Brain Tumors

A brain tumor occurs when abnormal cells in or near the brain grow into a mass. Brain tumors are relatively rare in children. Pediatric brain tumors can be benign (non-cancerous) or malignant (cancerous). The type of treatment your child will receive depends on the type of tumor, its location, and other factors.

There are many different brain tumor types and classifications based upon the tumor’s cell structure, composition, rate of growth, location, and other characteristics. The name and classification of the tumor may change as your doctor gains information about your child’s brain tumor or if the tumor changes over time.

The types of brain tumors most common in children are not the same as those most common in adults. Childhood brain tumors frequently appear in different locations and behave differently than brain tumors in adults. Types of pediatric brain tumors include:

Choroid plexus brain tumors

Choroid plexus tumors arise in the tissue located in the spaces of the brain called ventricles. This tissue makes cerebrospinal fluid, which surrounds the brain and spinal cord. These rare tumors are seen more often in younger children.

Germ cell tumors of the brain

Germ cell tumors of the brain, including germinoma, develop from germ cells — the cells that later become sperm in the testicles or eggs in the ovaries; during the fetal period, these cells may get “trapped” in the brain.

Gliomas

There are four stages or grades of gliomas, according to how the cells look under a microscope. Ordered from least severe to most severe, they are:

Low-grade gliomas

• Grade I (pilocytic)
• Grade II (fibrillary)

High-grade gliomas

• Grade III (anaplastic)
• Grade IV (glioblastoma multiforme or GBM)

Gliomas also can be named according to the type of glial cells involved or the location of the tumor. Glioma diagnoses include:

• Angiocentric glioma
• Astrocytoma: Pilocytic astrocytoma, fibrillary astrocytoma, or anaplastic astrocytoma
• Diffuse midline glioma (DMG)
• Gliomatosis cerebri
• Gliosarcoma
• Dysembryoplastic neuroepithelial tumor (DNET or DNT)
• Ganglioglioma and glial neuronal tumors
• Oligodendroglioma
• Optic nerve (pathway) glioma
• Pleomorphic xanthoastrocytoma (PXA)
• Tectal glioma (a brainstem glioma)
• Thalamic and hypothalamic astrocytoma

Neural tumors

• Atypical teratoid rhabdoid tumor (ATRT)
• Medulloblastoma
• Neurocytoma
• Primitive neuroectodermal tumors (PNET) and pineoblastoma

Other

• Craniopharyngioma
• Ependymoma and myxopapillary ependymoma
• Meningioma
• Neurofibroma/plexiform neurofibroma
• Schwannoma (neurilemoma)
• Spinal tumors
• Skull base tumors
• Infant brain tumors

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

Brain tumors can put pressure on the brain, causing symptoms such as:

• Headache
• Vomiting (usually in the morning)
• Nausea
• Personality changes
• Irritability
• Drowsiness
• Depression

Symptoms of brain tumors in the cerebellum, including cerebellar pilocytic astrocytoma and medulloblastoma, can include:

• Vomiting (usually occurs in the morning, without nausea)
• Headache
• Uncoordinated muscle movements
• Problems walking

Brain tumors in the brainstem, such as diffuse midline glioma and tectal glioma, can cause the following symptoms:

• Vision changes, including double vision
• Paralysis of nerves and/or muscles of the face or half of the body
• Respiratory changes
• Clumsy, uncoordinated walking

Symptoms of brain tumors in the cerebrum, including ganglioglioma, glioblastoma multiforme, and oligodendroglioma, include:

• Seizures
• Visual changes
• Slurred speech
• Paralysis or weakness on one half of the body or face
• Personality changes or impaired judgment
• Short-term memory loss
• Communication problems

Tumors in the optic pathway (eyes), such as optic nerve glioma, may cause symptoms such as:

• Visual problems
• Puberty or growth abnormalities
• Excessive urination

Symptoms of tumors in the spine (sometimes spreading from a tumor at a higher point on the spinal cord), including meningioma, 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

Brain tumors may develop when brain cells acquire mutations in the DNA that allow the cells to continue living after they would normally expire.

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

• Physical examination
• Magnetic resonance imaging (MRI)
• Magnetic resonance spectroscopy (MRS)
• Computerized tomography (CT or CAT) scan
• Biopsy
• Lumbar puncture (spinal tap)

After all tests are completed, doctors will be able to outline the best treatment options.

Treatment for brain tumors in children has progressed tremendously in the last decade. These treatments include neurosurgery, radiation therapy, or chemotherapy.

Neurosurgery for brain tumors

Surgery is often the first treatment to remove as much of the tumor as possible and to relieve pressure on the brain. In general, the more of the tumor that is removed, the greater the chance for survival.

Radiation therapy and chemotherapy for brain tumors

Precisely targeted and dosed radiation is used to kill cancer cells left behind after surgery. In tumors that have spread, radiation therapy can be sometimes delivered to the entire brain and spine. Chemotherapy includes drugs that interfere with cancer cells’ ability to grow or reproduce.

We treat children with brain tumors in the Brain Tumor Center at the Dana-Farber/Boston Children's Cancer and Blood Disorders Center.