Pediatric Brain Tumors

Brain tumors are the growth of abnormal or uncontrolled cells in the brain. Most brain tumors in children are primary, meaning they develop in the brain and do not spread to other parts of the body. Primary brain tumors can be slow growing with defined boundaries or fast growing with poorly defined borders. These tumors can be life-threatening if they grow in a vital area within the brain. In addition, as the tumor grows, it presses on other parts of the brain that control body functions.

The most common brain tumors that occur in children include:

Astrocytomas;
Primitive neuroectodermal tumors (for example, medulloblastoma);
Gliomas (for example, brain stem gliomas); and
Ependymomas.

WHAT ARE THE SYMPTOMS?

Symptoms may occur based on the age of the patient, location of the tumor, and size of the tumor. Symptoms may also imitate symptoms of other illnesses, which can cause a delay in diagnosis. Some common symptoms in infants and children may include:

Change in energy level;
Coordination problems;
Decreased social interactions;
Difficulty moving extremities (arms, legs);
Double vision and other vision problems;
Headache;
Imbalance;
Increased head circumference in children younger than 2 years;
Irritability;
Nausea and vomiting;
Optic nerve swelling;
Personality or behavior changes;
Pressure on the brain;
Rapid eye movements or difficulty moving the eyes;
Seizures; and
Weight loss or weight gain.

CAUSES AND RISK FACTORS

Physicians are not sure what causes brain tumors, making it difficult to pinpoint which factors put children at greater risk of one.

Although there are no established risk factors for childhood brain tumors, some evidence shows that children with certain rare conditions may be more likely to develop them. These conditions include:

Neurofibromatosis Type 1 (von Recklinghausen disease) and Type II;
Tuberous sclerosis;
von Hippel-Lindau syndrome; and
Li-Fraumeni syndrome.

Radiation treatment to the head for a previous condition, such as meningeal leukemia, may also increase a child's risk of developing a brain tumor.

DIAGNOSIS

To diagnose a brain tumor, a physician may recommend one or more of the following tests:

Neurological exams;
Magnetic resonance imaging (MRI);
Computed tomography (CT) scan;
Cerebrospinal fluid examination;
Positron Emission Tomography (PET) scan; or
Skeletal x ray.

To accurately determine the type of tumor and the type of treatment best suited for it, the physician may also perform a stereotactic biopsy, in which he or she removes a tissue sample from the child's brain, using MRI guidance.

TREATMENT APPROACH

The primary goal of treatment is to remove as much of the tumor as possible or to slow the tumor's growth with as little harm to the child's brain as possible. Treatment options and the child's outcome and chance of recovery depend on a variety of circumstances, which include:

Child's age;
Child's general health;
Tumor location;
Amount of tumor remaining after surgery; and
Whether the cancer has spread to other parts of the brain or parts of the body.

Once a tumor has been diagnosed, a surgeon may consider one or more of the following treatment options:

Ventriculo-peritoneal shunt placement surgery, in which the surgeon drains excess fluid by placing a small plastic tube called a shunt in the brain.
Surgery, typically the first treatment for brain tumors, in which as much of the tumor as possible is removed through a hole in the skull.
Radiation therapy, in which high-energy rays are used to prevent cells from growing and dividing. Radiation therapy may be performed before or after surgery, and it may be used in conjunction with chemotherapy.
Chemotherapy, a systemic treatment (it travels through the entire body) that is often used to treat tumors that are difficult to remove or are highly aggressive.

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