Children's Brain and Spinal Cord Tumors

The brain and spinal cord make up the central nervous system. This is the body’s command center for thought, emotion, speech, vision, hearing, and balance.

Brain and spinal cord tumors in children are the result of cells growing out of control. As they get bigger, these tumors can press on the cells around them and cause damage. This can prevent the central nervous system from working the way it should.

Because of where they’re located, these tumors can affect a child’s behavior, balance, sight, speech, and hearing. They can also affect bowel and bladder control. Sometimes, they’re life-threatening.

What Parts of the Body Do They Affect?

Children’s brain and spinal cord tumors can be located in the spinal cord or in any of the brain’s three main parts: the cerebrum, cerebellum, or brain stem.

The cerebrum is at the top of the head. It controls learning, emotions, and voluntary movements.

The cerebellum is near the middle of the head, farther back. It controls balance.

The brain stem is connected to the spinal cord. It controls breathing, heart rate, and the nerves and muscles you use to walk, talk, hear, eat, and see.

The spinal cord connects the brain with nerves throughout the body. It sends signals back and forth for things like moving muscles.

What Are the Different Types?

There are many, but they fall into two main categories: benign (not cancerous) or malignant (cancerous).

Benign brain and spinal cord tumors can affect the brain, brain stem, and spinal cord. They rarely spread to other parts of the body. Still, these tumors can cause serious problems because of where they’re located. They can even be life-threatening.

Malignant tumors are likely to grow quickly. They may also spread into other brain tissue, or to other parts of the body.

Some of the most common types of tumors that affect children include:

Astrocytomas

These tumors start in a common type of star-shaped glial cell called an astrocyte. They make up about 10% to 20% of all brain tumors in children. Astrocytomas often start in the pons, a part of the brainstem that controls breathing and heart rate, but they can form anywhere in the brain or spinal cord. They can be benign or malignant.

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Astrocytomas usually spread throughout the brain and blend with other tissue. But not all of these tumors behave the same. Some grow fast, and some grow slowly. Not all of them grow into other tissue.

High-grade and intermediate-grade astrocytomas grow and spread quickly. Low-grade astrocytomas tend to grow more slowly.

Pilocytic astrocytomas are low-grade astrocytomas that are responsible for 1 in 5 brain tumors in children. They usually start in the cerebellum, which is toward the back of the brain. They can also start in other areas such as the optic nerve, hypothalamus, and brain stem. These are called diffuse intrinsic pontine gliomas (DIPGs).

Primitive neuroectodermal tumors (PNETs)

These make up about 1 in 5 brain tumors in children. They start in immature central nervous cells (neuroectodermal cells). They’re more common in younger children than older ones, and they typically grow quickly.

The most common PNET is a medulloblastoma, which starts in the cerebellum. Other PNETS include pineoblastomas, which start in the pineal gland. Neuroblastomas start in the brain or spinal cord.

Ependymomas

These tumors start in the ependymal cells that line the ventricles in your brain or central canal of your spinal cord. Ependymal cells produce cerebrospinal fluid (CSF).

CSF flows along the canal and through the ventricles. Ependymomas can block the flow of CSF out of the ventricles. This can cause fluid buildup in the brain, a condition called hydrocephalus. When this happens, your doctor will likely have to drain the excess fluid. They may put in a shunt to help the fluid drain.

About 1 in 20 brain tumors in children is an ependymoma. They can be fast-growing or slow-growing. If they’re fast-growing, they’re called anaplastic ependymoma. These tumors spread along the CSF pathway but don’t spread into normal brain tissue.

Craniopharyngiomas

These tumors start just above the pituitary gland and just below the brain. They account for 1 in 25 childhood brain tumors and are thought to be inherited. That means they run in families.

Craniopharyngiomas can press into the optic nerve and cause vision problems. They can also press into the pituitary and the hypothalamus glands, leading to hormone problems.

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Oligodendrogliomas

This rare brain tumor starts in the brain, in glial cells called oligodendrocytes. This tumor tends to be slow-growing but can get into the surrounding tissues.

Schwannomas

These start in the Schwann cells that surround and insulate nerves. They tend to be benign. These tumors are rare in children and are usually the result of an inherited condition like neurofibromatosis type 2.

Schwannomas usually form near the cerebellum on a nerve responsible for hearing and balance. These are called vestibular acoustic or vestibular schwannomas.

Choroid plexus tumors

These tumors are rare, mostly benign, tumors that start in the ventricles of the brain.

Mixed gliomas

These are made up of more than one type of cell. They can include oligodendrocytes, astrocytes, and ependymal cells.

Mixed glial and neuronal tumors

These are made up of glial and neuronal cells. They tend to affect children and young adults. They include ganglioglioma, pleomorphic xanthoastrocytoma (PXA), and a dysembryoplastic neuroepithelial tumor (DNET).

What Causes Them?

Doctors aren’t sure.

In rare cases, children have inherited genes that increase the risk of a brain or spinal cord tumor. These include neurofibromatosis, Li Fraumeni syndrome, Lynch syndrome, and tuberous sclerosis.

