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Brain Tumors

  • Having a tumor in the brain is always a very serious matter, but today, more than 50 percent of all children diagnosed with a pediatric brain tumor will be cured of the disease.

    Tumors are masses of abnormal cells that can appear in all parts of the body and grow out of control. Tumors in the brain can be very complicated to treat because of the delicate surrounding tissue.

    While all pediatric brain tumors are life-threatening, most children and adolescents with this diagnosis survive into adulthood. Many of them face physical, psychological, social and intellectual challenges related to their treatment, and they require ongoing care to help with school and other skills they will use throughout adulthood.

    • Brain tumors in children are relatively rare, occurring in only five of every 100,000 children.
    • About 2,200 children and adolescents in the United States are diagnosed with a brain tumor each year.
    • Brain tumors are commonly treated with surgery and/or other therapies including chemotherapy and radiation.

    See the In-Depth section to learn more about pediatric brain tumors, or visit the Dana-Farber/Boston Children’s website to learn about different types of childhood brain tumors we treat.

    How Dana-Farber/Boston Children’s Cancer and Blood Disorders Center approaches pediatric brain tumors

    If your child is cared for at Boston Children’s, he’ll be seen through Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, an integrated pediatric oncology program through Dana-Farber Cancer Institute and Boston Children’s Hospital that provides—in one specialized program—all the services of both a leading cancer center and a pediatric hospital.

    Our pediatric neurosurgical, neurology, and neuro-oncology specialists at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center offer:

    • technological advances, such as the intra-operative magnetic resonance imaging (MRI), which allow our pediatric neurosurgeons to "see" the tumor as they operate with MRI scans.  This allows them to remove as much of the tumor as possible.
    • treatment with the best standard of care, including neurosurgery, radiation therapy, and chemotherapy.
    • access to unique Phase I clinical trials run by our own investigators, Boston Children's Oncology Group, Department of Defense and Pediatric Oncology Experimental Therapeutics Consortium.

    Reviewed by Michael Scott, MD
    © Boston Children’s Hospital, 2013

  • The brain is the organ that controls a lot of what we do—voluntarily (like thinking) or involuntarily (like breathing). The brain controls thought, memory, emotion, touch, motor skills, vision, respiration, temperature, hunger and processes that regulate the body.

    The brain can be divided into three main parts:

    • the cerebrum
    • the brainstem
    • the cerebellum

    The cerebrum is composed of the right and left hemispheres, and its functions include:

    • initiation of movement
    • coordination of movement
    • temperature sensitivity
    • touch
    • vision
    • hearing
    • judgment
    • reasoning
    • problem-solving
    • emotions
    • learning

    The brainstem, which includes the midbrain, the pons and the medulla, is responsible for:

    • movement of the eyes and mouth
    • relaying sensory messages (i.e., heat, pain, sound)
    • hunger
    • respiration
    • consciousness
    • cardiac function
    • body temperature
    • involuntary muscle movements
    • sneezing
    • coughing
    • vomitings
    • wallowing

    The cerebellum is located at the back of the head, and its functions are to:

    • coordinate voluntary muscle movements
    • maintain posture, balance and equilibrium

    Other parts of the brain and central nervous system include the following:

    • The brain floats in a liquid called cerebral spinal fluid, which acts as a shock absorber to protect the brain. This fluid is made in small spaces within the brain, called ventricles.
    • The spinal cord contains bundles of nerve fibers that emanate from the brain and spread out to all parts of the body. These fibers allow signals from the brain to travel to and communicate with different parts of the body.
    • The meninges are the three layers of protective tissue that wrap around the brain and spinal cord, which are surrounded, respectively, by the skull and spinal column (backbone).
    • The brain is connected to the face by 12 specific cranial nerves that control most eye, face and tongue movements.

    Brain Tumor Symptoms in Children

    Each child may experience symptoms of a brain tumor differently, and symptoms vary depending on size and location of the tumor—both in the brain and elsewhere in the central nervous system.

    There is no space in the skull for anything except for the brain and its fluid. This means that any tumor, extra tissue or extra fluid can cause pressure on the brain.

