Childhood Brain Tumors

Summary Type: Treatment
Summary Audience: Patients
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of various childhood brain tumors.

Childhood Brain Tumors

Description

What is childhood brain tumor?

Childhood brain tumors are a diverse group of diseases characterized by the abnormal growth of tissue contained within the skull. Brain tumors can be benign (without cancer cells) or malignant (contains cancer cells). The brain controls vital functions such as memory and learning, the senses (hearing, sight, smell, taste, and touch), and emotion. It also controls other parts of the body, including muscles, organs, and blood vessels. Other than leukemia and lymphoma, brain tumors are the most common type of cancer that occurs in children.

This PDQ treatment information summary refers only to tumors that originate in the brain (primary brain tumors). Metastatic brain tumors, which are secondary tumors formed by cancer cells that begin in other parts of the body and spread to the brain, are not included. Brain tumors can occur in both children and adults; however, treatment may be different for adults than for children. (Refer to the PDQ summary on Adult Brain Tumor Treatment for more information.)

If your child has symptoms that may be caused by a brain tumor, his or her doctor may order a computed tomographic (CT) scan, a diagnostic test that uses computers and x-rays to create pictures of the body. A magnetic resonance imaging (MRI) scan, a diagnostic test similar to a CT scan but which uses magnetic waves instead of x-rays, may also be performed.

Often, surgery is required to determine whether a brain tumor exists and what type of tumor it is. A small sample of tumor tissue may be surgically removed and examined under a microscope. This is called a biopsy. Sometimes a biopsy is done by making a small hole in the skull and using a needle to extract a sample of the tumor.

There are many types of brain tumors that occur in children. Treatment and chance of recovery (prognosis) depend on the type of tumor, its location within the brain, the extent to which it has spread, and your child’s age and general health.

Stage Explanation

Types of childhood brain tumor

Once childhood brain tumor is detected, additional tests will be performed to determine the type of tumor. If a biopsy specimen is taken, the tumor cells will be examined carefully under a microscope to see how different they appear from normal cells. This will determine the grade of the tumor. The grade of a tumor is determined by microscopic examination of its cells to see how similar the cells are to normal cells. Cells from higher-grade, more abnormal-looking tumors usually grow faster and are more malignant than cells from lower-grade tumors. Your child’s doctor needs to know the type and grade of tumor in order to plan treatment.

There is no staging for childhood brain tumors. Brain tumors are grouped according to their location within the brain and the appearance and behavior of the tumor tissue. The following groupings are used for childhood brain tumors:

Infratentorial tumors

Infratentorial tumors are those that occur in the lower part of the brain. Tumors found in this region include:

Medulloblastoma

(Refer to the PDQ summary on Childhood Medulloblastoma Treatment for more information.)

Cerebellar astrocytoma

(Refer to the PDQ summary on Childhood Cerebellar Astrocytoma Treatment for more information.)

Infratentorial ependymoma

Ependymal tumors are tumors that begin in the ependyma, the cells that line the hollow cavities within the brain (called ventricles) which are filled with cerebrospinal fluid). The growth of ependymal tumors can obstruct the flow of the cerebrospinal fluid through the brain and spinal cord. Infratentorial ependymomas begin in the lower part of the brain. These tumors may spread via the cerebrospinal fluid to other areas of the brain and spinal cord.

Brain stem glioma

(Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more information.)

Supratentorial tumors

Supratentorial tumors are those that occur in the upper part of the brain. Common supratentorial tumors include:

Cerebral astrocytoma

(Refer to the PDQ summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more information.)

Supratentorial ependymoma

Ependymal tumors are tumors that begin in the ependyma, the cells that line the hollow cavities within the brain (called ventricles) which are filled with cerebrospinal fluid. The growth of ependymal tumors can obstruct the flow of the cerebrospinal fluid through the brain. Supratentorial ependymomas begin in the upper part of the brain. These tumors may spread to other areas of the brain and spinal cord, depending on their grade.

Craniopharyngioma

Craniopharyngiomas are tumors that generally occur just above the pituitary gland. Located at the bottom of the brain, the pituitary gland is about the size of a pea and controls many vital functions. Craniopharyngiomas do not spread, but may interfere with important structures near them, causing serious problems.

Central nervous system germ cell tumor

Germ cell tumors arise from the sex cells found in the brain. There are different types of germ cell tumors, including germinomas, embryonal cell carcinomas, choriocarcinomas, and teratomas. These tumors usually occur in the center of the brain, and can spread to other parts of the brain and spinal cord.

Supratentorial primitive neuroectodermal tumors and pineoblastoma

(Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal Tumors Treatment for more information.)

Visual pathway and hypothalamic glioma

(Refer to the PDQ summary on Childhood Visual Pathway and Hypothalamic Glioma Treatment for more information.)

Spinal Cord Tumors

Spinal cord tumors are rare benign or cancerous tumors in the spinal cord (the bundles of nerves that carry messages between the brain and the body). The diagnosis of spinal cord tumors depends on how the tumor looks under a microscope and its location. Spinal cord tumors compress the spinal cord and the surrounding nerves causing symptoms such as pain or numbness in the back, arms, or legs, decreased muscle strength, and in some cases, loss of bowel or bladder control. X-rays of the brain and the entire spine are done at the time of diagnosis to determine extent of disease.

