Brain and Spinal Cord Tumors in Children

Brain and Spinal Cord Tumors in Children

Brain and spinal cord tumors are abnormal growths of cells in the brain or spinal cord that can be benign (non-cancerous) or malignant (cancerous). In children, brain and spinal cord tumors are the most common solid tumors and the second leading cause of cancer-related deaths after leukemia.

Benign cancer – They are low-grade tumors that grow and spread to nearby areas of the brain. It does not spread to nearby areas or into other brain tissue. 

Malignant cancer – They are high-grade tumors that spread quickly to other brain tissue. 

Types of Brain and Spinal Cord Tumors in Children

There are many different types of brain and spinal cord tumors that can occur in children. Here are some of the most common types –

1. Astrocytomas – These are tumors that develop from cells called astrocytes, which are the most abundant cells in the brain. Astrocytomas can be benign or malignant.
2. Medulloblastomas – These are fast-growing tumors that develop in the cerebellum, which is the part of the brain that controls movement and coordination. They are most commonly found in children under the age of 10.
3. Ependymomas – These are tumors that develop from cells lining the ventricles, which are fluid-filled spaces in the brain. Ependymomas can be slow-growing or fast-growing.

Brain and Spinal Cord Tumors in Children

4. Craniopharyngiomas – These are tumors that develop near the pituitary gland, which controls hormone production. Craniopharyngiomas can affect hormone levels and growth in children.

5. Germ cell tumors – These are tumors that develop from cells that produce eggs or sperm. Germ cell tumors can develop in the brain or spinal cord and can be benign or malignant.

6. Meningiomas – These are tumors that develop from the membranes that cover the brain and spinal cord. Meningiomas are usually benign, but can occasionally be malignant.

7. Neurofibromas – These are tumors that develop from cells that make up the protective covering of nerves. Neurofibromas can develop anywhere in the body, including the brain and spinal cord.

8. Schwannomas – These are tumors that develop from cells that make up the protective covering of nerves. Schwannomas can develop anywhere in the body, including the brain and spinal cord.

9. Gliomas – These are tumors that develop from glial cells, which provide support and nutrition to the nerve cells in the brain and spinal cord. Gliomas can be benign or malignant.

These are just a few examples of the types of brain and spinal cord tumors that can occur in children. The type of tumor, as well as its location and size, will determine the treatment approach and prognosis.

Symptoms

The symptoms of brain and spinal cord tumors in children can vary depending on the location, size, and type of the tumor. Some common symptoms may include –

1. Headaches – Recurrent and severe headaches, particularly in the morning, can be a symptom of a brain or spinal cord tumor.
2. Vomiting – Children with brain or spinal cord tumors may experience unexplained vomiting, particularly in the morning.
3. Seizures – Seizures can be a symptom of a brain tumor. They may be partial or generalized and can include convulsions, staring spells, or repetitive movements.
4. Changes in vision or hearing – Children with brain tumors may experience vision problems, such as blurred vision, double vision, or loss of peripheral vision. They may also experience hearing problems, such as ringing in the ears or hearing loss.
5. Changes in speech or language – Brain tumors can affect language processing and production, resulting in speech difficulties, slurred speech, or difficulty finding the right words.
6. Weakness or numbness – Children with spinal cord tumors may experience weakness or numbness in their arms or legs, which can affect their ability to walk or move.
7. Balance problems – Tumors in the cerebellum or brainstem can cause problems with coordination and balance, resulting in stumbling, clumsiness, or difficulty walking.
8. Personality or behavior changes – Brain tumors can affect a child’s mood, behavior, and personality. They may become irritable, withdrawn, or have sudden mood swings.
9. Delayed development or milestones – Brain tumors can affect a child’s development, resulting in delayed milestones or regression in skills they have already acquired.

These symptoms can also be caused by other conditions, and not all children with brain or spinal cord tumors will experience these symptoms. If a child is experiencing any of these symptoms, they should be evaluated by a healthcare provider to determine the underlying cause.

