Pediatric brain tumors: types, causes, diagnosis and treatment
Pediatric brain tumors are masses or growths of abnormal cells that occur in a child’s brain or the tissue and structures that are near it
Many different types of pediatric brain tumors exist — some are noncancerous (benign) and some are cancerous (malignant)
Treatment and chance of recovery (prognosis) depend on the type of tumor, its location within the brain, whether it has spread, and your child’s age and general health.
Because new treatments and technologies are continually being developed, several options may be available at different points in treatment.
Treatment for brain tumors in children is typically quite different from treatment for adult brain tumors, so it’s very important to enlist the expertise and experience of pediatric specialists in neurology and cancer.
Types of pediatric brain tumors
- Choroid plexus carcinoma
- Craniopharyngioma
- Embryonal tumors
- Ependymoma
- Glioma
- Medulloblastoma
- Pineoblastoma
Symptoms of pediatric brain tumors
Signs and symptoms of a brain tumor in children vary greatly and depend on the brain tumor type, size, location and rate of growth.
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Some signs and symptoms may not be easy to detect because they’re similar to symptoms of other conditions.
Some of the more common symptoms of a brain tumor in children include:
- Headaches, which may become more frequent and more severe
- Feeling of increased pressure in the head
- Unexplained nausea or vomiting
- Abrupt onset of vision problems, such double vision
Other possible signs and symptoms, depending on the tumor location, include:
- A fuller soft spot (fontanel) on the skull in babies
- Seizures, especially when there’s no history of seizures
- Abnormal eye movement
- Slurred speech
- Trouble swallowing
- Loss of appetite; or in babies, difficulty feeding
- Difficulty with balance
- Trouble walking
- Weakness or loss of sensation in an arm or a leg
- Weakness or drooping on one side on the face
- Confusion, irritability
- Memory problems
- Personality or behavior changes
- Hearing problems
When to see a doctor
Make an appointment with your child’s doctor if your child has signs and symptoms that concern you.
In most cases, the exact cause of a pediatric brain tumor is not known
Pediatric brain tumors typically are primary brain tumors — tumors that start in the brain or in tissues close to it.
Primary brain tumors begin when normal cells have errors (mutations) in their DNA.
These mutations allow cells to grow and divide at increased rates and to continue living when healthy cells would die.
The result is a mass of abnormal cells, which forms a tumor.
Many different types of brain tumors — which may or may not be cancerous — can occur in children.
Risk factors
In most children with primary brain tumors, the cause of the tumor isn’t clear.
But certain types of brain tumors, such as medulloblastoma or ependymoma, are more common in children.
Though uncommon, a family history of brain tumors or a family history of genetic syndromes may increase the risk of brain tumors in some children.
Diagnosis
If it’s suspected that your child has a brain tumor, the doctor may recommend several tests and procedures to aid in diagnosis and help determine treatment options.
Neurological exam. This exam may include, among other things, checking your child’s vision, hearing, balance, coordination, strength and reflexes. Difficulty in certain areas may provide clues about the part of the brain that could be affected by a brain tumor.
Imaging tests. Imaging tests help determine the location and size of the brain tumor. Magnetic resonance imaging (MRI) is often done. It may be used along with specialized MRI, such as functional MRI or magnetic resonance spectroscopy. Other imaging tests include computerized tomography (CT) and positron emission tomography (PET).
Biopsy. Removing a sample of tissue for testing (biopsy) may be done as part of surgery to remove the brain tumor. Or if the brain tumor is hard to reach or in a sensitive area that might be damaged by extensive surgery, a stereotactic needle biopsy may be done. The pediatric neurosurgeon drills a small hole into the skull, inserts a thin needle through the hole and removes tissue using the needle. The biopsy sample is analyzed in a lab to determine the types of cells and their level of aggressiveness.
Precision medicine diagnosis. In addition to traditional biopsy analysis, tumor tissue can also be tested for genetic mutations and the molecular basis of the tumor. Targeted drug therapy can then be tailored to the individual’s needs.
Tests to see if cancer has spread. If it’s suspected that your child’s brain tumor may be a result of cancer that has spread from another area of the body, the doctor may recommend tests and procedures to determine where the cancer started.
