Brain Tumors

What are brain tumors?

Tumors of the central nervous system (brain and spinal cord) are the most common type of solid tumor that occurs in children of any age. There are several different types of brain tumors seen in children and adolescents. It is not known what causes most tumors. Brain tumors are not contagious, and nothing you have done or not done is responsible for your child’s tumor.

The symptoms, treatment and outlook vary depending on the type of tumor and its location in the brain. Common brain tumors are astrocytomas, medulloblastomas, ependymomas, and brain stem gliomas, among others.

The terms “benign” and “malignant” are used to describe how aggressively (quickly) these tumors grow, and if they have the potential to spread to other parts of the body (metastasize). Overall, treatment for pediatric brain tumors has a better success rate when compared to treatment of adult brain tumors.

What are symptoms of a brain tumor?

Many symptoms of brain tumors are the result of increased pressure within the skull. In addition to taking up space, the tumor can push on normal brain tissue and cause it to swell inside the skull. The tumor can also block the flow of normal fluid (cerebral spinal fluid) in the brain. When this happens, the tumor acts like a dam with fluid building up and causing more pressure. Increased pressure in the brain (called increased intracranial pressure) can cause headaches, vomiting, vision changes, seizures, and changes in behavior and coordination.

How is a brain tumor diagnosed?

When a brain tumor is suspected, a thorough physical examination and patient history are taken. Tumors are diagnosed by a neurologic examination and by a series of diagnostic tests. These tests may include some or all of the following:

All of these diagnostic procedures lead to a probable diagnosis but the only completely accurate diagnostic test is a surgical biopsy.

Once these tests have been performed, you will be given specific information about the type of tumor and its treatment. Brain tumors rarely spread outside of the central nervous system (brain and spinal cord) so further testing to check for disease spread is rarely needed.

How are brain tumors treated?

Brain tumors can present problems that do not exist with tumors located in other areas of the body. There may be difficulty in getting to the tumor site, since many areas of the brain cannot be removed without causing serious damage or even death. Thus, if a tumor is located in a vital area, it may be impossible to remove or, occasionally, even to biopsy.

Treatment of brain tumors may include surgery, radiation therapy, and/or chemotherapy. Treatment also may involve steroids, which decrease swelling, or sometimes a shunt that relieves fluid pressure. Surgery to completely remove the tumor is the goal whenever possible. Because surgical techniques and life support methods are continually improving, surgical therapy is becoming more aggressive, with fewer serious short- and long-term problems. However, the tumor cannot always be completely removed, especially if it is located near vital structures. It also is sometimes difficult to identify the area (called the margin) between tumor and normal tissue.

Radiation therapy consists of special x-ray beams that can be focused on a tumor and surrounding tissue. Radiation to the tumor site and to areas of potential spread often is used in an attempt to destroy the remains of the tumor. Not all brain tumors respond favorably to this type of treatment. Radiation therapy often produces side effects such as (temporary) hair loss (also called alopecia), nausea and vomiting, headache and fatigue. Long-term side effects also are possible, depending on the site of the treatment. Physical growth, hormone function, and cognitive (learning) function are a few possible areas where problems can occur. There also is a risk of second cancers developing in the radiation site.

Chemotherapy (drug therapy) may be administered intravenously (into a vein), take by mouth, or sometimes given intrathecally (into the spinal canal). The goal of drug therapy is to find tumor cells wherever they are, destroy them, and prevent their future growth. Some types of brain tumors are more sensitive to chemotherapeutic drugs than others. Each drug has side effects that will be described to you specifically.

Sometimes chemotherapy does not easily cross the blood-brain barrier. This is the membrane that protects the brain against foreign material and infection, and it also can prevent drugs from entering brain tissue. The goal is to find a combination of chemotherapy drugs that are most effective in crossing the blood-brain barrier.

Chemotherapy often is used in very young children, especially those under five years of age, in order to treat the tumor and delay radiation therapy. Delaying radiation helps to minimize long-term side effects.

What is the follow-up care for brain tumors?

All patients with brain tumors will be seen periodically in the brain tumor clinic. Clinic visits in the brain tumor clinic are held one to two times per month in the same area as the oncology clinic. Patients may be seen by the neurosurgeon, neurologist, oncologist, endocrinologist, radiation therapist, nurse practitioner, nurse, and social worker. The neurologic examination is an important method of following progress. CT or MRI scans also are done at intervals as part of the patient’s follow-up care. Other testing may be done to evaluate side effects of treatment. Physical therapy and rehabilitation also may be important for those patients who have neurologic changes resulting from the tumor and/or treatment.

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About treatment for brain tumors at Children’s

Children’s hematology/oncology program consistently achieves treatment results ranking it as one of the top ten programs in the U.S. Children’s treats the majority of children with cancer and blood disorders in Minnesota and provides patients with access to a variety of clinical trials of ground-breaking new treatments, such as intra-operative MRI available during brain tumor surgery. Through our renowned brain tumor program, patients experience unparalleled family support, a nationally renowned pain management team, and compassionate, coordinated care.