Causes and Risk Factors

The exact cause of brain and spinal cord tumors in children is not known, but there are several factors that may increase a child’s risk of developing these tumors. Here are some of the potential causes and risk factors –

1. Genetic predisposition – Certain genetic syndromes, such as neurofibromatosis, Li-Fraumeni syndrome, and tuberous sclerosis, can increase a child’s risk of developing brain and spinal cord tumors.
2. Exposure to radiation – Exposure to ionizing radiation, such as radiation therapy for previous cancer treatment, may increase the risk of developing brain and spinal cord tumors.
3. Environmental factors – Exposure to certain environmental toxins, such as pesticides and chemicals, may increase the risk of developing brain and spinal cord tumors.
4. Family history – Children with a family history of brain tumors may be at an increased risk of developing these tumors themselves.
5. Age – Brain and spinal cord tumors can occur at any age, but some types, such as medulloblastomas, are more common in children.
6. Gender – Some types of brain tumors, such as ependymomas and craniopharyngiomas, are more common in boys than girls.
7. Immune system disorders – Children with certain immune system disorders, such as HIV or AIDS, may be at an increased risk of developing brain and spinal cord tumors.

It is important to note that in many cases, the cause of brain and spinal cord tumors in children is unknown. Early detection and treatment are important for improving outcomes, regardless of the cause or risk factors.

Diagnosis and Tests

Diagnosing brain and spinal cord tumors in children involves several steps, including a medical history review, physical exam, and diagnostic tests. Here are some of the tests that may be used to diagnose brain and spinal cord tumors in children –

1. Neurological exam – The healthcare provider will perform a neurological exam to assess the child’s reflexes, strength, coordination, and sensory function.
2. Imaging tests – Imaging tests such as CT scans, MRI scans, and PET scans can help identify the location, size, and type of the tumor.
3. Biopsy – A biopsy involves taking a small sample of tissue from the tumor for examination under a microscope. This can help determine the type and grade of the tumor.
4. Lumbar puncture – A lumbar puncture, also known as a spinal tap, involves taking a sample of cerebrospinal fluid (CSF) from the spinal cord to check for the presence of cancer cells or other abnormalities.
5. Blood tests – Blood tests may be performed to check for tumor markers or other abnormalities.
6. Vision and hearing tests – These tests can help identify any changes in vision or hearing that may be associated with the tumor.
7. Neuropsychological testing – Neuropsychological testing can help assess the child’s cognitive and behavioral function.

It is necessary to work closely with a healthcare provider and a team of specialists to determine the best diagnostic approach for each individual child.

Treatments

The treatment for brain and spinal cord tumors in children depends on several factors, including the type, size, location, and grade of the tumor, as well as the child’s age and overall health. Here are some of the treatments that may be used –

1. Surgery – Surgery may be used to remove as much of the tumor as possible. This can help relieve symptoms and improve outcomes, particularly for low-grade tumors.

Here are some common types of surgery for brain and spinal cord tumors in children –

• Biopsy – A biopsy involves removing a small sample of the tumor for analysis. This can help determine the type of tumor and guide further treatment.
• Craniotomy – A craniotomy is a surgery that involves opening the skull to access the brain. It may be used to remove tumors located in the brain.
• Transsphenoidal surgery – This is a surgery that involves accessing the brain through the nose and the sphenoid bone. It may be used to remove pituitary tumors.
• Endoscopic surgery – Endoscopic surgery involves using a thin, flexible tube with a camera to visualize and remove tumors. It may be used for certain types of brain and spinal cord tumors.
• Spinal surgery – Spinal surgery may be used to remove tumors located in the spinal cord or the bones of the spine.
• Shunt placement – A shunt is a device that helps drain excess fluid from the brain. It may be placed during surgery to treat tumors that block the flow of cerebrospinal fluid.

2. Radiation therapy – Radiation therapy uses high-energy radiation to kill cancer cells. It may be used in combination with surgery or as the primary treatment for certain types of tumors.