    Symptoms related to pressure on the brain can include:

    • headache
    • vomiting (usually in the morning)
    • nausea
    • personality changes
    • irritability
    • drowsiness
    • depression
    • decreased cardiac and respiratory function, and even eventually coma, if left untreated

    Symptoms of brain tumors in the cerebellum may include:

    • vomiting (usually occurs in the morning without nausea)
    • headache
    • uncoordinated muscle movements
    • ataxia (problems walking)

    Brain tumors in the lower part of the brain often press on the cerebellum, which may cause symptoms including:

    • ataxia (problems walking)
    • loss of control of the nerves and/or muscles of the face

    Brain tumors in the brainstem may compress nerves and cause symptoms including:

    • visual changes, such as double vision
    • paralysis of nerves and/or muscles of the face, or half of the body
    • respiratory changes
    • clumsy, uncoordinated walk

    Symptoms of brain tumors in the cerebrum may include:

    • seizures
    • visual changes
    • slurred speech
    • paralysis or weakness on half of the body or face
    • drowsiness and/or confusion
    • personality changes and/or impaired judgment
    • short-term memory loss
    • ataxia (problems walking)
    • communication problems

    Symptoms of brain tumors in the optic pathway (eyes) may include:

    • visual problems
    • puberty or growth abnormalities
    • excessive urination

    Symptoms of tumors in the spine (usually spreading from a tumor at a higher point on the spinal cord) may include:

    • bowel or bladder dysfunction
    • back pain
    • weakness or loss of sensation in one area of the body, depending on where in the spine the tumor is located

    It’s important to remember that the symptoms of a brain tumor may resemble other, more common conditions or medical problems. Always consult your child's physician for a diagnosis.

    What Causes Brain Tumors in Children?

    Although we do not know for certain why brain tumors develop in certain children, we know that a small number of brain tumors may be related to genetics. In these cases, a child may have a brain tumor, because he has inherited certain genes from his parents, or because his genes have mutated on their own.

    How are brain tumors classified?

    Dana-Farber/Boston Children’s Cancer and Blood Disorders Center uses the World Health Organization (WHO) classification system for most pediatric brain tumors. This system incorporates:

    • different aspects of the appearance of the cells, which indicate what type of brain cell the tumor arose from and how "aggressive" (likely to spread)  the cells are likely to be
    • the tumor's location within the brain

    Why do brain tumors sometimes have more than one name?

    Brain tumors have traditionally been given names (classified) according to how they looked under a microscope. As researchers have come to understand more about the cellular and molecular differences between groups of tumors, some tumor names have changed.

    What does it mean to say that a tumor is “benign” or “malignant”?

    Tumors also can be classified as benign or malignant:

    • Benign tumors usually remain localized, without the ability to spread. Complete removal of the tumor is usually all that is required for treatment.
    • Malignant tumors can spread and invade other areas, meaning that even if the tumor is surgically removed, other cells will grow back, continuing to invade your child’s body.

    What is meant by the “grade” of the tumor?

    Many pediatric brain tumors have a second important component to them after their name, which is the grade. This is an estimate of how aggressive or malignant a particular type of tumor is.

    For example, glial tumors come in four grades. Grade I is the lowest, meaning that these tumors tend to be less aggressive than their grade IV counterparts, which are usually highly malignant and very difficult to treat.

    The grade is based on a number of factors, such as how many cells are dividing at any one time or how different the cells look from their normal counterparts.

    Who’s at risk for pediatric brain tumors?

    • Children with certain genetic conditions (such as neurofibromatosis, von Hippel-Lindau disease, Li-Frameni syndrome, Gorlin’s syndrome and retinoblastoma) have an increased risk of developing tumors of the central nervous system.
    • If your child has received radiation therapy to the head as part of previous treatment for other malignancies, he also may be at an increased risk for new brain tumors.
    • Research has been looking into the relationship between past exposures to certain chemicals and having a child with a brain tumor. It is currently thought that some chemicals may change the structure of a gene that protects the body from diseases, including cancer.

