Pediatric brain tumors

Overview

Pediatric brain tumors are growths of cells that start in or near the brain in children. The growths, called tumors, can grow to press on nearby parts of the brain. This can cause symptoms, such as headaches and nausea.

Many types of pediatric brain tumors exist. Some grow quickly, and some grow slowly. Some are cancerous, and some aren't cancerous. Noncancerous brain tumors also are called benign brain tumors.

The type of brain tumor a child has helps determine the best treatment plan. Other things your child's healthcare team considers include the tumor's location, whether it has spread beyond the brain, and your child's age and overall health.

Treatment for brain tumors in children is often quite different from treatment for adult brain tumors. For this reason, seek out care at a medical center that has experience caring for children with brain tumors.

Symptoms

Pediatric brain tumor symptoms may vary depending on the tumor's location within the brain. Symptoms also might depend on the size of the tumor and how quickly it's growing.

Some of the more common signs and symptoms of pediatric brain tumors include:

• Headaches, which may become more frequent and more severe. In children who don't talk, a parent might notice that the child is more irritable than usual.
• Nausea and vomiting.
• Vision changes, such as double vision. In children who don't talk, a parent might notice that a child squints or covers one eye when trying to look at something.

Other possible signs and symptoms include:

• A fuller soft spot on the skull in babies.
• Changes in the way the eyes move.
• Confusion and irritability.
• Difficulty with balance.
• Hearing problems.
• Memory problems.
• Personality or behavior changes.
• Seizures, especially in a child who hasn't had a seizure before.
• Slurred speech.
• Trouble walking.
• Trouble swallowing.
• Weakness or drooping on one side on the face.
• Weakness or loss of sensation in an arm or a leg.

When to see a doctor

Make an appointment with your child's doctor or other healthcare professional if your child has symptoms that worry you.

Causes

Most of the time, the cause of a pediatric brain tumor isn't known.

Pediatric brain tumors start when cells in the brain develop changes in their DNA. A cell's DNA holds the instructions that tell a cell what to do. In healthy cells, the DNA gives instructions to grow and multiply at a set rate. The instructions tell the cells to die at a set time. In tumor cells, the DNA changes give different instructions. The changes tell the tumor cells to make many more cells quickly. Tumor cells can keep living when healthy cells would die. This causes too many cells.

The extra cells might form a mass called a tumor. A tumor can grow and press on nearby brain tissue. Sometimes a growing tumor causes swelling and other changes in the nearby brain tissue.

Some tumor cells develop other DNA changes that turn them into cancer cells. Cancer cells can invade and destroy healthy tissue. Sometimes cancer cells can break away and spread beyond the brain. If brain cancer spreads, it tends to go to the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid.

Risk factors

Factors that may increase the risk of pediatric brain tumors include:

Younger age

Brain tumors can happen at any age. In children, brain tumors tend to happen more often in those younger than 5.

Exposure to radiation

Children who receive radiation therapy treatments to the head have an increased risk of brain tumors. For example, radiation therapy for one type of brain tumor may increase the risk of developing another type of brain tumor.

Weakened immune system

If the body's germ-fighting immune system is weakened by medicines or illness, there might be a higher risk of pediatric brain tumors. Children with weakened immune systems include those taking medicines to control their immune systems, such as after organ transplant. Certain medical conditions, such as infection with HIV, can weaken the immune system.

Genetic syndromes that run in families

Some genetic syndromes that run in families can increase the risk of brain tumors in children. Examples include:

• Neurofibromatosis 1.
• Neurofibromatosis 2.
• Tuberous sclerosis.
• Gorlin syndrome.
• Turcot syndrome.
• Cowden syndrome.

Tests of your child's DNA can show whether these syndromes are present.

Prevention

There's no way to prevent pediatric brain tumors. If your child develops a brain tumor, you didn't do anything to cause it.

Diagnosis

Pediatric brain tumor diagnosis often begins with questions about your child's symptoms and an exam. The exam can give your child's healthcare team clues about what's happening in your child's brain. It can help the healthcare team decide which tests are needed next.

Tests and procedures used to diagnose pediatric brain tumors include:

Neurological exam

A neurological exam tests different parts of the brain to see how they're working. During the exam, a healthcare professional might check your child's:

• Vision.
• Hearing.
• Balance.
• Coordination.
• Strength.
• Reflexes.

If your child has trouble in one or more areas, this is a clue for the healthcare professional. A neurological exam helps the healthcare team understand what part of the brain might have a problem.

Imaging tests

Imaging tests can make pictures of the brain that show the brain tumor's location and size. The most common imaging test for brain tumors is magnetic resonance imaging, also called MRI. Sometimes a special type of MRI is needed to get more-detailed pictures. Special types of MRI include functional MRI and magnetic resonance spectroscopy.

Other imaging tests include computerized tomography scans, also called CT scans, and positron emission tomography scans, also called PET scans.

Biopsy

A biopsy is a procedure to remove a sample of tissue for testing in a lab. For pediatric brain tumors, the sample is most often collected during surgery to remove the tumor.

