Brain Tumor in Children

A pediatric brain tumor is a mass of abnormal brain cells in a child. Brain cells can become abnormal from genetic changes. The changes make the cells malfunction and turn into tumors.

Brain tumors in children come in many different types. They can be benign (not cancerous) or malignant (cancerous). Malignant tumors fall under childhood cancers. Benign tumors are usually less dangerous, but all brain tumors are potentially serious.

Types of pediatric brain tumors

There are more than 120 types of central nervous system (CNS) tumors. Your central nervous system includes your brain, spinal cord and optic nerves. Experts group tumors from all three places together.

There are a few more common types of pediatric brain tumors. They include (in order from most common to least common):

• Gliomas
• Sellar region tumors
• Embryonal tumors
• Meningeal tumors
• Glioneuronal and neuronal tumors

Gliomas

Gliomas come from glial cells, the support cells in your nervous system. They maintain and protect neurons, the cells that send and relay brain and nerve signals. Gliomas account for nearly half of all childhood brain tumors. They can be low-grade (slow-growing) or high-grade (aggressive and fast-growing).

Most gliomas are pilocytic astrocytomas, a low-grade type of tumor. Other types of gliomas include:

• Astrocytomas
• Ependymomas
• Glioblastomas
• Oligodendrogliomas

Gliomas can sometimes be spread out instead of concentrated in one place. Diffuse intrinsic pontine glioma (DIPG) is an example of this.

Sellar region tumors

The sellar region is a small area at the lower front of your brain. It’s just behind the sinuses at the back of your nasal passages. It’s home to your pituitary gland. Several major nerves and blood vessels pass through this area, too.

Pituitary tumors like pituitary adenomas are the second-most common CNS tumor in children. About 1 in 7 childhood CNS tumors is a pituitary tumor.

Craniopharyngiomas are the other main type of tumor in this region. They account for about 1 in 30 of all childhood CNS tumors.

Embryonal tumors

Embryonal tumors start in cells that are left over from fetal development (before birth). If those leftover cells malfunction, they can turn into tumors.

The most common of the embryonal tumors is medulloblastoma. They’re usually malignant and aggressive. About 1 in 16 of all childhood CNS tumors are this type.

Second-most common of the embryonal tumors are atypical teratoid/rhabdoid tumors (AT/RTs). They’re also usually aggressive. While they mainly affect children, about 3 in 10 AT/RTs happen in adults.

Meningeal tumors

Your meninges are layers of tissue that surround your brain and spinal cord. Meningiomas are the most common type of tumor that starts in these layers. These tumors are usually benign.

Glioneuronal and neuronal tumors

Neurons don’t often turn into tumors. But when they do, they’re called neuronal tumors. Sometimes, glial cells also become part of the tumor, causing glioneuronal (also known as neuronal-glial) tumors.

Experts combine these into a single type. Tumors under this type account for 1 in 20 childhood CNS tumors. Some examples of these include gangliogliomas and gangliocytomas.

Other common tumor types

Five different types of child CNS tumors account for about 11% of all cases. Those types are:

• Cranial nerve and spinal nerve tumors: Tumors in these areas affect nerves that connect directly to your brain or spinal cord.
• Germ cell tumors: Some examples include germinomas and teratomas.
• Choroid plexus tumors: Choroid plexus carcinomas fall under this type.
• Pineal region tumors: Pineoblastoma is an example of a tumor that can develop in the region around your pineal gland.
• CNS lymphomas and blood-forming cell neoplasms: In rare cases, lymphatic system and blood-forming cell (hematopoietic cell) cancers can happen in your central nervous system.

