Types of brain and spinal cord tumors, symptoms, and diagnosis
The Jaydie Lynn King Neuro-oncology Program at Phoenix Children's Hospital is the only comprehensive pediatric program of its kind in Arizona, combining the expertise of subspecialists in the Children’s Neuroscience Institute and the Center for Cancer and Blood Disorders (CCBD). We offer family-centered, multidisciplinary, coordinated care to provide hope, healing and the best healthcare for children and their families.
Brain and spinal cord tumors are the second most common cancers (after leukemia) affecting children. They make up about 21 percent of all childhood tumors.
When a child is diagnosed with a brain tumor, we present their case to the Phoenix Children’s Neuro-oncology Tumor Board, a group of physicians from a variety of specialties including radiation oncology, Neuro-oncology, neurosurgery, neuroradiology, pathology and neurology. Together, we decide the best treatment plan for each and every child.
Types of tumors commonly seen in children
- astrocytomas: Astrocytomas are glial cell tumors that are derived from connective tissue cells called astrocytes. These cells can be found anywhere in the brain or spinal cord. Astrocytomas are the most common type of childhood brain tumor. Astrocytomas are generally subdivided into high-grade, medium-grade, or low-grade tumors. High-grade astrocytomas are the most malignant of all brain tumors. Astrocytomas are further classified for presenting signs, symptoms, treatment, and prognosis, based on the location of the tumor. The most common location of these tumors is in the cerebellum, where they are called cerebellar astrocytomas. These tumors usually cause symptoms of increased intracranial pressure, headache, and vomiting. There can also be problems with walking and coordination, as well as double vision.
- primitive neuroectodermal tumors (PNET)/medulloblastoma: Both PNETs and medulloblastomas are in the same family of tumors. PNET can occur anywhere in the brain of a child, whereas medulloblastomas occur in the back of the brain. Both of these tumor types can metastasize (spread) to other parts of the central nervous system (i.e. the spinal cord). PNETs and medulloblastomas are treated very similarly with a combination of surgery, radiation, and chemotherapy, although PNETs tend to be more aggressive overall from medulloblastomas.
- brain stem tumors: Brain stem gliomas are tumors found in the brain stem. Most brain stem tumors cannot be surgically removed because of the remote location and delicate and complex function this area controls. Brain stem gliomas occur almost exclusively in children; the group most often affected is the school-age child. The child usually does not have increased intracranial pressure, but may have problems with double vision, movement of the face or one side of the body, or difficulty with walking and coordination.
- ependymomas: Ependymomas are also glial cell tumors. They usually develop in the lining of the ventricles or in the spinal cord. The most common place they are found in children is near the cerebellum. The tumor often blocks the flow of the CSF (cerebral spinal fluid, which bathes the brain and spinal cord), causing increased intracranial pressure. Ependymomas can be slow growing, compared to other brain tumors, but may recur after treatment is completed. Recurrence of ependymomas results in a more invasive tumor with more resistance to treatment. About 5 percent to 10 percent of childhood brain tumors are ependymomas.
- germ cell tumors: Germ cell tumors comprise less than 4 percent of brain tumors in children. They most commonly occur in the middle of the brain, specifically near the pituitary and pineal glands. There are two major types of germ cell tumors: germinomas, and non-germinomatous germ cell tumors (NGGCT). Since these tumors are near structures in the brain which secrete hormones, often patients will have decreased amounts of these hormones and require supplementation. Given their location, often these tumors cannot be completely surgically removed and are only biopsied at the time of surgery. Further therapy for these tumors includes radiation, chemotherapy, or both.
Symptoms of a brain tumor
The following are the most common symptoms of a brain tumor. However, each child may experience symptoms differently. Symptoms vary depending on the child’s age and size and location of tumor. Many symptoms are related to an increase in pressure in or around the brain. There is no spare space in the skull for anything except the delicate tissues of the brain and its fluid. Any tumor, extra tissue, or fluid can cause pressure on the brain and result in the following symptoms:
- increased intracranial pressure (ICP) - caused by extra tissue or fluid in the brain. Pressure may increase because one or more of the ventricles that drain cerebrospinal fluid (CSF, the fluid that surrounds the brain and spinal cord) has been blocked, causing the fluid to be trapped in the brain. Increased ICP can cause the following:
- vomiting (usually in the morning)
- other symptoms could include
- personality changes
- decreased cardiac and respiratory function and eventually coma if not treated
- visual problems
- head tilt
- difficulty swallowing
In addition to a complete medical history and physical examination of your child, examination procedures for a brain tumor may include:
- neurological exam - your child's physician tests reflexes, muscle strength, eye and mouth movement, coordination, and alertness.
- computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.
- magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. MRI is very helpful for looking at the brain and spinal cord.
- positron emission tomography (PET) – a type of nuclear medicine scan that measures the metabolic activity of cells. A PET scan may show areas of cancer that may not be seen on a CT scan or an MRI scan.
- lumbar puncture/spinal tap - a special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing. CSF is the fluid which bathes the brain and spinal cord.
In some cases, the medical team at Phoenix Children’s may use more advanced procedures such as spectroscopy, tractography, and MRA and MRV to diagnose your child’s condition.