Children's brain and spinal cord tumors

Children's brain and spinal cord tumors

Children's brain and spinal cord tumors

The brain and spinal cord make up the central nervous system. It is the command center of the body for thoughts, emotions, speech, vision, hearing and balance.

Tumors of the brain and spinal cord in children are the result of uncontrolled cell growth. As these tumors grow, they can press on the cells around them and cause damage. This can prevent the central nervous system from working properly.

Because of their location, these tumors can affect a child's behavior, balance, vision, speech, and hearing. They can also affect bowel and bladder control. Sometimes they are life threatening.

What parts of the body do they affect?

Tumors of the brain and spinal cord in children can be located in the spinal cord or in one of the three main parts of the brain: cerebrum, cerebellum, or brainstem.

The brain is located at the top of the head. It controls learning, emotions, and voluntary movements.

The cerebellum is located closer to the middle of the head, further back. He controls the balance.

The brain stem is connected to the spinal cord. It controls breathing, heart rate, and the nerves and muscles you use to walk, talk, hear, eat, and see.

The spinal cord connects the brain to nerves throughout the body. It sends signals back and forth for things like muscle movement.

What are the different types?

There are many of them, but they fall into two broad categories: benign (non-cancerous) and malignant (cancerous).

Benign tumors of the brain and spinal cord can affect the brain, brain stem, and spinal cord. They rarely spread to other parts of the body. However, these tumors can cause serious problems due to their location. They can even be life-threatening.

Malignant tumors can grow rapidly. They can also spread to other brain tissues or other parts of the body.

Some of the most common types of tumors that affect children include:

Astrocytomas

These tumors begin in a common type of stellate glial cells called astrocytes. They account for about 10-20% of all brain tumors in children. Astrocytomas often begin in the pons, the part of the brainstem that controls breathing and heart rate, but they can form anywhere in the brain or spinal cord. They can be benign or malignant.

Astrocytomas usually spread throughout the brain and mix with other tissues. But not all of these tumors behave in the same way. Some grow quickly, others slowly. Not all grow into other tissues.

High-grade and moderate-grade astrocytomas grow and spread rapidly. Low-grade astrocytomas tend to grow more slowly.

Pilocytic astrocytomas are low-grade astrocytomas responsible for one in five brain tumors in children. They usually start in the cerebellum, located near the back of the brain. They can also start in other areas such as the optic nerve, hypothalamus, and brainstem. They are called diffuse intrinsic pontine gliomas.

Primary neuroectodermal tumors

They account for approximately 1 in 5 brain tumors in children. They begin in immature central nerve cells (neuroectodermal cells). They are more common in young children than in older children and usually grow rapidly.

The most common primary neuroectodermal tumor is medulloblastoma, which occurs in the cerebellum. Other primary neuroectodermal tumors include pineoblastomas, which begin in the pineal gland. Neuroblastomas begin in the brain or spinal cord.

Ependymomas

These tumors begin in ependymal cells lining the ventricles of the brain or the central canal of the spinal cord. Ependymal cells produce cerebrospinal fluid.

Cerebrospinal fluid circulates through the canal and through the ventricles. Ependymomas can block the flow of cerebrospinal fluid from the ventricles. This can cause a buildup of fluid in the brain, a condition called hydrocephalus. When this happens, your doctor will likely need to drain the extra fluid. They may put in a shunt to help drain the fluid.

Approximately 1 in 20 brain tumors in children is an ependymoma. They can be fast growing or slow growing. If they grow rapidly, they are called anaplastic ependymomas. These tumors spread along the cerebrospinal fluid route but do not spread to normal brain tissue.

Craniopharyngiomas

These tumors start just above the pituitary gland and just below the brain. They represent 1 in 25 brain tumors in children and are considered hereditary. This means that they live in families.

Craniopharyngiomas can compress the optic nerve and cause vision problems. They can also put pressure on the pituitary and hypothalamus, leading to hormonal problems.

Oligodendrogliomas

This rare brain tumor begins in the brain, in glial cells called oligodendrocytes. This tumor tends to grow slowly but may invade surrounding tissues.

Schwannomas

They begin in Schwann cells, which surround and insulate nerves. They tend to be soft. These tumors are rare in children and are usually the result of an inherited disorder such as neurofibromatosis type 2.

Schwannomas usually form near the cerebellum on the nerve responsible for hearing and balance. They are called vestibular or vestibular acoustic schwannomas.

