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Overview of Brain and Spinal Cord Tumors in Children

By

Kee Kiat Yeo

, MD, Harvard Medical School

Reviewed/Revised May 2023
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The central nervous system is made up of the brain and spinal cord. Central nervous system tumors are the second most common cancer in children Overview of Childhood Cancer In the United States, the overall incidence of cancer in children and adolescents has increased over time. From 1975 to 2022, rates increased by approximately 0.8 per 100,000 each year. However... read more under 15 years of age (after leukemia) and the leading cause of death in children from cancer.

Symptoms of Brain and Spinal Cord Tumors in Children

The first brain tumor symptoms may result from increased pressure within the skull (intracranial pressure). Pressure may be increased because the tumor blocks the flow of cerebrospinal fluid within the brain or because the tumor takes up space. Increased pressure can cause the following symptoms:

Other symptoms vary depending on where the tumor is located in the brain or the spine.

Diagnosis of Brain and Spinal Cord Tumors in Children

  • Imaging tests

  • Usually biopsy or sometimes surgery to remove the entire tumor

  • Sometimes a spinal tap

Doctors suspect a central nervous system tumor based on symptoms.

To check for a central nervous system tumor, doctors typically do an imaging test such as magnetic resonance imaging Magnetic Resonance Imaging (MRI) Magnetic resonance imaging (MRI) is a type of medical imaging that uses a strong magnetic field and very high frequency radio waves to produce highly detailed images. During an MRI, a computer... read more Magnetic Resonance Imaging (MRI) (MRI) of the brain, which can usually detect the tumor. Computed tomography Computed Tomography (CT) Computed tomography (CT) is a type of medical imaging that combines a series of x-rays to create cross-sectional, detailed images of internal structures. In computed tomography (CT), which used... read more Computed Tomography (CT) (CT) may also be done. Before MRI or CT is done, a contrast agent is usually injected into a vein (intravenously). Contrast agents are substances that make organs and other structures clearer to see on imaging tests.

If a central nervous system tumor is suspected, doctors usually remove a small piece of tissue (biopsy) to confirm the diagnosis. Sometimes, instead of removing a small piece, doctors surgically remove as much of the tumor as possible.

Sometimes a spinal tap (lumbar puncture How a Spinal Tap Is Done How a Spinal Tap Is Done ) is done to obtain cerebrospinal fluid for examination under a microscope. This procedure is done routinely to determine whether tumor cells have spread to the cerebrospinal fluid or when the diagnosis is unclear.

Treatment of Brain and Spinal Cord Tumors in Children

  • Surgical removal of the tumor

  • Chemotherapy, radiation therapy, or both

  • Drainage of cerebrospinal fluid

Usually, treatment of central nervous system tumors involves surgically removing the tumor Surgery for Cancer Surgery is a traditional form of cancer treatment. It is the most effective in eliminating most types of cancer before it has spread to lymph nodes or distant sites (metastasized). Surgery may... read more . Then, chemotherapy Chemotherapy and Other Systemic Cancer Treatments Systemic treatments are those that have effects throughout the body rather than being applied directly to the cancer. Chemotherapy is a form of systemic treatment that uses drugs to kill cancer... read more , radiation therapy Radiation Therapy for Cancer Radiation is a form of intense energy generated by a radioactive substance, such as cobalt, or by specialized equipment, such as an atomic particle (linear) accelerator. Radiation preferentially... read more , or both Combination Cancer Therapy Cancer drugs are most effective when given in combination. The rationale for combination therapy is to use drugs that work by different mechanisms, thereby decreasing the likelihood that resistant... read more are used. Treatment should be planned by a team of experts Care team for cancer treatment In the United States, the overall incidence of cancer in children and adolescents has increased over time. From 1975 to 2022, rates increased by approximately 0.8 per 100,000 each year. However... read more who have experience treating central nervous system tumors in children. The care team may include doctors who specialize in the care and treatment of babies, children, and adolescents such as pediatric cancer specialists (oncologists), pediatric neurologists, pediatric neurosurgeons, and radiation oncologists.

When possible, the tumor is removed surgically. Brain tumors are removed by opening the skull (called a craniotomy). Some brain tumors can be removed with little or no damage to the brain. After surgery, MRI is done to determine whether any of the tumor is left and, if so, how much.

If the tumor cannot be removed surgically, radiation therapy, chemotherapy, or both are usually required. In children younger than 5 years of age, depending on the tumor type, chemotherapy may be used first because radiation therapy can interfere with growth and brain development. If needed, radiation therapy may be used when children are older. Chemotherapy may also have serious side effects.

If the tumor is blocking the flow of cerebrospinal fluid, a small tube (catheter) may be used to drain the cerebrospinal fluid before the tumor is surgically removed. After a local or general anesthetic is used, the tube is inserted through a tiny opening drilled in the skull, and fluid is withdrawn to reduce the pressure within the skull. The tube is connected to a gauge that measures the pressure within the skull. After a few days, the tube is removed or may be converted to a permanent drain (shunt—see Hydrocephalus Hydrocephalus Hydrocephalus is an accumulation of extra fluid in the normal spaces within the brain (ventricles) and/or between the inner and middle layers of tissues that cover the brain (the subarachnoid... read more Hydrocephalus ).

Because cancer is relatively rare in children, the doctor may speak with the parents about entry into a clinical trial, if available. In such trials, some children receive the standard treatment, and others receive the treatment being tested (called experimental treatment). The experimental treatment may involve new chemotherapy drugs, new combinations of older drugs, or new surgical or radiation techniques. However, experimental treatments are not always effective, and side effects or complications may not be known.

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

  • American Cancer Society: If Your Child Is Diagnosed With Cancer: A resource for parents and loved ones of a child who has cancer that provides information about how to cope with some of the problems and questions that come up just after a child is diagnosed

The brain tumors organizations here provide information about types of and treatments for brain tumors as well as information for caregivers about support resources:

NOTE: This is the Consumer Version. DOCTORS: VIEW PROFESSIONAL VERSION
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