Brain Tumor in Children

What is a pediatric brain tumor?

A pediatric brain tumor is a growth of abnormal brain cells in a child. A brain cell becomes abnormal when it undergoes genetic changes. The change in a specific gene of brain cells can cause the cell to form a tumor.

There are many types of pediatric brain tumors, and they can occur at any age — from birth to adolescence and sometimes even in adulthood. Brain tumors (neoplasms) may be malignant (cancerous) or non-malignant (or benign, not cancerous).

How common are brain tumors in children?

Pediatric brain tumors are the most common type of cancer in children, affecting over 5,000 kids each year.

What are the different types of brain tumors in children?

There are many types of pediatric brain tumors. They’re grouped by the kind of brain cell in which they develop. The main categories include:

• Gliomas.
• Embryonal tumors.
• Pineal tumors.
• Craniopharyngiomas.
• Germ cell tumors.
• Choroid plexus tumors.
• Schwannomas.
• Meningiomas.

Gliomas

Gliomas originate from glial cells in your brain. Glial cells support, nourish and protect your brain tissue and nerve cells or neurons. About half of all pediatric brain tumors are gliomas. Gliomas can be low-grade (slow growing) or high-grade (aggressive and fast growing).

Specific types include:

• Astrocytoma starts in a kind of glial cell called astrocytes. This type of tumor can form in your brain or spinal cord. It can be slow growing or aggressive.
• Oligodendroglioma starts in a type of glial cell called oligodendrocytes. This type of neoplasm is often found in the outer layer of your brain.
• Neuroglial cells consist of both glial cells and neuronal cells. Neuroglial tumors can occur in both your brain and spine and can often cause seizures.
• Ependymoma tumors begin in the ependymal cells, which line the fluid-filled spaces of your brain.

Embryonal tumors

Embryonal tumors start in fetal or embryonic cells in your central nervous system. These are cancerous tumors that can occur at any age, but they’re most common in babies and young children.

Specific types of embryonal tumors include:

• Medulloblastoma,the most common type of embryonal tumor, starts in the back part of your brain — your cerebellum.
• Medulloepithelioma is a rare, fast-growing tumor that usually occurs in infants and young children.
• Atypical teratoid/rhabdoid tumor (ATRT) is a rare neoplasm that often starts in the cerebellum of very young children.
• Embryonal tumor with multilayered rosettes (ETMR) is an aggressive childhood brain cancer in your central nervous system.

Pineal tumors

A pineal tumor develops in your pineal gland. Your pineal gland is in the middle of your brain and secretes a hormone called melatonin. There are different kinds of tumors that originate in your pineal gland. The tumors can be benign (non-cancerous) or malignant (cancerous).

Specific types of tumors that occur in the pineal gland in children include:

• Pineoblastoma, the most aggressive kind of embryonal tumor that can spread quickly to your brain and spine.
• Pineal parenchymal tumors, are of intermediate grade and mostly confined to the pineal region if detected on time.
• Germ cell tumors, which form from the embryonic tissue left in your pineal gland.

Craniopharyngiomas

Craniopharyngiomas are noncancerous tumors that start, near your pituitary gland. They arise from the embryonic tissue of your pituitary gland. Craniopharyngiomas are solid, cystic (sac of fluid) or mixed. They can be slow growing or fast growing.

These tumors can press on your pituitary gland, which makes hormones that regulate growth, blood pressure and reproduction. They also press on your hypothalamus, an important area of your brain that controls many functions, including body temperature, bodily fluids, emotions and much more. Craniopharyngiomas can also put pressure on your optic nerves, which can affect vision.

Germ cell tumors

Germ cell tumors are cancerous tumors that begin from embryonic cells called “germ” cells. During development, germ cells migrate outside of your brain to form ovaries or testes. The germ cells that remain in your brain can become cancerous to form germ cell tumors. These tumors can spread into your spine and cerebrospinal fluid (CSF).

Choroid plexus tumors

Choroid plexus tumors start in your choroid plexus, which lines the ventricles (fluid-filled cavities) of your brain. These tumors can be noncancerous (like choroid plexus papilloma) or cancerous (like choroid plexus carcinoma). Atypical choroid plexus papillomas are intermediate-grade tumors that can become malignant if not removed.

Schwannomas

Schwannomas are tumors that start in the Schwann cells, which insulate nerves in your brain. This type of tumor usually grows near the nerve that manages hearing and balance. It may also form near your spinal cord, causing weakness and problems with your senses. Although schwannomas are usually benign (not cancerous), they can be malignant (cancerous).

Meningiomas

Meningiomas are another type of brain tumor, but they’re less common in children. Meningiomas begin in your meninges, a layer of tissue around your brain. They can press on your brain and spinal cord. The majority of meningiomas are benign, but they can grow large enough to be life-threatening.

What causes a brain tumor?