    Types of pediatric brain tumors

    To learn more about different types of brain tumors, visit our Pediatric Brain Tumors page on the Dana-Farber/Boston Children’s website

  • Diagnostic procedures for brain tumors are used to determine the exact type of tumor your child has and whether the tumor has spread. These may include:

    • physical exam, tests of reflexes, muscle strength, eye and mouth movement, coordination and alertness
    • magnetic resonance imaging (MRI) to produce detailed images of the brain and/or spine
    • magnetic resonance spectroscopy (MRS), which is performed along with an MRI to detect the presence of particular organic compounds produced by the body's metabolism within sample tissue. The MRS can help identify tissue as either normal or tumor and may be able to distinguish between glial tumors and tumors of neuronal (nerve cell) origin.
    • computerized tomography scan (also called a CT or CAT scan) to capture a detailed view of the bones and fluid filled spaces of the brain
    • biopsy or tissue sample from the tumor to provide definitive information about the type of tumor
    • lumbar puncture (spinal tap) to remove a small sample of cerebrospinal fluid (CSF) and determine if any tumor cells have started to spread. In young children, this procedure is safely performed under sedation and is less difficult and less painful than placing an intravenous (IV) catheter.

    After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then, we will meet with you and your family to discuss the results and outline the best treatment options.

  • Treatment for brain tumors in children has progressed tremendously in the last decade. Your child’s team will determine the best treatment plan based on a number of factors, including, but not limited to:

    • your child's age, overall health and medical history
    • your child's tolerance for specific medications, procedures or therapies
    • type, grade, and location of tumor(s)
    • expectations for the course of cancer
    • your opinion or preference

    Children with brain tumors are treated through the Brain Tumor Center at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, an integrated pediatric hematology and oncology partnership between Dana-Farber Cancer Institute and Boston Children’s Hospital. The Pediatric Brain Tumor Center at Dana-Farber/Boston Children’s a world-renowned destination for children with malignant and non-malignant brain and spinal cord tumors.

    Surgery

    Surgery has multiple roles in the diagnosis and treatment of brain tumors, including release of pressure on the brain, biopsy and tumor removal.

    If your child has a brain tumor, the first treatment is usually surgery to remove as much of the tumor as possible.

    • Tumor specimens are examined by neuropathologists to determine the exact diagnosis.
    • When possible, it’s best to remove the entire tumor. In general, the more of the tumor that is removed, the greater the chance for survival.
      • Most high-grade gliomas cannot be completely removed because of the infiltrating fingers of the tumor that characterize their growth.
      • Tumors of the cerebral hemispheres are generally more easily removed than those of the midline, more inner-brain structures.
    • Using the latest molecular profiling techniques, all pediatric brain tumors are now processed to identify abnormal genes within the tumor (whether due to an inherited condition or a new mutation that occurred to start the tumor).

    Pediatric radiation therapy

    Our doctors use precisely targeted and dosed radiation to kill cancer cells left behind after your child’s surgery. Depending on the type of tumor, some patients are treated with targeted focal radiation therapy, which isolates a small area for radiation treatment. In those tumors that may have spread, pediatric radiation therapy can sometimes be delivered to the entire brain and spine.

    While radiotherapy can be quite effective in treating certain cancers, the radiation damages both cancerous and non-cancerous cells. Because of this, there can be many undesirable side effects during and after treatment. Being able to anticipate these side effects can help the care team, parents and child prepare, and in some cases prevent these symptoms from occurring.

    Chemotherapy for children

    Chemotherapy (“chemo”) refers to drugs that interfere with the cancer cell’s ability to grow or reproduce. For some kinds of tumors, chemotherapy before surgery may help shrink the tumor, making it possible to remove.

    • Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.
    • Often, a combination of chemotherapy drugs is used.
    • Certain chemotherapy drugs may be given in a specific order, depending on the type of cancer it is being used to treat.

    While chemotherapy can be quite effective in treating certain cancers, the drugs treat cancerous and non-cancerous cells the same. Because of this, there can be many undesirable side effects during treatment. Being able to anticipate these side effects can help the care team, parents and child prepare, and, in some cases, prevent these symptoms from occurring.

    Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells. It may be given:

    • orally, as a pill to swallow
    • intramuscularly, as an injection into the muscle or fat tissue
    • intravenously, directly to the bloodstream (also called IV)
    • intrathecally, directly into the spinal fluid with a needle

    Chemotherapy also refers to the use of drugs that are made to specifically inhibit a molecular pathway required to keep the tumor going. These drugs are often referred to as “targeted” therapy. Rather than the standard side effects associated with radiation and chemotherapy (loss of hair, nausea and vomiting, damage of the blood producing cells), these drugs tend to be much better tolerated.

