Brain and Spinal Cord Tumors in Children

Brain and spinal cord tumors are the second most common childhood cancer, according to ACS. 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 starts in the cerebellum. ACS says it tends to grow quickly and can spread to other parts of the brain, the spinal cord, or spinal fluid. ACS names gliomas as the most common group in children. Ependymomas most often grow in the back part of the skull, near the brain stem.

Diffuse intrinsic pontine glioma, often called DIPG, is a brain stem glioma. ACS says that because of where it grows, surgery is not a good option. Craniopharyngioma grows very close to the pituitary gland, the optic nerves, and blood vessels that supply the brain.

Signs depend on where the tumor is and how old your child is. ACS lists these signs:

• Headaches, including headaches when waking up.
• Nausea or vomiting.
• Crossed eyes or blurred vision.
• Balance problems.
• Seizures.
• Poor school performance, tiredness, or personality changes in older children.
• Irritability, loss of appetite, trouble swallowing, or developmental delays in young children.

See a doctor promptly if signs do not go away or get worse. ACS names headaches that last longer than 4 weeks as a reason to be seen. Several signs together, or a headache that keeps getting worse, also deserve a prompt visit.

An MRI is usually the main test. It shows the brain and spinal cord in detail. ACS says a biopsy, which removes some tumor tissue, is needed to confirm the tumor. Doctors also test tumor cells for gene changes. These results help determine the exact type or subtype of tumor.

ACS lists surgery, radiation therapy, chemotherapy, and targeted therapy as the main treatments. Most often the first step is for the neurosurgeon to remove as much of the tumor as possible while limiting harm to normal brain function. Children younger than 3 are usually not given radiation because of long-term effects on brain development. They are treated mainly with surgery and chemotherapy. Depending on gene changes in the tumor, targeted therapy may be used.

ACS says children with brain tumors and their families have special needs that are best met by children's cancer centers. Ask whether a clinical trial fits your child's exact tumor type.

ACS notes that some children have problems with normal functioning and schoolwork after treatment, and that these can often be helped with support. Ask your child's team early about support services, rather than waiting to see if problems appear on their own.

Call 911 or go to the emergency room right away, or call your child's care team at once, 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.

• What is the exact tumor type, and what are its genetic features, if known?
• What surgery, radiation, or chemotherapy is planned, and why?
• Is there a clinical trial that fits?
• What will long-term follow-up look like?

Treatment can affect learning, growth, and development, so ask what your child's team will be watching for over time.

• American Cancer Society — Key Statistics for Brain and Spinal Cord Tumors in Children
• American Cancer Society — Signs and Symptoms of Brain Tumors in Children
• American Cancer Society — Tests for Brain and Spinal Cord Tumors in Children
• American Cancer Society — Treating Brain Tumors in Children
• American Cancer Society — Treating Specific Types of Childhood Brain and Spinal Cord Tumors