Recurrent brain tumor

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may recur in its original location, in another part of the central nervous system, or systemically (throughout the body).

Treatment Option Overview

There are treatments for all children with brain tumors. Three kinds of treatment are used:

• Surgery (removing the tumor in an operation)
• Radiation therapy (using high-dose x-rays to kill tumor cells)
• Chemotherapy (using drugs to kill tumor cells)

More than one method of treatment may be used, depending on the needs of the patient.

Experienced doctors working together may provide the best treatment for children with brain tumors. Your child’s treatment will often be coordinated by a pediatric oncologist, a doctor who specializes in cancer in children. The pediatric oncologist may refer your child to other specialists, such as a pediatric neurosurgeon (a specialist in childhood brain surgery), a pediatric neurologist, a psychologist, a radiation oncologist, and other doctors who specialize in the type of treatment your child requires.

Treatment options often depend on the type of tumor and its location within the brain. Complete or near complete removal of the tumor is often possible. If the tumor cannot be completely removed, radiation therapy and/or chemotherapy may also be given.

Radiation therapy uses high-energy radiation from x-rays and other sources to kill cancer cells and shrink tumors. Radiation therapy for childhood brain tumors usually comes from a machine outside the body (external radiation therapy). For some types of brain tumors, clinical trials are evaluating radiation therapy given in several small doses per day (hyperfractionated radiation therapy). Since radiation therapy can affect growth and brain development, other clinical trials are testing ways to decrease or delay radiation therapy, especially for younger children who have not yet achieved full growth.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs may be taken by mouth or injected into a vein (intravenous) or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy is being studied in clinical trials as a means of delaying, modifying or eliminating the need for radiation therapy in younger patients, as well as for use prior to or during radiation therapy.

Treatment by type

Treatment for childhood brain tumor depends on the type and grade of the tumor, its location within the brain, and your child’s age and overall health.

Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child enter a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat people with cancer. Clinical trials are ongoing in most parts of the country for childhood brain tumors. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Childhood Medulloblastoma

(Refer to the PDQ summary on Childhood Medulloblastoma Treatment for more information.)

Childhood Cerebellar Astrocytoma

(Refer to the PDQ summary on Childhood Cerebellar Astrocytoma Treatment for more information.)

Childhood Infratentorial Ependymoma

Treatment for childhood infratentorial ependymoma is usually surgery to remove as much of the tumor as possible, followed by radiation therapy. For children younger than 3 years of age, chemotherapy may be given to delay, modify, or eliminate the use of radiation therapy.

Childhood Brain Stem Glioma

(Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more information.)

Childhood Cerebral Astrocytoma/Malignant Glioma

(Refer to the PDQ summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more information.)

Childhood Supratentorial Ependymoma

Treatment for childhood supratentorial ependymoma may be surgery followed by radiation therapy. Clinical trials are evaluating surgery followed by chemotherapy with or without radiation therapy. For children younger than 3 years of age, chemotherapy may be given to delay or modify the use of radiation therapy. Clinical trials evaluating radiation therapy with or without chemotherapy are ongoing.

Childhood Craniopharyngioma

Treatment for childhood craniopharyngioma may be surgery, radiation therapy, or a combination of the two.

Childhood Central Nervous System Germ Cell Tumor

Treatment for childhood central nervous system germ cell tumor may be radiation therapy. In some cases, chemotherapy may be given in addition to radiation therapy.

Spinal Cord Tumors

Treatment for spinal cord tumors may be surgery with or without radiation therapy. In some cases, chemotherapy may be given in addition to radiation therapy.

Childhood Visual Pathway Glioma

(Refer to the PDQ summary on Childhood Visual Pathway and Hypothalamic Glioma Treatment for more information.)

Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma

(Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal Tumors Treatment for more information.)

Recurrent Childhood Brain Tumor

Treatment for recurrent disease depends on the type of tumor, whether the tumor recurs in the site in which it originated or elsewhere, the amount of time between initial treatment and the recurrence, and the type of treatment previously given.

Recurrent low-grade glial tumors

Treatment options consist of surgery, radiation therapy, and chemotherapy. Clinical trials are currently evaluating the role of chemotherapy for treatment of these tumors.

Recurrent infratentorial ependymomas

Treatment options include surgery and chemotherapy. Clinical trials are currently evaluating the role of chemotherapy for treatment of these tumors.

Recurrent supratentorial ependymoma

Treatment usually consists of chemotherapy. Clinical trials are currently evaluating the role of chemotherapy for treatment of these tumors.

Recurrent central nervous system germ cell tumors

Treatment usually consists of chemotherapy. Clinical trials are currently evaluating the role of chemotherapy for treatment of these tumors.

Changes to This Summary (06/10/2004)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Editorial changes were made to this summary.

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About PDQ

PDQ is a comprehensive cancer database available on NCI's Web site.

PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

PDQ contains cancer information summaries.

The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.

Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

PDQ also contains information on clinical trials.

In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."

Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

The PDQ database contains listings of groups specializing in clinical trials.

The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

The PDQ database contains listings of cancer health professionals and hospitals with cancer programs.

Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.