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Brain tumor - children

Definition

A tumor is any growth of abnormal cells, or the uncontrolled growth of cells. This article is about primary brain tumors. These start in the brain, rather than spreading to the brain from another part of the body.

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Causes, incidence, and risk factors

Primary brain tumors include any tumor that starts in the brain. Tumors may be confined to a small area, invasive (spread to nearby areas), benign (not cancerous), or malignant (cancerous).

Tumors can directly destroy brain cells. They can also indirectly damage cells by producing inflammation, compressing other parts of the brain as the tumor grows, causing swelling in the brain, and increasing pressure within the skull.

Brain tumors are classified depending on the exact site of the tumor, the type of tissue involved, benign or malignant tendencies of the tumor, and other factors. The cause of primary brain tumors is unknown.

Tumors may occur at any age, but many specific tumors have a particular age group in which they are most common. The most common childhood brain tumors are gliomas, astrocytomas, medulloblastomas, ependymomas, and brain stem gliomas. Most brain tumors are rare in the first year of life.

Childhood nervous system tumors may be classified as either infratentorial (located below the tentorium cerebelli), meaning they are in the back third of the brain, or as supratentorial, meaning they are in the front two-thirds of the brain.

Central nervous system tumors, including brain tumors, account for about 20% of all childhood cancers. Only leukemias are more common.

The specific symptoms, treatment, and probable outcome vary according to the site and type of the tumor and the age and general health of the child.

SPECIFIC TUMOR TYPES

Cerebellar astrocytoma:

  • Accounts for about 20% of pediatric brain tumors (peak age is 5 to 8 years old).
  • Usually benign, cystic, and slow-growing.
  • Signs usually include clumsiness of one hand, stumbling to one side, headache, and vomiting.
  • The cornerstone of treatment is surgical removal of the tumor. If complete removal is not possible, radiation therapy may help. Chemotherapy is usually reserved for unremovable, progressive cases.
  • The cure rate varies, depending on the ability of the tumor to be completely removed by surgery, the tumor type, and the response to other therapies if needed.

Medulloblastoma:

  • The most common pediatric malignant brain tumor (10-20% of all pediatric brain tumors).
  • Occurs more frequently in boys than in girls. Peak age is about 5 years old. Most occur before 10 years of age.
  • Signs include headache, vomiting, uncoordinated movements, and lethargy.
  • Can spread (metastasize) along the spinal cord.
  • Surgical removal alone does not cure medullablastoma. Radiation therapy or chemotherapy are often used with surgery.
  • If the cancer returns, it is usually within the first 5 years of therapy.
Ependymoma:
  • Accounts for 8% to 10% of pediatric brain tumors.
  • Tumor growth rates vary.
  • Tumors are located in the ventricles of the brain and obstruct the flow of cerebrospinal fluid (CSF).
  • Signs include headache, vomiting, and uncoordinated movements.
  • Single or combination therapy includes surgery, radiation therapy, and chemotherapy.
  • The cure rate varies, depending on the ability of the tumor to be completely removed by surgery, the tumor type, and the response to other therapies if needed.
Brainstem glioma:
  • Tumor of the pons and medulla
  • Occurs almost exclusively in children
  • Accounts for 10% to 15% of primary brain tumors in children; average age is about 6 years old
  • May grow to very large size before symptoms are present
  • Signs include double vision, facial weakness, difficulty walking, vomiting.
  • Surgical removal is usually not possible due to the location of the tumor.
  • Radiation therapy and chemotherapy are used to shrink the tumor size and prolong life.
  • Overall 5-year survival rate is low.
Craniopharyngioma:
  • Tumor located near the pituitary stalk.
  • Often close to vital structure, making surgical removal difficult.
  • Rare, less than 10% of childhood brain tumors; average age is about 7 to 12 years old.
  • Signs include vision changes, headache, weight gain, endocrine changes.
  • Treated with surgery, radiation therapy, or a combination. There is some controversy over the optimal approach to therapy for craniopharyngioma.
  • Survival and cure rates are favorable, though endocrine dysfunction may persist as well as the effects of radiation on cognition (thinking ability).

Symptoms

The specific symptoms vary, but may include:

IN INFANTSAdditional symptoms that may be associated with primary brain tumors:

Signs and tests

A doctor can often identify signs and symptoms that are specific to the location of the tumor. Some tumors may not show symptoms until they are very large and cause a rapid decline in the child's mental function. Other tumors have symptoms that develop slowly.

Most brain tumors increase pressure within the skull and compress brain tissue because of their size and weight.

The following tests may confirm the presence of a brain tumor and identify its location:

  • CT scan of the head
  • MRI of the head
  • EEG
  • Examination of tissue removed from the tumor during surgery or CT-guided biopsy (may confirm the exact type of tumor)
  • Examination of the cerebral spinal fluid (CSF) may reveal cancerous cells

Treatment

A primary brain tumor should have prompt treatment. Early treatment improves the chance of a good outcome for many tumors.

The treatment approach varies with the size and type of the tumor and the general health of the child. The goals of treatment may be to cure the disorder, relieve symptoms, and improve brain function or the child's comfort.

Surgery is necessary for most primary brain tumors. Some may be completely removed. Tumors that are deep or that infiltrate brain tissue may be debulked (reducing the tumor's size and mass) rather than removed.

In cases where the tumor cannot be removed, surgery may still help reduce pressure and relieve symptoms.

Radiation therapy may be advised for tumors that are sensitive to radiation. Anticancer medications (chemotherapy) may be recommended.

Other medications may include the following:

  • Corticosteroids such as dexamethasone to reduce brain swelling
  • Osmotic diuretics such as urea or mannitol to reduce brain swelling and pressure
  • Anti-convulsants such as phenytoin to reduce seizures
  • Pain medications
  • Antacids or histamine blockers to control stress ulcers
Comfort measures, safety measures, physical therapy, occupational therapy and other such steps may be required to improve quality of life. Counseling, support groups and similar measures may be needed to help in coping with the disorder.

Support Groups

For additional information, see cancer resources.

Complications

  • Brain herniation (often fatal)
  • Permanent, progressive, profound neurologic losses
  • Loss of ability to interact or function
  • Side effects of medications, including chemotherapy
  • Side effects of radiation treatments
  • Return of tumor growth

Calling your health care provider

Call the child's health care provider if he or she develops any new, persistent headaches or other symptoms suggestive of a brain tumor.

Call the provider or go to the emergency room if the child has seizures that are new, or suddenly develops stupor (reduced alertness), vision changes, or speech changes.

Illustrations

Brain
Brain
Primary brain tumor
Primary brain tumor

Page Content:

Glioblastoma multiforme - children; Ependymoma - children; Glioma - children; Astrocytoma - children; Medulloblastoma - children; Neuroglioma - children; Oligodendroglioma - children; Meningioma - children; Cancer - brain tumor (children)