Treatment
Treatment for a pediatric brain tumor depends on the type, size and location of the tumor, as well as your child’s age and overall health.
Surgery
If the brain tumor is located in a place that makes it accessible for an operation, your child’s pediatric neurosurgeon will work to remove as much of the brain tumor as safely as possible.
In some cases, tumors are small and easy to separate from surrounding brain tissue, which makes complete surgical removal possible.
In other cases, tumors can’t be separated from surrounding tissue or they’re located near sensitive areas in the brain, making surgery risky.
In these situations the pediatric neurosurgeon removes as much of the tumor as possible.
Even removing a portion of the brain tumor may help reduce signs and symptoms.
Surgery to remove a pediatric brain tumor carries risks, such as infection and bleeding.
Other risks may depend on the part of your child’s brain where the tumor is located.
For instance, surgery on a tumor near nerves that connect to the eyes may carry a risk of vision loss.
Traditional radiation therapy
Radiation therapy uses high-energy beams, such as X-rays or protons, to kill tumor cells.
Radiation therapy can come from a machine outside the body (external beam radiation), or, in very rare cases, radiation can be placed inside the body close to the brain tumor (brachytherapy).
External beam radiation can focus just on the area of your child’s brain where the tumor is located, or it can be applied to the entire brain (whole-brain radiation).
Whole-brain radiation is most often used to treat cancer that has spread to the brain from some other part of the body.
Side effects of radiation therapy depend on the type and dose of radiation your child receives.
Common side effects, during or immediately following radiation, include fatigue, scalp irritation temporary hair loss and headaches.
Sometimes nausea and vomiting occur, but anti-nausea medication can help control those symptoms.
Proton beam therapy
Available at only a limited number of major health care facilities in the United States, proton beam therapy delivers higher targeted doses of radiation to brain tumors, minimizing radiation exposure to nearby healthy tissue.
This appears to reduce short-term and long-term side effects and reduces the chance of developing new cancers.
Proton beam therapy is especially beneficial for children with certain types of brain tumors because a child’s brain is still developing and especially sensitive to the effects of even low and medium doses of radiation.
Radiosurgery
Stereotactic radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area.
Each beam of radiation isn’t particularly powerful, but the point where all the beams meet — at the brain tumor — receives a very large dose of radiation to kill the tumor cells.
There are different types of technology used in radiosurgery to deliver radiation to treat brain tumors, such as a Gamma Knife or linear accelerator (LINAC).
Radiosurgery is typically done in one treatment, and in most cases your child can go home the same day.
Chemotherapy
Chemotherapy uses drugs to kill tumor cells. Although the drugs can be taken orally in pill form, in children with pediatric brain tumors the drugs are usually injected into a vein (intravenous chemotherapy). Many chemotherapy drugs are available, and options depend on the type of cancer.
Chemotherapy side effects depend on the type and dose of drugs. General side effects of chemotherapy include nausea, vomiting, temporary hair loss and reduced production of blood cells (myelosuppression).
Targeted drug therapy
Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.
For example, one targeted drug therapy used to treat a type of brain cancer called a low-grade glioma is bevacizumab (Avastin).
This drug, given through a vein (intravenously), stops the formation of new blood vessels, cutting off blood supply to a tumor and killing the tumor cells.
Drugs such as dabrafenib, vemurafenib, trametinib, everolimus and various other drugs are currently being used to treat brain tumors if the molecular target is identified in the tumor.
With better understanding of the molecular basis for tumor formation, there are several clinical trials underway using targeted drug therapy.
Rehabilitation after treatment
Because brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking, rehabilitation may be a necessary part of recovery.
Your doctor may refer you to services that can help your child, such as:
- Physical therapy to help your child regain lost motor skills or muscle strength
- Occupational therapy to help your child get back to daily activities
- Speech therapy if your child has difficulty speaking
- Tutoring if your school-age child needs help to cope with changes in memory and thinking after a brain tumor
Clinical trials
Clinical trials are studies of new treatments.
These studies can give your child a chance to try the latest treatment options, but the risk of side effects may not be known.
Depending on the type and aggressiveness of the tumor and the chance of recovery (prognosis) for your child, consider asking the doctor whether your child might be eligible to participate in a clinical trial.
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