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.