Brain tumors are the most common solid tumors affecting children and adolescents, with close to 5,000 children diagnosed each year in the US alone.
Because of their location, some pediatric brain tumors and their required treatments can cause significant long-term impairment to intellectual and neurological function. Some forms of brain tumor can be life-threatening.
Pediatric brain tumors are masses of abnormal cells that result from uncontrolled growth of cells in the brain. A tumor develops if DNA mutations in brain cells lead to abnormal growth or uncontrolled cell division. Some tumors are benign and stay localized, while others become malignant, invading nearby tissues. Malignant tumor cells can enter the cerebrospinal fluid (CSF) and spread to other parts of the brain or spine, forming metastatic tumors.
Causes of Brain Tumors
There are few established causes of brain tumors in children:
Inherited Causes
Gene changes associated with rare inherited syndromes increase the risk. These include:
- Neurofibromatosis
- Tuberous sclerosis
- Li-Fraumeni syndrome
- von Hippel-Lindau syndrome
Acquired Causes
Severe radiation exposure can cause brain tumors. Apart from radiation, no known lifestyle or environmental factors are clearly linked. Most gene changes appear to be random events within cells.
Signs and Symptoms of Pediatric Brain Tumors
Symptoms depend on the tumor's type, size, location, and growth rate. They are caused by compression and destruction of healthy brain tissue.
Common symptoms include:
- Headaches
- Seizures
- Nausea and vomiting
- Irritability
- Lethargy
- Personality and mental activity changes
- Macroencephaly (enlarged head in infants)
- Coma or death (if untreated)
Symptoms from increased intracranial pressure may include:
- A fuller soft spot on the skull in babies under 1 year
- Abnormal eye movement
- Slurred speech
- Trouble swallowing
- Loss of appetite or feeding difficulties in babies
- Balance problems
- Trouble walking
- Weakness or loss of sensation in limbs
- Facial drooping
- Confusion, memory problems, hearing issues
Diagnosis
Diagnosis typically involves medical imaging such as CT scans, but more commonly MRI. A definitive diagnosis requires a tissue biopsy to analyze the tumor's molecular characteristics.
If a scan shows a tumor, a neurosurgical consultation follows to develop a treatment plan. The care team may include a neurosurgeon, radiation oncologist, ophthalmologist, epileptologist, and other specialists.
Types of Brain Tumors in Children
Brain tumors are categorized as:
- Primary: Start in the brain.
- Metastatic: Spread from other parts of the body to the brain.
- Benign: Slow-growing and non-cancerous, but can be hard to treat if near critical brain structures.
- Malignant: Cancerous, aggressive, fast-growing, and capable of spreading to other brain areas.
Treatment
Treatment depends on tumor type, grade, and symptoms, and often involves a combination of surgery, chemotherapy, and radiation. The specific plan is guided by the tumor's molecular profile from a biopsy. High-grade or incompletely removed tumors have a higher recurrence risk. Treatment typically lasts 3–6 months, including rehabilitation.
Surgery
Surgery is the first step for most pediatric brain tumors. The goal is to remove as much of the tumor as safely possible to relieve intracranial pressure. For low-grade tumors, surgery may be the only treatment needed.
Radiation Therapy
High-energy radiation beams target the tumor and a small surrounding area. For tumors like medulloblastoma, radiation may be needed for the entire brain and spinal cord. It is used cautiously in young children due to brain development. Proton-beam therapy is an advanced option with promising results.
Chemotherapy
Used for aggressive, high-grade tumors, chemotherapy can be administered orally, intravenously, into the cerebrospinal fluid, or directly into the surgical cavity.
Follow-up Care After Surgery
Recovery varies. Promptly treated children often do well. Some may experience temporary neurological deficits like muscle weakness, which usually resolve unless there was prior permanent damage. Physical, occupational, and speech therapy can aid recovery. Regular follow-ups with the neurosurgeon are crucial to monitor function, side effects, and recurrence.
Palliative Care and Follow-up for Brain Tumor
Palliative care ensures the best quality of life for children with brain tumors. It is a holistic, supportive approach that manages symptoms and side effects, addressing emotional, social, practical, and spiritual needs throughout the cancer journey.