Tumors of the choroid plexus

These tumors are rare, mostly benign tumors that begin in the ventricles of the brain.

Mixed gliomas

They are made up of more than one type of cell. They may include oligodendrocytes, astrocytes, and ependymal cells.

Mixed glial and neuronal tumors

They are composed of glial and neuronal cells. They tend to affect children and young adults. They include ganglioglioma, pleomorphic xanthoastrocytoma, and dysembryoplastic neuroepithelial tumor.

What causes them?

The doctors are not sure.

Rarely, children have inherited genes that increase the risk of brain or spinal cord tumors. These include neurofibromatosis, Li Fraumeni syndrome, Lynch syndrome, and tuberous sclerosis.

What puts a child at risk?

Radiation is the only known environmental risk factor. This is usually the result of treatment for another disease. Radiation therapy, computed tomography, and x-rays of the head increase the risk of tumors.

Electromagnetic radiation from cell phones and power lines has been studied as possible risk factors. But researchers have not found conclusive evidence linking these things to brain tumors in children.

At what age are children usually diagnosed?

Unless children are at high genetic risk, they are usually not tested for brain or spinal cord tumors. They are usually only tested if they show symptoms. This means that there is no standard age at which children are diagnosed with a tumor in the brain or spinal cord.

Children may develop tumors when they are infants or teenagers. Symptoms such as headache, vomiting, dizziness, and imbalance may develop slowly or quickly.

How are these tumors diagnosed?

Your child's doctor may ask a specialist called a pediatric neurologist to check on your child. If it's cancer, they'll see a pediatric oncologist.

First, the doctor will ask you about your child's symptoms and medical history. They will also ask questions and do tests to see how well your child's brain and spinal cord are working. This is called a neurological exam. The doctor will test your child's reflexes, feelings, and thinking skills.

Other tests used to diagnose tumors include:

  • Magnetic resonance imaging. This test uses a powerful magnet and radio waves to take pictures of your baby's brain and spinal cord. It can show the location and size of the tumor. Your child may be given medicine to help him sleep so that he remains still during the test. Before the MRI scan, the doctor may give them an injection of gadolinium into a vein. This substance makes the tumor lighter in the photograph.
  • CT scan. This test uses X-rays and a computer to produce detailed images of the inside of the body. Your child may have a dye injected into a vein before the test to make it easier for the doctor to see the tumor.
  • Lumbar puncture (spinal centesis). In this test, the doctor inserts a needle into the child's back and removes a small sample of cerebrospinal fluid. The medicine is used to numb the area first. The laboratory assistant checks the liquid under a microscope for the presence of cancer cells.
  • Biopsy. This is the only test that can confirm if your child has a tumor. The surgeon removes a small piece of brain tissue through a needle. If cancer cells are present, the doctor will remove the tumor during the same operation.

After the tests, the doctor will give the tumor a score depending on how fast it can grow. Low-grade tumors grow more slowly than high-grade ones. Once the doctor knows the grade, they can better plan your child's treatment.

Treatment of tumors of the brain and spinal cord in children

If your child is diagnosed with a tumor in the brain or spinal cord, the doctor will discuss the best treatment options with you. This usually means surgery to remove the tumor. Depending on whether it is benign or malignant, other treatments such as radiation therapy or chemotherapy may follow.

A number of factors will determine the type of treatment your doctor recommends. This includes:

  • Size and location of tumor
  • If the tumor is benign or malignant
  • Your child’s age and overall health
  • The risks of a particular treatment
  • The treatment of you -- the parent -- most prefer

Is surgery always necessary?

No. A benign tumor is a concern but may not need to be removed immediately. If your child's tumor is growing slowly or doesn't seem to be changing, the doctor may decide to wait and see. They can monitor the tumor with magnetic resonance imaging. This painless test uses a magnetic field and radio waves to create images inside your child's body.

Before the doctor decides to operate, he will take a biopsy of the tumor to see if it contains cancer.

Non-surgical treatment

In many cases, monitoring is not enough. The tumor may be cancerous and grow. If the operation is not possible, you still have other options such as:

Radiation therapy. This uses high-energy particles or waves to kill cancer cells. It can also damage healthy cells around the tumor and have a major impact on brain development. Radiation therapy is generally not given to children under 3 years of age. New methods are making radiotherapy more accurate.

Chemotherapy. This includes medicines your child takes by mouth or injected into a vein. It is often used for rapidly growing tumors. It can be obtained by children under 3 years old.