What Puts a Child At Risk?

Radiation is the only known environmental risk factor. This is usually the result of medical treatment for some other condition. Radiation therapy, CT scans, and X-rays to the head all increase the risk of tumors.

Electromagnetic radiation from cell phones and power lines have both been studied as possible risk factors. But researchers haven’t found convincing evidence that links these things to childhood brain tumors.

At What Age Are Children Typically Diagnosed?

Unless they have a higher genetic risk, children aren’t routinely tested for brain or spinal cord tumors. They’re usually tested only if they’re showing symptoms. That means there’s no standard age for children to be diagnosed with a brain or spinal cord tumor.

Children can develop tumors as infants or teenagers. Symptoms like headaches, vomiting, dizziness, and feeling off balance can develop slowly or come on quickly.

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How Are These Tumors Diagnosed?

Your child’s doctor may have a specialist called a pediatric neurologist check your child. If it’s cancer, they’ll see a pediatric oncologist.

To start, the doctor will ask about your child's symptoms and health history. They’ll also ask questions and do some tests to see how well your child's brain and spinal cord are working. This is called a neurological exam. The doctor will check your child's reflexes, senses, and thinking ability.

Other tests used to diagnose tumors include:

  • Magnetic Resonance Imaging (MRI). This test uses a powerful magnet and radio waves to make pictures of your child's brain and spinal cord. It can show the location and size of a tumor. Your child might get medicine to help them sleep so they stay still during the test. Before the MRI, the doctor might give them an injection of gadolinium into a vein. This substance makes the tumor show up clearer on the picture.
  • Computed tomography, or CT. This test uses X-rays and a computer to make detailed pictures inside the body. Your child might have dye injected into a vein before the test to help the doctor see the tumor more easily.
  • Lumbar puncture (spinal tap). In this test, the doctor places a needle into your child's back and removes a small sample of spinal fluid. Medicine is used to numb the area first. A lab technician checks the fluid under a microscope to see if it contains cancer cells.
  • Biopsy. This is the only test that can confirm your child has a tumor. The surgeon removes a small piece of brain tissue through a needle. If cancer cells are present, the doctor will remove the tumor during the same surgery.

After the tests, your doctor will give the tumor a grade based on how fast it is likely to grow. Low-grade tumors grow more slowly than high-grade ones. Once the doctor knows the grade, they can better plan your child's treatment.

Children's Brain and Spinal Cord Tumors Treatment

If your child has been diagnosed with a brain or spinal cord tumor, their doctor will discuss the best treatment options with you. Usually that means surgery to remove the tumor. Depending on whether it’s benign or malignant, other treatments like radiation therapy or chemotherapy, may follow.

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A number of things will determine what kind of treatment your doctor recommends. These include:

  • Size and location of tumor
  • If the tumor is benign or malignant
  • Your child’s age and overall health
  • The risks of a particular treatment
  • The treatment you -- the parent -- most prefer

Is surgery always necessary?

No. A benign tumor is a concern, but it might not need to be removed right away. If your child’s tumor is slow growing or doesn’t appear to be changing, the doctor may decide to take a wait-and-see approach. They can monitor the tumor with the help of an MRI. This painless test uses a magnetic field and radio waves to make pictures inside your child’s body.

Before the doctor decides to operate, they’ll do a biopsy on the tumor to see if it contains cancer.

Nonsurgical treatments

In many cases, monitoring isn’t enough. The tumor may be cancerous and growing. If surgery isn’t an option, you still have others, such as:

Radiation therapy. This uses high-energy particles or waves to destroy cancer cells. It can also damage healthy cells around a tumor, and have serious effects on brain development. Radiation usually isn’t done on children under 3 years old. Newer techniques are making radiation therapy more precise.

Chemotherapy (“chemo”). This involves medications that your child takes by mouth or gets in a vein through an IV. It’s often used on fast-growing tumors. Children under age 3 can get it.

Both radiation therapy and chemo may cause nausea and fatigue. Spinal radiation therapy tends to cause more nausea than radiation to the brain. But radiation of the brain can cause children to lose some brain function.

Other possible side effects of chemo include:

Surgical treatment s

Craniotomy. This is the most common surgery to remove a brain tumor. The surgeon starts by cutting through the scalp. They’ll remove a piece of skull to expose the brain. The goal is to remove the entire tumor or as much as possible (this depends on where the tumor is located). The surgeon places the piece of skull back into position and sews the scalp back together. If a new tumor appears or if your child continues to have symptoms, they may need a second surgery.

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Neuroendoscopy. A surgeon makes a small hole in the skull or goes through the nose or mouth, depending on the location of the tumor. They use small tools to remove the tumor. One of these has a tiny camera that sends images back to a monitor next to the operating table. The surgeon uses these images to find and remove the tumor.