Symptoms of brain tumors in children

Children with a brain tumor may have one or more of the following symptoms:

• Consistently holding their neck or body tilted, or other signs of one-sided weakness
• Excessive sleepiness or signs of sleep apnea
• Headaches, especially ones that wake your child at night or that they have when they wake up in the morning
• Increase in size of your child’s head (especially noticeable in infants)
• Loss of coordination over time or balance trouble
• Nausea and vomiting, especially projectile vomiting without a cause you can find
• Seizures, including signs of focal seizures (repetitive, automatic movements) and absence seizures (staring into space)
• Squinting or other vision trouble
• Sudden changes in behavior or personality
• Issues with hearing or speaking

Childhood brain tumor causes

Tumors happen when healthy cells malfunction and multiply. This makes clusters of cells that grow where they shouldn’t. Experts don’t fully understand how or why this happens. But they suspect it has to do with:

• Genetics: Children can inherit some genetic changes from their biological parents. And some inherited diseases may increase your risk of developing brain tumors. But tumors can also happen from genetic changes that aren’t inherited.
• Environment: The world around you can affect your chances of having cancer. Radiation exposure is the only factor experts are sure increases the risk of childhood tumors. Researchers are trying to find and confirm other causes, too.

It’s important to remember that genetic changes and diseases are unpredictable. It’s not your fault if your child develops a brain tumor. Your child can inherit or develop them for reasons that you can’t control. If you know you have a genetic condition or family history of one, you may want to talk to a genetic counselor. They can explain any genetic issues and what you can do about them.

How doctors diagnose this condition

Healthcare providers may suspect and diagnose a brain tumor using a combination of methods, including:

• Physical exam
• Neurological exam
• Imaging tests, like CT scans, PET scans or MRIs
• Blood tests
• Diagnostic nervous system tests, like electroencephalogram (EEG), electromyogram (EMG) or lumbar puncture (spinal tap)
• Biopsy

If providers can analyze tissue from the tumor, they can grade it. Tumor grades mean the following:

• Grade 1 tumors are slow-growing growing, and the cells look very similar to normal.
• Grade 2 tumors grow slowly and look somewhat abnormal. These tumors are less likely to spread to other places.
• Grade 3 or 4 tumors are malignant. Their cells look very abnormal because of how they’re malfunctioning. Tumors in these grades are more aggressive and more likely to spread.

How are brain tumors in children treated?

There are several possible treatments for brain tumors. In most cases, a combination approach is best. Treatments can include:

• Surgery: Removing a brain tumor with surgery is usually the main treatment. Surgery can also help with related issues, like too much pressure on your child’s brain.
• Chemotherapy or similar treatments: Chemotherapy drugs can sometimes attack a tumor directly, either shrinking or destroying it. Other treatments, like targeted treatments or immunotherapy, work similarly.
• Radiation therapy: In some cases, radiation therapy can destroy tumors or leftover tumor tissue. Whether it’s an option can vary depending on several factors, like the location of the cancer or your child’s age.

The exact course of treatment for brain tumors can be very specific to your child’s case. Your child’s cancer care team can tell you more about the treatments and what to expect.

What can I expect if my child has a brain tumor?

The outlook for childhood brain tumors varies widely depending on factors such as:

• Your child’s age and health (especially any other conditions they have)
• The type of tumor
• Where the tumor is
• How big the tumor is
• How the tumor responds to treatment
• If the tumor has spread

A research analysis from 2022 shows that about 5 in 6 children with CNS tumors will survive at least five years. But it’s important to remember that statistics aren’t the whole story. Your child’s healthcare team is the best source of information about your child’s case. They can tell you the outlook, what to expect and support you through the process.

Can a childhood brain tumor return after treatment?

Yes, childhood tumors can return (recur). That can happen if new tumors form or if the same tumor regrows due to leftover cells from the original tumor. If treatment is successful, your child will likely need monitoring for several years to check for signs of recurrence.

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

Some questions you may want to ask your child’s cancer care team include:

• Where is the tumor?
• Is it benign or malignant?
• Has it spread to any other areas, or is it likely to spread?
• What treatments do you recommend?
• How likely is it to come back after treatment?
• Does my child have a condition that caused their cancer or might cause future health issues?