Brain & Spinal Cord Tumors

Brain tumors are the most common solid tumors in children and the second most common childhood cancer. Approximately 4,000 children and adolescents in the U.S. are diagnosed with primary brain tumors (tumors that originate in the brain) each year. Those that occur in infants and children are different from adult brain tumors in terms of the type of cells and the responsiveness to treatment.

The exact cause of brain and spinal cord tumors is not fully understood. Most brain tumors involve abnormalities in genes that control the cell cycle (when cells grow, divide and die). These abnormalities cause uncontrolled cell growth.

Other than exposure to radiation, there are no known lifestyle-related or environmental causes of childhood brain and spinal cord tumors. If your child has a brain or spinal cord tumor, it is important to remember that there is nothing you or your child could have done to prevent it.

What are Brain & Spinal Cord Tumors

Brain and spinal cord tumors, either benign (noncancerous) or malignant (cancerous), are abnormal growths of tissue that originate in the cells of the brain or spinal cord. Tumors in the spinal cord are rarer than brain tumors, but both behave in similar ways.

Benign tumors do not contain cancer cells and once removed, typically do not come back. These tumors can cause symptoms similar to malignant tumors because of their size and location in the brain.

Malignant tumors contain cancer cells, and are usually fast-growing and invade surrounding tissue. Malignant brain tumors rarely spread outside of the brain and spinal cord, but they may recur after treatment.

Tumor Types

There are many types of brain and spinal cord tumors. Some of the more common ones include:

Choroid plexus papilloma/carcinoma. These tumors generally occur in the ventricles (fluid-filled spaces in the brain). They may be benign or malignant and may spread through the nervous system.
Embryonal tumors. Developed from embryonic cells in the nervous system during gestation, these tumors are made up of poorly differentiated neuroepithelia cells. The two main types are primitive neuroectodermal (PNET) and atypical teratoid/rhabdoid tumors. After birth, most CNS embryonal tumors in children become malignant, growing quickly and spreading into other parts of the brain and spine.
Ependymoma. Slow-growing tumors form in the cells that line the ventricles (fluid-filled spaces in the brain) and the center of the spinal cord. These tumors may reoccur (come back) after treatment.
Gliomas: The most common form of brain and spinal cord tumors at all ages are gliomas, developing in parts of the brain called glial cells. These cells make up more than half of the brain and help neurons function normally. There are several types of glial cells, and glioma tumors are named for the types of glial cells on which they develop. Types of gliomas include astrocytomas, anaplastic astrocytomas and glioblastomas.
Medulloblastoma. This relatively common tumor is highly malignant and often causes rapidly progressive symptoms. Medulloblastomas are treated with a combination of surgery, radiation, and chemotherapy. Most medulloblastomas can be treated effectively, despite the tumor’s aggressive nature.
Meningeal tumors. Developed in the membranes that surround the brain and spinal cord, these tumors, called meningiomas, are more common in adults than children.
Mixed neuronal-glial tumors. Formed as a mix of glial cells and neurons, these types of brain tumors tend to be small, slow-growing, relatively rare and benign. Examples of these types of tumors are ganglioglioma and pleomorphic xanthoastrocytoma.
Tumors arising from non-neuroepithelial tissue. These tumors develop at the base of the brain and are usually benign in nature. These tumors include craniopharyngiomas and pineal region tumors, like germinomas.

What are the Symptoms of Brain & Spinal Tumors?

Symptoms of brain or spinal cord tumors depend on the tumor’s size, type and location. Symptoms may be caused when a tumor presses on a nerve or damages a part of the brain. They may also be caused by a tumor blocking fluid that flows through and around the brain causing the brain to swell.

Common symptoms include:

Balance problems
Back pain or numbness
Changes in mood, personality or ability to concentrate
Changes in speech, vision or hearing
Headaches (usually worse in the morning)
Memory problems
Nausea and vomiting
Numbness or tingling in the arms or legs
Seizures or convulsions
Scoliosis

How are Brain & Spinal Cord Tumors Diagnosed?

Diagnosis starts with a complete medical history and physical exam. Other procedures and tests may be needed to diagnose a brain or spinal cord tumor, including:

Angiogram
Biopsy
Computed tomography (CT)
Lumbar puncture/spinal tap
Magnetic resonance imaging (MRI)
Positron emission tomography (PET) scan
X-ray

How are Brain & Spinal Cord Tumors Treated?

A customized treatment plan is put together for your child based on:

The type of brain or spinal tumor
The tumor’s location and size
Your child’s age and general health
Your child’s tolerance for treatment
You and your child’s preferences

Surgery

Surgery is often the first step of treating brain tumors in children. The goal of surgery is to obtain a sample of tissue, known as a biopsy, to aid in the diagnosis, or removal of all or most of the tumor to minimize further complications for the patient.

Medical Treatments

Medical treatments for brain and spinal cord tumors include:

Chemotherapy: drugs that attack tumor cells
High-dose chemotherapy: uses very high doses of chemotherapy and is typically given by intravenous (IV) line
Stem cell transplant (also referred to as bone marrow transplant): type of transplant that uses an infusion of healthy bone marrow to replace damaged or diseased bone marrow
Radiation therapy: high-energy particles or waves that kill or shrink cancer cells
Proton therapy: a precise form of radiation that uses proton beams to destroy cancer cells
Steroids: help to relieve symptoms such as brain swelling and fluid retention

Supportive Care

Supportive care or treatments for brain and spinal cord tumors include:

Rehabilitation to help your child recover from lost or diminished physical functions. Rehabilitation may include physical therapy, occupational therapy, or speech therapy.
Follow-up care to regularly monitor your child for worsening symptoms, tumor recurrence, the effectiveness of treatment, and manage late effects of treatment.

Prognosis

Your child’s prognosis (long-term outlook) depends on:

The type of tumor
The size and location of the tumor
Metastasis (spreading of malignant tumors)
The tumor's response to therapy
The age and overall health of your child
Your child's tolerance of specific medicines, procedures or therapies

Each child’s prognosis is unique to his or her individual situation. Prompt and aggressive treatment based on an accurate diagnosis gives your child the best chance to overcome their disease. Long-term, continuous follow-up care is essential for the management of a child diagnosed with a brain or spinal cord tumor.

Key Points to Remember

Brain tumors are the most common solid tumors in children, with approximately 4,000 American children and adolescents diagnosed with primary brain tumors each year.
The cause of brain & spinal cord tumors is typically unknown and it's important to remember that there is nothing you or your child could have done to prevent one from occurring.
The symptoms and treatment plan of a brain or spinal tumor depends on a number of factors, including the tumor's size, type and location as well as your child's age and overall health.
Surgery is often the first line of treatment for brain or spinal cord tumors.
Riley at IU Health has access to various clinical trials and advanced care techniques, which may become part of your child’s treatment plan.

Support Services & Resources

Visit the links below to learn more about brain tumor support groups and resources.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

The American Brain Tumor Association

The goal of this national association is to aid in funding brain tumor research and providing information and education about all tumor types in all age groups.

The American Cancer Society

The American Cancer Society is a national, community-based volunteer health organization that is dedicated to eliminating cancer as a major health problem. Learn more about brain and spinal cord tumors in children on its website.