Radiation therapy and chemotherapy can cause nausea and fatigue. Radiation therapy to the spine tends to cause more nausea than radiation therapy to the brain. But irradiation of the brain can lead to the loss of some brain functions in children.

Other possible side effects of chemotherapy include:

  • Sores in the mouth
  • Loss of appetite and weight loss
  • Diarrhea
  • Hair loss
  • Easy bruising and bleeding
  • Increased risk of infections due to a weakened immune system

Surgery

  • Craniotomy. This is the most common surgery to remove a brain tumor. The surgeon starts by making an incision in the scalp. They will remove a piece of the skull to expose the brain. The goal is to remove all or as much of the tumor as possible (depending on where the tumor is). The surgeon returns part of the skull to its place and sews up the scalp. If a new tumor appears or your child continues to have symptoms, they may need a second operation.
  • Neuroendoscopy. The surgeon makes a small hole in the skull or goes through the nose or mouth, depending on where the tumor is. They use small instruments to remove the tumor. One of them has a small camera that sends images back to a monitor next to the operating table. The surgeon uses these images to find and remove the tumor.
  • Spinal surgery. It can take many forms, depending on whether the tumor is in the lower back (lumbar) or in the upper back (thoracic region). Sometimes spinal surgeries are performed from the front. Other times it is done from behind or even a combination of both. This access may be necessary when the tumor is in a hard to reach area in order to safely and completely remove it from one side.
  • If the tumor is cancerous, doctors may recommend radiation therapy or chemotherapy in addition to surgery to make sure all cancer cells are dead.
  • Brain and spine surgeries are complex and risky procedures. But treatments are improving every year, giving children with tumors a better chance than ever.

Aftercare

Surgery for tumors of the brain and spinal cord usually requires at least a few days of recovery in the hospital. This may take longer, depending on your child's age, general health, and type of treatment. They may need chemotherapy or radiation therapy after surgery. It can also affect the time they spend in the hospital.

While recovering, they may have painless tests such as CT scans and magnetic resonance imaging. Both provide doctors with images of the brain to help them see if there have been any obvious changes.

Depending on your child's condition, he may need to stay in a rehabilitation center.

Your child will be taken care of by a team of doctors and nurses. Together they will develop a plan for postoperative treatment and recovery. Some of the specialists your child may turn to include:

  • Neurologist to evaluate and treat diseases of the nervous system
  • Endocrinologist to help make sure your child has the right hormone levels for healthy growth and development
  • Physiotherapist to help with walking and other important muscle activities
  • An occupational therapist to help with minor muscle functions such as using kitchen utensils, buttoning a shirt, brushing teeth, and similar activities.
  • Speech therapist to help improve speaking and communication skills
  • Ophthalmologist to check your child's vision
  • An audiologist to check your child's hearing
  • A psychiatrist or psychologist to evaluate any changes in your child's learning ability, memory, general intelligence and other related areas

Possible complications

Other symptoms that should prompt you to see your child's doctor include:

  • Memory problems
  • Hallucinations
  • Major mood changes
  • Trouble with bowel movements and urination
  • Frequent headaches
  • Weakness or tingling in the arms or legs
  • Nausea
  • Fever

Call your doctor any time you have questions about your child's health during recovery.

The quality of life after treatment of a tumor of the brain or spinal cord is determined by the degree of the disease and its treatment. Your child may fully recover from tumor treatment in just a few months, or it may take more than a year. Some children may have several long-term problems associated with their tumor. Others may have learning problems or certain restrictions on sports and other recreational activities. The first year is usually the hardest.

As far as possible, your child should go to school, spend time with friends, and try to re-establish a normal daily routine. Realize that their friends and classmates may not know much about tumors in the brain or spinal cord. You can help bridge this gap by working with your child's teacher.

Some health centers have programs to help schools successfully transition your child. These programs provide schools with information about student health and advice about any special education or services they may need.

Long term problems

One of the big problems of living after treatment for a tumor in the brain or spinal cord is that some effects may not appear for many years. This is especially true if your child is very small at the time of treatment. Some learning disabilities may only show up after you've been in school for a while.

Your child may be at greater risk of developing other tumors later in life. It will be important to follow your doctor's advice regarding ongoing examinations and long-term care.

As your child grows, he may resent the thought of having to get treated and get well. They may also worry about a normal life later. This is where the support of friends, family, and others who have gone through similar experiences can make a positive difference. 


Related Links

Previous Post Next Post