Brain and Spinal Cord Tumors in Children

Brain tumors are among the most common childhood cancers, along with leukemia. A tumor that starts in the brain is called a primary brain tumor. Treatment and outlook vary a lot by tumor type. Getting the exact diagnosis matters as much as knowing it is a brain tumor at all.

Medulloblastoma is one of the most common childhood brain tumors. It grows in the cerebellum, the part of the brain that controls balance and coordination. Gliomas, including astrocytomas, grow from the brain's supporting cells. They can be low-grade, meaning slower growing, or high-grade, meaning faster growing. Ependymomas grow from cells that line the fluid-filled spaces in the brain and spinal cord.

Diffuse intrinsic pontine glioma, often called DIPG, grows in the brainstem. This is the part of the brain that controls breathing and heartbeat. Its location makes DIPG especially hard to treat. Craniopharyngioma grows near the pituitary gland, the gland that controls many of the body's hormones.

Signs depend on where the tumor is and how old your child is. Common signs include morning headaches, vomiting without feeling sick to the stomach, new problems with balance, vision changes, seizures, or a change in behavior or grades at school. In babies, a rapidly growing head size can be a sign, since a baby's skull can still expand. Any of these signs deserves a prompt doctor visit. This is especially true if more than one sign appears together, or a headache keeps getting worse.

An MRI is usually the main test. It shows the brain and spinal cord in detail. A biopsy, or surgery to remove part or all of the tumor, lets doctors examine the tissue directly. This tells them the exact tumor type. It can also reveal specific gene changes inside the tumor. That genetic information can guide treatment choices, and sometimes points toward a clinical trial.

Treatment depends on the tumor type, its location, and your child's age. When the tumor's location allows it, surgery to remove as much of it as safely possible is often the first step. Radiation therapy is used for some tumors. Doctors try to limit radiation in very young children, because of its effect on a still-developing brain. Chemotherapy is used for many tumor types. Sometimes it comes before surgery, to shrink the tumor. Sometimes it comes after. For some tumor types, newer targeted therapies aimed at specific gene changes are now part of standard treatment.

Childhood brain tumors are complex. Treatment at a children's cancer center with specific experience in pediatric brain tumors matters. Many centers offer clinical trials, including through the Children's Oncology Group and specialized brain tumor research networks. Ask whether a trial fits your child's exact tumor type.

Recovery after a childhood brain tumor often includes rehabilitation: physical therapy, occupational therapy, or speech therapy, depending on what the tumor or its treatment affected. School support matters too. Many survivors benefit from an individualized education plan that adjusts pace, testing, or classroom support. Ask your child's team for a referral to rehabilitation services early, rather than waiting to see if problems appear on their own.

Call your child's care team, or go to the emergency room, for a sudden severe headache, repeated vomiting, a seizure, sudden trouble walking or talking, or a rapid change in alertness. These can be signs of pressure building inside the skull. That needs urgent evaluation, not a wait-and-see approach.

Ask for the exact tumor type, and its genetic features if known. Ask what surgery, radiation, or chemotherapy is planned, and why. Ask about a clinical trial. Ask what long-term follow-up will look like. Brain tumor treatment carries a higher chance of late effects on learning, hormones, and growth, so ask what your child's team will be watching for over time.

• National Cancer Institute — Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ).
• National Cancer Institute — Late Effects of Treatment for Childhood Cancer (PDQ).
• American Cancer Society — Key Statistics for Brain and Spinal Cord Tumors in Children.