The central nervous system (CNS) is made up of the brain and the spinal cord. Together, these important organs control functions necessary to sustain life, such as breathing, heart rate, movement, thinking and learning. Important substances produced in the brain (hormones) stimulate and control many other organs in the body. Tumors that develop in this critical area have many unique properties and symptoms.

Brain tumors are not a single kind of tumor, but include several different tumor types. As a group, these are the most common solid tumors in children under 15. Brain tumors account for approximately 20% of all cancers diagnosed in this population. Other important facts about tumors that occur in the brain and spinal cord include the following:

• Tumors can arise at any age in any area of the brain and spinal cord. Some specific types of children’s tumors tend to occur more often in certain parts of the brain.
• Brain tumors are more common in children under age 8 than in older children.
• Brain tumors are categorized by the type of cancer cell and by the area of the brain in which they develop.
• The terms “benign” and “malignant” as usually applied to tumors are not as useful when describing CNS tumors. Because the brain and skull comprise a “box” of a fixed size, even “benign” or slow-growing tumors can cause serious problems or eventual death if they develop in an area where complete surgical removal is not possible.

Most brain tumors tend NOT to “metastasize” or spread to distant areas of the body outside the brain and/or spinal cord (CNS).  They do, however, tend to recur locally, or spread to other areas of the central nervous system.

Symptoms of Brain Tumors

Typical symptoms of CNS tumors are directly related to the location of the tumor, how fast it is growing and any associated tissue swelling that occurs in conjunction with the tumor. Parents often are the first to notice symptoms related to the development of a CNS tumor. Occasionally, the child’s teacher or physician may note signs and symptoms that are worrisome.

Typical symptoms of CNS tumors include:

• Headaches (frequent, recurrent), especially after waking up in the morning
• Vomiting, especially in the morning
• Eye movement problems and/or vision changes
• Unsteady gait or worsening balance
• Weakness of one side of the face
• Loss of previously acquired developmental milestones
• Weakness in the arms or legs
• Bulging fontanelle (soft spot on an infants head where the bones that make up the skull have not fully joined) or increased head size in infants
• Tilting of the head or neck to one side
• Seizures
• Difficulty with speech, swallowing or drooling
• Back or neck pain, often awakening the child at night

Less common symptoms include:

• Changes in eating or thirst
• Growth problems
• Dizziness
• Lethargy, irritability or other behavior changes
• Deterioration in school performance
• Loss of sensation in the arms or legs
• Loss of consciousness, without history of injury
• Changes in, or loss of control of, bowel or bladder
• Hearing loss, without evidence of infection

Diagnosing Brain Tumors

Certain important facts are needed to help determine the prognosis (chance of recovery) for each type of brain tumor:

• The specific type of tumor, as determined by the pathologist
• The specific area of the brain involved
• The ability to surgically remove the tumor partially or completely
• The growth rate of the tumor
• The age of the child at the time of diagnosis

The development of advanced imaging equipment and techniques has provided an important breakthrough in the diagnosis and treatment of brain tumors. Standard tests used to diagnose these tumors include:

• Computerized Tomography scans (CT scans)
• Magnetic Resonance Imaging (MRI) scans

Both of these tests provide clear pictures of the brain or spinal cord. They assist physicians in identifying the precise location of the tumor. Additional tests often performed during the diagnostic work-up of brain tumors may include any or all of the following:

• Positron Emission Tomography (PET) scan, similar to CT and MRI, but assesses the metabolic activity of the tumor.
• SPECT scan, similar to an MRI but measures the uptake of certain substances in the brain. A SPECT scan is also helpful in differentiating normal brain, tumor and scar tissue following surgery.
• Electroencephalogram (EEG), used to evaluate seizure activity.

In most cases, surgery will be performed once the location of the tumor is precisely defined. The purpose of the surgery is to obtain a portion of the tumor for the pathologist to examine carefully under the microscope. This is necessary to make the correct diagnosis and to plan subsequent treatment. The surgeon will attempt to remove as much of the tumor as possible, without damaging any normal adjacent brain tissue.

After the specific diagnosis is established, a variety of other tests may be necessary to determine whether the tumor has spread to any other organs in the body. Further testing will also help to evaluate the function of other body systems prior to starting any subsequent therapy.  Such tests may include:

• Lumbar puncture (spinal tap) to evaluate spinal fluid for tumor cells
• Audiogram (hearing test)
• Blood tests of liver and kidney function, salt balance and hormone function
• Neuropsychologic evaluation

The child’s primary oncologist will have a lengthy diagnosis and treatment planning conference (also called  informed consent conference) with the parents. The purpose of the conference is to review the information related to the tumor, its location, the amount surgically removed, test results and to present a plan for further care of the child.

Causes of Brain Tumors

We currently DO NOT know what causes brain tumors.  Only a few risk factors for brain tumors are known for sure.

Genetic conditions

Children with some genetic syndromes are more likely to develop brain tumors than other children. The syndromes are neurofibromatosis, von Hippel-Lindau disease, Li-Fraumeni syndrome, ataxia telangiectasia, basal cell nevus syndrome and hereditary non-polyposis colon cancer (Gorlin syndrome). Children with these genetic conditions are more at risk for brain tumors, but these account for only a small fraction of cases. These syndromes are usually recognized early in childhood, so it is most likely that you would know if your child has one of these conditions.

Prior Radiation

Children who have received radiation therapy to the head as part of treatment for an earlier cancer are at an increased risk for a new brain tumor.

Male/Female

The patterns differ depending on the type of brain tumor.  Boys and girls are equally likely to develop an astrocytoma. Boys are more likely to develop a medulloblastoma, ependymoma or germ cell tumor than girls.

Race and Ethnicity

Caucasian children are more likely than African American children to develop a medulloblastoma or ependymoma. Other types of brain tumors affect Caucasian and African American children equally. Differences in other ethnic groups have not yet been identified.

According to the current state of medical knowledge, the following exposures have NOT been shown to increase a child’s risk of developing a brain tumor:

• Electromagnetic fields such as those from power lines and electric appliances (such as televisions)
• Mother’s consumption of alcohol during pregnancy
• Mother’s smoking during pregnancy

Last updated September, 2011

About Brain Tumors
In Treatment for Brain Tumors
After Treatment for Brain Tumors