Brain & Spinal Tumors

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

A benign tumor does not contain cancer cells and, once removed, typically does not recur (come back). Most benign brain tumors have clear borders, meaning they do not invade surrounding tissue. These tumors can cause symptoms similar to cancerous tumors because of their size and location in the brain.

Malignant brain tumors contain cancer cells. They are usually fast growing and invade surrounding tissue. Malignant brain tumors rarely spread to other areas of the body, but they may recur after treatment.

Brain tumors are the most common solid tumors in children. 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, both in terms of the type of cells and the responsiveness to treatment.

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

Gliomas. Gliomas are the most common form of brain and spinal tumor and develop 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.
Medulloblastoma. This relatively common tumor is Grade 4, 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.
Embryonal tumors. These tumors develop in embryonic cells in the central nervous system (CNS) during the gestation period of a fetus. After birth, most CNS embryonal tumors in children become malignant. These malignant tumors are likely to grow quickly and spread into other parts of the brain and spine.
Mixed neuroglial tumors. This type of brain tumor tends to be small and slow growing. They are rare and mostly benign.
Tumors arising from non-neuroepithelial tissue. These tumors develop at the base of the brain and are usually benign but not always.
Choroid plexus papilloma/carcinoma. These tumors generally occur in the ventricles (natural spaces deep inside the brain). They may be benign or malignant.
Meningeal tumors. These tumors develop in the meninges membrane, which surrounds the brain and spinal cord. Meningeal tumors are often benign but may become malignant. These tumors are rare in children and more common in adults.
Ependymoma tumors. These tumors form in the cells that line the ventricles of the brain and the center of the spinal cord.

The exact cause of brain and spinal tumors is not fully understood. Researchers have found that some of the chemical changes that occur in normal brain cells may lead to brain tumors. Most brain tumors involve abnormalities in genes that control the cell cycle (when cells grow, divide and die). These abnormalities cause uncontrolled cell growth.

Spinal tumors can also be caused by tumors that start in tissues that surround the spinal cord and spinal column and push in. They can come from surround muscle or bone and may put pressure on the spinal cord. These types of tumors can include:

Neuroblastomas begin in primitive nerve cells in young children.
Sarcomas are tumors that begin in muscle.
Osteochondromas are tumors that start in bone.

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

Symptoms of a brain or spinal tumor depend on the tumor’s size, type and location. Symptoms may be caused by a tumor pressing on a nerve or harming a part of the brain. They may also be caused by a tumor blocking the fluid that flows through and around the brain or the brain swelling because of the buildup of fluid.

Some of the most common symptoms of brain and spinal tumors 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

Many other conditions can cause the same symptoms, so it is important to check with your child’s doctor for an accurate diagnosis. Only a doctor experienced in recognizing the exact combination of symptoms that indicate a brain or spinal tumor can make a firm diagnosis.

Diagnosis of Brain & Spinal Tumors

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

Angiogram. This is a live X-ray that shows blood flowing in the body.
Computed tomography (CT). This is a X-ray that shows the inside of the brain from different angles.
Lumbar puncture/spinal tap. This test checks the fluid that surrounds the brain and spinal cord.
Magnetic resonance imaging (MRI). A MRI scan uses powerful magnets to create detailed pictures of internal body tissues, including the brain.
Detailed neurologic exam. This is an assessment of the body’s nervous system, including neurons and motor responses such as reflexes.
Positron emission tomography (PET) scan. This imaging test uses mild radiation to produce images of processes within the body.
X-ray. This is a common imaging test that takes pictures of bones and organs inside of the body.
Biopsy. If a tumor is found, samples of the tumor cells are extracted and studied under a microscope to gain more information about the specific kind of brain or spinal tumor.

Treatments

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

Treatment for a brain tumor may include one or a combination of the following options:

Surgery. Surgery to remove the tumor is often the first step of brain tumor treatment.
Antibiotics. These medicines may be prescribed to treat and prevent infections.
Anti-seizure medicines. These medicines may be prescribed to relieve nerve pain and to prevent or stop seizures. A seizure is a surge of electrical activity in the brain that can cause violent shaking of the body and loss of physical control.
Stem cell transplant (also known as bone marrow transplant). This type of transplant is an infusion of healthy bone marrow to replace damaged or diseased bone marrow.
Chemotherapy. Patients will often have surgery to implant a “port”—an easily accessible device that acts as a permanent IV. Chemotherapy attacks dividing cells, which are usually present in growing tumors. The type of medication is based on the tumor and is usually performed in context of specific protocols.
- High-dose chemotherapy. During this procedure, very high doses of chemotherapy (medicines designed to treat cancer) are given to the patient usually by intravenous (IV) line.
Radiation. This treatment uses high-energy particles or waves to kill cancer cells by damaging their DNA. Radiation may be focal (concentrated in one spot) or generalized (treating the entire brain and spine). The choice depends on the type of tumor.
Proton therapy. This treatment is a form of radiation therapy that uses proton beams to destroy cancer cells.
Steroids. These medicines may provide temporary relief of brain tumor symptoms, such as swelling and fluid retention around the tumor.
Ventriculoperitoneal (VP) shunt. This surgical procedure relieves the pressure of hydrocephalus (excess fluid within the ventricles of the brain). A shunt is a thin tube that allows excess fluid to flow to another area of the body.

Treatment for a spinal tumor depends on the type of tumor. Treatments may include:

Chemotherapy
Radiation
Surgery to remove the tumor

Secondary treatments for brain and spinal tumors include:

Speech-language pathology. Brain and spinal tumors and their treatments may affect your child's ability to speak and swallow. Speech-language pathology helps patients regain those skills or compensate for diminished skills.
Physical therapy. Brain and spinal tumors and their treatments may impair your child's balance, range of motion and strength. Physical therapy helps patients regain those skills or compensate for diminished skills.
Occupational therapy. Brain and spinal tumors and their treatments may impair your child's ability to perform the functions of daily life, like eating, going to the restroom, dressing and bathing. Occupational therapy helps a patient manage these daily functions.
Rehabilitation. Rehabilitation includes treatment to help your child recover lost or diminished physical functions caused by the brain or spinal tumor or its treatment. Rehabilitation may include speech-language pathology, physical therapy and occupational therapy.
Follow-up care. This includes regular monitoring for worsening of symptoms, effectiveness of treatment and, if the tumor was removed, recurrence of the tumor.

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

The type of tumor
The size and location of the tumor
Metastasis (spreading of cancerous 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 the tumor and any damage it may have caused. Treatment sometimes causes side effects, and these also affect your child’s prognosis. Recurrence of the tumor is sometimes possible, and this can have a significant effect as well.

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.
There are many types and subtypes of brain tumors which occur in different parts of the brain and cause different symptoms.
The symptoms, as well as the treatment, of a brain tumor depend on the tumor’s size, type and location.
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.