If surgery isn't possible, the tissue sample might be removed with a needle. Removing a sample of brain tumor tissue with a needle is done with a procedure called stereotactic needle biopsy. During this procedure, a surgeon drills a small hole in the skull. The surgeon inserts a thin needle through the hole and into the brain tissue and draws out a sample of cells.

The sample goes to a lab for testing. In the lab, tests can show whether the cells are cancerous and how quickly the cells are growing. Special tests can look at the tumor cells' DNA. Your child's healthcare team uses the results from these tests to create a treatment plan.

Lumbar puncture

A lumbar puncture is a procedure to collect fluid from around the spinal cord. A lumbar puncture, also called a spinal tap, is done using a needle. A healthcare professional inserts the needle between two bones in the lower back and draws out some of the fluid that surrounds the brain and spinal cord. This fluid is called cerebrospinal fluid. The fluid goes to a lab where it's tested for cancer cells.

Your child might need a lumbar puncture if there's a risk that the cancer has spread. Brain cancer usually doesn't spread. When it does, it tends to go to the cerebrospinal fluid. The fluid can carry the cancer cells to other parts of the brain and to the spinal cord.

Treatment

Treatment for pediatric brain tumors depends on many factors. Your child's healthcare team considers the type, size and location of the tumor. The care team also considers your child's age and overall health. Treatment options might include surgery, radiation therapy, radiosurgery, chemotherapy and targeted therapy.

Surgery

The goal of surgery for pediatric brain tumors is to remove all of the tumor cells. It's not always possible to do that. Sometimes the brain tumor is in a spot that's hard to reach. Sometimes it is near important parts of the brain that could be hurt during surgery. In these situations, the surgeon may remove as much of the tumor as is safely possible.

Surgery to remove a pediatric brain tumor carries risks, such as infection and bleeding. Other risks may depend on the part of the 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.

Radiation therapy

Radiation therapy for brain tumors uses powerful energy beams to kill tumor cells. The energy can come from X-rays, protons and other sources.

During radiation therapy, your child lies on a table in the treatment room. A machine moves around the child and aims radiation at precise points. Radiation treatments require keeping very still so that the machine targets the exact area. Young children and others who have trouble holding still might need medicine to help them relax and keep still.

Some medical centers offer different types of energy sources for radiation therapy, such as:

• X-ray radiation. Radiation that comes from X-rays is the most common type of radiation therapy. It's also called photon radiation. X-ray radiation is available at most medical centers.
• Proton radiation. Proton radiation uses energy from protons. This is a newer form of radiation therapy. It's not available at all medical centers. Proton beams can be more carefully targeted to the tumor cells. Proton therapy may be less likely to hurt healthy tissue near the brain tumor. Children may benefit from this type of radiation because their brains are still developing.

Side effects of radiation therapy depend on the type and dose of radiation your child receives. Common side effects include feeling very tired, scalp irritation, temporary hair loss and headaches. Sometimes nausea and vomiting occur, but anti-nausea medicine can help control those side effects.

Radiosurgery

Stereotactic radiosurgery for brain tumors is an intense form of radiation treatment. It aims beams of radiation from many angles at the brain tumor. Each beam isn't very powerful. But the point where the beams meet gets a very large dose of radiation that kills the tumor cells.

Radiosurgery treatment is typically done in one treatment.

Different types of energy can be used during radiosurgery treatment. Which type is best for your child will depend on your child's situation. Options might include:

• Linear accelerator radiosurgery. Linear accelerator machines also are called LINAC machines. LINAC machines are known by their brand names, such as CyberKnife, TrueBeam and others. A LINAC machine aims carefully shaped beams made of X-rays one at a time from several different angles.
• Gamma Knife radiosurgery. A Gamma Knife machine aims many small beams made of gamma rays at the same time.
• Proton radiosurgery. Proton radiosurgery uses beams made of protons. It's becoming more common but isn't available at all hospitals.

Side effects of radiosurgery include feeling very tired and skin changes on the scalp. The skin on your child's head may feel dry, itchy and sensitive. Some children have blisters on the skin or hair loss. Sometimes the hair loss is permanent.

Chemotherapy

Chemotherapy for brain tumors uses strong medicines to kill tumor cells. Chemotherapy medicines can be taken in pill form or injected into a vein. Sometimes the chemotherapy medicine is placed in the brain tissue during surgery.

Chemotherapy side effects depend on the medicines your child receives. General side effects of chemotherapy include nausea, vomiting and temporary hair loss.

Targeted therapy

Targeted therapy for brain tumors uses medicines that attack specific chemicals present within the tumor cells. By blocking these chemicals, targeted treatments can cause tumor cells to die.

Targeted therapy medicines are available for certain types of brain tumors in children. Your child's brain tumor cells may be tested to see whether targeted therapy might help.

Clinical trials

Clinical trials are studies of new treatments. These studies provide a chance to try the latest treatments. The risk of side effects might not be known. Ask your child's healthcare team if your child might be able to be in a clinical trial.

