Alternative names: Glioblastoma multiforme — children; Ependymoma — children; Glioma — children; Astrocytoma — children; Medulloblastoma — children; Neuroglioma — children; Oligodendroglioma — children; Meningioma — children; Cancer — brain tumor (children)
Definition: A brain tumour is a group (mass) of abnormal cells that grow in the brain.
This article focuses on primary brain tumours in children.
The cause of primary brain tumours is usually unknown. Some primary brain tumours are associated with other syndromes or have a tendency to run in a family:
- Not cancerous (benign)
- Invasive (spread to nearby areas)
- Cancerous (malignant)
Brain tumours are classified based on:
- The exact site of the tumour
- The type of tissue involved
- Whether it is cancerous
Brain tumours can directly destroy brain cells. They can also indirectly damage cells by pushing on other parts of the brain. This leads to swelling and increased pressure inside the skull.
Tumours can occur at any age. Many tumours are more common at a certain age. In general, brain tumours in children are very rare.
COMMON TUMOUR TYPES
Astrocytomas are usually noncancerous, slow-growing tumours. They most commonly develop in children ages 5 to 8. Also called low-grade gliomas, these are the most common brain tumours in children.
Medulloblastomas are the most common type of childhood brain cancer. Most medulloblastomas occur before age 10.
Ependymomas are a type of childhood brain tumour that can be benign (noncancerous) or malignant (cancerous). The location and type of ependymoma determine the type of therapy needed to control the tumour.
Brainstem gliomas are very rare tumours that occur almost only in children. The average age at which they develop is about 6. The tumor may grow very large before causing symptoms.
Symptoms may be subtle and only gradually become worse, or they may occur very quickly.
Headaches are often the most common symptom. But only very rarely do children with headaches have a tumour. Headache patterns that may occur with brain tumours include:
- Headaches that are worse when waking up in the morning and go away within a few hours
- Headaches that get worse with coughing or exercise, or with a change in body position
- Headaches that occur while sleeping and with at least one other symptom such as vomiting or confusion
Sometimes, the only symptoms of brain tumors are mental changes, which may include:
- Changes in personality and behavior
- Unable to concentrate
- Increased sleep
- Memory loss
- Problems with reasoning
Other possible symptoms are:
- Unexplained frequent vomiting
- Gradual loss of movement or feeling in an arm or leg
- Hearing loss with or without dizziness
- Speech difficulty
- Unexpected vision problem (especially if it occurs with a headache), including vision loss (usually of peripheral vision) in one or both eyes, or double vision
- Problems with balance
- Weakness or numbness
The health care provider will perform a physical exam. Infants may have the following physical signs:
- Bulging fontanelle
- Enlarged eyes
- No red reflex in the eye
- Positive Babinski reflex
- Separated sutures
Older children with brain tumours may have the following physical signs or symptoms:
- Vision changes
- Change how the child walks (gait)
- Weakness of a specific body part
- Head tilt
The following tests may be used to detect a brain tumour and identify its location:
Treatment depends on the size and type of tumour and the child’s general health. The goals of treatment may be to cure the tumor, relieve symptoms, and improve brain function or the child’s comfort.
Surgery is needed for most primary brain tumours. Some tumours may be completely removed. In cases where the tumour cannot be removed, surgery may help reduce pressure and relieve symptoms. Chemotherapy or radiation therapy may be used for certain tumours.
The following are treatments for specific types of tumours:
- Astrocytoma: Surgery to remove the tumour is the main treatment. Chemotherapy or radiation therapy may also be necessary.
- Brainstem gliomas: Surgery may not be possible because of the tumour’s location deep in the brain. Radiation is used to shrink the tumour and prolong life. Sometimes targeted chemotherapy can be used.
- Ependymomas: Treatment includes surgery. Radiation and chemotherapy may be necessary.
- Medulloblastomas: Surgery alone does not cure this type of tumor. Chemotherapy with or without radiation is often used in combination with surgery.
Medicines used to treat children with primary brain tumours include:
- Corticosteroids to reduce brain swelling
- Diuretics (water pills) to reduce brain swelling and pressure
- Anticonvulsants to reduce or prevent seizures
- Pain medicines
- Chemotherapy to help shrink the tumor or prevent the tumour from growing back
Comfort measures, safety measures, physical therapy, occupational therapy, and other such steps may be required to improve quality of life.
You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you and your child feel less alone.
How well a child does depends on many things, including the type of tumour. In general, about 3 out of 4 children survive at least 5 years after being diagnosed.
Long-term brain and nervous system problems may result from the tumour itself or from treatment. Children may have problems with attention, focus, or memory. They may also have problems processing information, planning, insight, or initiative or desire to do things.
Children younger than age 7, especially younger than age 3, seem to be at greatest risk of these complications.
Parents need to make sure that children receive support services at home and at school.
Call a provider if a child develops headaches that do not go away or other symptoms of a brain tumour.
Go to the emergency room if a child develops any of the following:
- Physical weakness
- Change in behaviour
- Severe headache of unknown cause
- Seizure of unknown cause
- Vision changes
- Speech changes
National Cancer Institute website. Childhood brain and spinal cord tumors treatment overview (PDQ): health professional version. www.cancer.gov/types/brain/hp/child-brain-treatment-pdq. Updated August 2, 2017. Accessed August 26, 2019.
Zaky W, Ater JL, Khatua S. Brain tumors in childhood. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 524.