A neoplasm forms when healthy cells multiply and grow out of control. Scientists don’t understand what causes cells to grow uncontrollably, but it may relate to:

• Genetic changes in a cell.
• Inheritance of cancer-forming genes.
• Prior radiation exposure (for another type of cancer).

There’s a link between some pediatric brain tumors and cancer syndromes (a collection of seemingly related health issues). Experts don’t fully understand this link yet.

Associated cancer syndromes include:

• Li-Fraumeni.
• Neurofibromatosis type I.
• Neurofibromatosis type II.
• Tuberous sclerosis.
• Von-Hippel Lindau disease.
• Nevus basal cell carcinoma syndrome or Gorlin syndrome.
• Cowden syndrome.
• Familial adenomatosis polyposis (FAP).
• Lynch syndrome.

What are the symptoms of a brain tumor in a child?

Signs and symptoms of a brain tumor vary widely depending on the type of neoplasm, severity, rate of growth and location. They may include:

• Excessive sleepiness.
• Early morning headaches that go away after your child vomits.
• Increase in size of your infant’s head.
• Nausea and vomiting, usually associated with headaches and without diarrhea.
• Issues with vision, hearing or speech.
• Balance issues.
• Lack of coordination.
• Sudden changes in behavior.
• Weakness in your child’s arm, leg or on one side of their body.
• Seizures.

How is a pediatric brain tumor diagnosed?

If a healthcare provider suspects a brain tumor, your child will have several exams and tests, which may include:

• Physical exam:A healthcare provider will examine your child to determine general health. They’ll ask about your child’s symptoms, personal medical history and family medical history.
• Neurological exam: This exam includes questions and tests to check how your child’s brain is working. It’ll test mental state, balance, coordination, the senses, reflexes and more.
• Imaging tests: A healthcare provider may order tests to take detailed pictures of your child’s brain and/or spine, such as an MRI, CT scan or PET scan. The test may include an injection of a substance into their bloodstream first, which helps cancer cells show up on the scan.
• Blood test:A blood test called a serum marker test can measure substances in your child’s body linked to cancer (called tumor markers).
• Biopsy: A biopsy involves taking a tissue sample from the tumor so scientists can look at the cells under a microscope.
• Spinal tap: During a spinal tap (lumbar puncture), a healthcare provider inserts a special needle into your child’s lower back. It collects fluid that circulates around their brain and spinal cord, then tests it for abnormal cells.

If the tests discover abnormal cells, the healthcare team will determine whether the neoplasm is noncancerous or malignant. They also may give the brain tumor a grade to help define how serious it is and how likely it is to grow:

• Grade 1 tumors are slow growing. Tumor cells look almost normal.
• Grade 2 tumors grow slowly and are less likely to spread to other areas of the body. Tumor cells look somewhat abnormal.
• Grade 3 or 4 tumors are malignant. They’re more aggressive and likely to spread to other parts of the brain. The cells look distinctly abnormal.

How are brain tumors in children treated?

If a brain tumor is cancerous or causes troubling symptoms, your child may need treatment. Treatment depends on the type of tumor, where it is and how quickly it might spread. Options may include:

• Surgery to remove part or all of the tumor or to drain fluid that’s causing pressure.
• Chemotherapy, targeted therapy, immunotherapy or other medications to kill the cancer cells or help symptoms.
• Radiation therapy.
• Rehabilitation to help your child function better (if the tumor affects speech, balance or other abilities).

How can I reduce the risk of childhood brain cancer?

Because scientists don’t fully understand what causes brain tumors, there aren’t any proven ways to prevent them.

What is the outlook for children with brain tumors?

The outlook for children with brain tumors varies widely, depending on:

• Child’s age and general health.
• Location of the tumor.
• Size of the tumor.
• Tumor grade.
• Type of tumor.
• Success of treatment in removing some or all of the tumor.
• Whether the tumor has spread.

A large, aggressive tumor can be life-threatening, but advances in diagnosis and treatment have helped more and more children survive.

Can a childhood brain tumor return after treatment?

A pediatric brain tumor can come back (recur) during childhood or adulthood.

Recurrence means that a new and different neoplasm may develop. Or the same tumor can grow again if any abnormal cells remained after treatment.

What should I ask my healthcare provider about my child’s brain tumor?

Consider asking your child’s healthcare team the following questions:

• Where is the brain tumor?
• Is it pressing on any nearby structures?
• Is it benign or malignant?
• Has it spread to any other areas, or will it spread?
• What grade is the tumor?
• What treatments do you recommend? What are the risks and side effects of those options?
• How likely is it to come back after treatment?
• Does my child have a cancer syndrome that may cause other health issues?

A note from Cleveland Clinic

Learning that your child has a brain tumor can be scary. You may wonder where to turn for support and answers. There are many resources available, including local and online support groups. Talking with other families who are going through the same thing can be beneficial during this trying time. Although some tumor types can be life-threatening, advances in diagnosis and treatment have helped many children survive.