Palliative care

Palliative care is a special type of healthcare that helps children with serious illnesses feel better. For children with brain tumors, palliative care can help relieve pain and other symptoms. A team of healthcare professionals offers palliative care. The team can include doctors, nurses and other specially trained professionals. The goal is to improve the quality of life for your child and your family.

Palliative care specialists work with you, your family and your care team to help your child feel better. They provide an extra layer of support during your child's treatments. Your child can have palliative care at the same time as brain tumor treatments, such as surgery, chemotherapy and radiation therapy.

Recovering after treatment

Children may need support after treatment to help them recover. Brain tumors can develop in parts of the brain that control motor skills, speech, vision and thinking. Rehabilitation services to help regain these functions include:

• 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 brain tumor treatment.

Alternative medicine

Little research has been done on alternative treatments for pediatric brain tumors. No alternative medicine treatments have been proved to cure brain tumors and some may be harmful.

Alternative medicine is a term that's commonly used to describe treatments that aren't usually offered by healthcare professionals. As researchers study these treatments and the evidence for these alternative methods grows, doctors and other healthcare professionals are including them in treatment plans alongside the standard treatments. It's an approach that healthcare professionals sometimes call integrative medicine.

Some integrative medicine treatments might help your child cope with pediatric brain tumor symptoms and the side effects of treatment. Your healthcare team will work with your family to make sure your child is comfortable. Combining integrative treatments with standard treatments may offer some extra comfort.

Options may include:

• Acupuncture.
• Creative therapies, such as art therapy and music therapy.
• Hypnosis.
• Massage therapy.
• Meditation.
• Relaxation techniques, such as guided imagery and deep breathing.

If your child is interested in trying any of these treatments, talk with your healthcare team about what might work best for your child. Ask your team to recommend care professionals who have experience working with children with brain tumors.

Coping and support

Here are some suggestions to help guide your family through your child's brain tumor treatment.

At the hospital

When your child has medical appointments or stays in the hospital:

• Bring a favorite toy or book to office or clinic visits, to keep your child occupied while waiting.
• Stay with your child during a test or treatment, if possible. Use words that your child will understand to describe what will happen.
• Include playtime in your child's schedule. Many hospitals have a playroom for children undergoing treatment. Healthcare team members may offer activities to support your child while going through treatment. Ask to speak with a social worker or child life specialist.
• Ask for support from clinic or hospital staff members. Seek out organizations for parents of children with cancer. Parents who have already been through this can provide encouragement and hope, as well as practical advice. Ask your child's healthcare team about local support groups.

At home

After leaving the hospital:

• Monitor your child's energy level outside of the hospital. If your child feels well enough, gently encourage participation in regular activities. At times your child will seem tired or listless, particularly after chemotherapy or radiation, so make time for enough rest too.
• Keep a daily record of your child's condition at home. Make note of your child's body temperature, energy level and sleeping patterns. Note any medicines given and any side effects. Share this information with your child's healthcare team.
• Stick to your child's usual diet unless your healthcare team suggests otherwise. Prepare favorite foods when possible. Treatment can affect your child's appetite. Sometimes eating may be difficult. Seek the advice of a registered dietitian to be sure your child gets sufficient nutrients and calories.
• Check with the healthcare team before any vaccinations because cancer treatment affects the immune system.
• Be prepared to talk with your other children about the brain tumor. Tell them about changes they might see in their sibling, such as hair loss and tiredness. Listen to their concerns.

Preparing for an appointment

See your child's doctor or other healthcare professional if your child has any symptoms that worry you. If a brain tumor is suspected, ask for a referral to an experienced specialist in pediatric brain tumors.

Consider taking a relative or friend along to the appointment to help remember all the information provided.

Here's some information to help you and your child get ready for the appointment.

What you can do

Before your child's appointment, make a list of:

• Symptoms, including any that seem not related to the reason for the appointment.
• Any medicines, including vitamins, herbs and over-the-counter medicines that your child is taking, and their dosages.
• Key personal information, including any major stresses or recent changes in your child's life.
• Questions to ask your child's healthcare team to make the most of your time.

For a pediatric brain tumor, some basic questions to ask include:

• What type of brain tumor does my child have?
• Where is the brain tumor located? How large is it?
• How aggressive is the brain tumor?
• Is the brain tumor cancerous?
• Will my child need additional tests?
• What are the treatment options?
• What are the benefits and risks of each treatment?
• Can any treatments cure my child's brain tumor?
• Is there one treatment you feel is best?
• Should my child see additional specialists? What will that cost, and will my insurance cover it?
• Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions that occur to you.

What to expect from your doctor

Be prepared to answer some questions about your child's medical history and symptoms. These might include:

• When did your child first begin experiencing symptoms?
• Are the symptoms continuous or occasional?
• How severe are the symptoms?
• What, if anything, seems to improve your child's symptoms?
• What, if anything, appears to worsen the symptoms?