Spinal surgery. This can take many forms, depending on whether the tumor is in the lower back (lumbar) or the upper back (thoracic). Sometimes spinal surgery is done from the front. Other times, it’s done from the back or even a combination of both. This approach may be necessary when the tumor is in a place that’s hard to reach safely and completely from one side.

If the tumor is cancer, the doctors may recommend radiation therapy or chemotherapy in addition to surgery to help make sure all the cancer cells are dead.

Brain and spinal surgeries are complicated and risky procedures. But treatments are improving every year, giving children with tumors better odds than ever before.

Follow-up care

Brain and spinal cord tumor surgery usually requires at least a few days of recovery in the hospital. The time could be longer, depending on your child’s age, overall health, and the type of treatment. They may need chemotherapy or radiation therapy after surgery. That could also affect how much time they spend in the hospital.

They may get painless tests, like a CT scan and MRI during recovery. Both of these provide doctors with images of the brain to help them see if there have been any obvious changes.

Depending on your child’s condition, they may need a stay in a rehabilitation center.

A team of doctors and nurses will care for your child. Together, they’ll come up with a post-surgery treatment and recovery plan. Some of the specialists your child may see include:

  • Neurologist to evaluate and treat conditions of the nervous system
  • Endocrinologist to help make sure your child has the right hormone levels for healthy growth and development
  • Physical therapist to help with walking and other large-muscle activities
  • Occupational therapist to help with smaller muscle function, such as using eating utensils, buttoning a shirt, brushing teeth, and similar activities
  • Speech therapist to help improve talking and communication skills
  • Ophthalmologist to check your child’s vision
  • Audiologist to check your child’s hearing
  • Psychiatrist or psychologist to evaluate any changes in your child’s learning ability, memory, general intelligence, and other related areas

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Possible Complications

After you get home, you should call 911 if your child has trouble breathing or has a seizure -- especially if it’s different from previous seizures or if your child has never had one.

Other symptoms that should prompt a call to your child’s doctor include:

Call your doctor anytime you have questions about your child’s health during recovery.

Outlook for Children With Brain and Spinal Tumors

The quality of life after brain or spinal cord tumor treatment is determined by the extent of the illness and its treatment. Your child could fully recover from tumor treatment in as little as a few months, or it could take more than a year. Some children might have few lasting problems related to their tumor. Others may have learning problems or some restrictions on sports and other recreational activities. The first year is usually the most challenging.

As much as possible, your child should attend school, spend time with friends, and try to re-establish normal routines. Understand that their friends and classmates may not understand much about brain or spinal cord tumors. You can help bridge this gap by working with your child’s teacher.

Some medical centers have programs to help schools make your child’s adjustment successful. These programs provide schools with a student’s health information and advice about any special education or services they may need.

Long-Term Concerns

One of the great challenges in dealing with life after brain or spinal cord tumor treatment is that some effects may not become obvious for years afterward. This is especially true if your child is very young when treated. Some learning disabilities may not show up until they’ve been in school for some time.

Your child might be at a higher risk for other tumors developing later in life. It’ll be important to follow the doctor’s advice about ongoing checkups and long-term care.

As your child grows, they may have some resentment about having had to go through treatment and recovery. They might also worry about having a normal life down the road. This is where the support of friends, family, and others who have gone through similar experiences can make a positive difference.

WebMD Medical Reference Reviewed by Michael W. Smith, MD on September 10, 2020

Sources

SOURCES:

National Cancer Institute: “Childhood Brain and Spinal Cord Treatment Overview,” “Childhood Ependymoma Treatment -- Health Professional Version,” “Childhood Astrocytomas Treatment -- Health Professional Version,” “Childhood Craniopharyngioma Treatment -- Health Professional Version.”

American Cancer Society: “What Are Brain and Spinal Cord Tumors in Children?” “What are the Risk Factors for Brain and Spinal Cord Tumors in Children?” “Can Brain and Spinal Cord Tumors in Children Be Found Early?” “Types of Brain and Spinal Cord Tumors in Children,” “Treating Brain and Spinal Cord Tumors in Children,” “Radiation Therapy for Brain and Spinal Cord Tumors in Children,” “Chemotherapy for Brain and Spinal Cord Tumors in Children,” “Recovering from the Effects of the Tumor and Its Treatment,” “Social, Emotional, and Other Issues in Children with Brain or Spinal Cord Tumors.”

Seattle Children’s Hospital: “Brain and Spinal Cord Tumors.”

University of Texas MD Anderson Cancer Center: “Cell Phone Use and Brain Tumors in Children.”

National Center for Biotechnology Information: “Neuroglial Cells,” “Astrocytes: Pathology and Biology.”

National Institute of Neurological Disorders and Stroke: “Hydrocephalus Fact Sheet.”

John Hopkins Medicine: “Brain Tumors in Children,” “Care and Recovery After Brain Surgery,” “Treatment for Brain and Spinal Cord Tumors in Children.”

American Association of Neurological Surgeons: “Spinal Tumors.”

St. Jude Children’s Research Hospital: “What to Expect When Your Child Needs Brain Tumor Surgery.”

 

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