    What is the long-term outlook for a child with a brain tumor?

    As with other tumors in both children and adults, surgery is the primary brain tumor treatment, and it is usually followed by radiation treatment and/or chemotherapy. Unfortunately, because your child’s brain is still developing, these treatments can result in more substantial and permanent side effects than they would for an adult.

    Many children who are treated for brain tumors experience significant long-term problems, such as changes in intellectual and motor function. They require ongoing assessment and specialized care to help them function at school and throughout life as well as possible.

    Your child’s prognosis greatly depends on:

    • the type of tumor
    • the extent of the disease
    • size and location of the tumor
    • presence or absence of metastasis (spreading)
    • the tumor's response to therapy
    • your child’s age and overall health
    • your child’s tolerance for specific medications, procedures or therapies
    • new developments in treatment

    Today, more than half of all children diagnosed with a brain tumor will be cured of the disease. But with any cancer, prognosis and long-term survival varies greatly. Prompt medical attention and aggressive therapy are very important, as is continuous follow-up care.

    Your child also may need a lot of rehabilitation for lost motor skill and muscle strength. If appropriate, he also may see speech therapists and physical and occupational therapists.

    New methods are continually being discovered to improve treatment and decrease side effects. For more information on the research, see the Pediatric Brain Tumor Center.

    What kind of long-term follow-up care should my child get?

    Because of the possible long-term problems and the risk of a tumor returning, assessments and care usually continue for years after the tumor is removed.

    One of the major goals of the Dana-Farber/Boston Children’s Cancer and Blood Disorders Center Pediatric Brain Tumor Program is to maximize the long-term function of your child. This is achieved through multidisciplinary monitoring and interventions, as needed, in a wide range of areas, including:

    • intellectual function and school performance
    • endocrine evaluation and treatment
    • neurologic assessment
    • psychosocial care
    • hearing and vision
    • ovarian dysfunction in girls
    • motor function

    After your child’s treatment is complete, your family can find resources to cope with any side effects of treatment through our childhood brain tumor survivorship program at the Stop & Shop Family Neuro-Oncology Outcomes Clinic. Through the Clinic, your child will be able to meet with her neurosurgeon, radiation oncologist, pediatric neuro-oncologist and neurologists at the same follow-up visit.

    • Our pediatric brain tumor survivorship clinic is held weekly.
    • In addition to meeting with your pediatric neuro-oncologists, neurologist and neurosurgeon, your child also may see one of our endocrinologists and/or alternative/complementary therapy specialists.
    • School liaisons and psychosocial personnel from the pediatric brain tumor team are also available.
    • If your child needs rehabilitation, she also may meet with speech, physical and occupational therapists during and after treatments.

    Resources & support
    We understand that you may have a lot of questions if your child is diagnosed with a brain tumor. We’ve tried to provide some answers to those questions in these pages, but there are also a number of resources and support services to help you and your family through this difficult time.

    Back-to-school program

    At age 11, Ronald (R.J.) Agostinelli was diagnosed with acute lymphoblastic leukemia, a cancer of the white blood cells. He missed seven months of elementary school while having chemotherapy. R.J. talks about how the Back-to-School program helped him return to his class after a long absence.

  • A hopeful future for patients with pediatric brain tumors

    Treatment for brain tumors in children has progressed tremendously in the last decade:

    • New tools are being used to help doctors diagnose tumors sooner and with more accuracy
    • Radiation therapy and chemotherapy are increasingly targeting tumors more accurately and effectively while keeping clear of healthy brain cells and tissue.
    • A successful new surgical technique is the intra-operative MRI, which gives surgeons a three-dimensional picture of the tumor, so they can remove the cancer while leaving other parts of the brain relatively untouched.

    Clinical trials

    For many children with brain tumors or other rare or hard-to-treat conditions, clinical trials provide new options. 

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U.S. News & World Report 2013-14 | Best Children's Hospitals | Cancer

Dana-Farber/Boston Children's Cancer and Blood Disorders Center

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
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