormones and corticosteroids, may be given to help children with brain tumors feel better.