There are several types of radiation therapy that may be used to treat brain and spinal cord tumors in children –

• External beam radiation therapy – This is the most common type of radiation therapy. It uses a machine to deliver radiation to the tumor from outside the body.
• Proton beam therapy – This is a type of external beam radiation therapy that uses protons instead of X-rays to treat the tumor. Proton beam therapy may be used for certain types of tumors or in children who are at a higher risk of developing long-term side effects from radiation therapy.
• Brachytherapy – This is a type of radiation therapy that involves placing a radioactive source inside the body, close to the tumor. It is not commonly used for brain or spinal cord tumors in children.
• Stereotactic radiosurgery – This is a type of radiation therapy that delivers a high dose of radiation to the tumor in a single session. It may be used for small tumors or tumors that are difficult to remove with surgery.

3. Chemotherapy – Chemotherapy involves using drugs to kill cancer cells. It may be used in combination with surgery and radiation therapy, particularly for high-grade tumors.

• Alkylating agents – Alkylating agents are a type of chemotherapy drug that works by damaging the DNA in cancer cells. Examples of alkylating agents used to treat brain and spinal cord tumors in children include cyclophosphamide and ifosfamide.
• Antimetabolites – Antimetabolites are a type of chemotherapy drug that interferes with the metabolism of cancer cells, preventing them from growing and dividing. Examples of antimetabolites used to treat brain and spinal cord tumors in children include methotrexate and cytarabine.
• Vinca alkaloids – Vinca alkaloids are a type of chemotherapy drug that interferes with the formation of the microtubules in cancer cells, preventing them from dividing. Examples of vinca alkaloids used to treat brain and spinal cord tumors in children include vincristine and vinblastine.
• Topoisomerase inhibitors – Topoisomerase inhibitors are a type of chemotherapy drug that interferes with the action of topoisomerases, enzymes that help cancer cells divide. Examples of topoisomerase inhibitors used to treat brain and spinal cord tumors in children include etoposide and irinotecan.

4. Targeted therapy – Targeted therapy uses drugs that target specific molecules involved in tumor growth. It may be used in combination with other treatments, particularly for tumors that are resistant to standard treatments.

There are several targeted therapies that have been developed for brain and spinal cord tumors in children. One approach is to target the signaling pathways that control cell growth and division. For example, some drugs target the epidermal growth factor receptor (EGFR) pathway, which is often overactive in cancer cells. Other drugs target the vascular endothelial growth factor (VEGF) pathway, which is involved in the formation of new blood vessels that tumors need to grow.

Another approach is to target specific genetic mutations that are present in the cancer cells. For example, some brain tumors in children have mutations in the BRAF gene, which can be targeted with drugs such as vemurafenib or dabrafenib. Similarly, some spinal cord tumors have mutations in the NF2 gene, which can be targeted with the drug bevacizumab.

5. Supportive care – Supportive care, such as pain management, physical therapy, and counseling, can help manage symptoms and improve quality of life.

The treatment plan for each child will be individualized based on their specific needs and the characteristics of the tumor. It is important to work closely with a healthcare provider and a team of specialists to develop the best treatment plan for each child.

Outlook

The outlook for children with brain and spinal cord tumors depends on several factors, including the type, size, and grade of the tumor, as well as the child’s age, overall health, and response to treatment. Some children may have a better prognosis than others.

In general, low-grade tumors tend to have a better prognosis than high-grade tumors. However, even low-grade tumors can be serious if they are located in certain areas of the brain or spinal cord or if they cannot be completely removed.

Treatment for brain and spinal cord tumors in children can be challenging and may have side effects. It is important to work closely with a healthcare provider and a team of specialists to develop the best treatment plan for each child.

With advances in treatment and supportive care, the outlook for children with brain and spinal cord tumors has improved in recent years. However, long-term follow-up care is important to monitor for potential complications and to manage any late effects of treatment. It is necessary for families to receive emotional support and to have access to resources, such as support groups and counseling, to help cope with the challenges of having a child with a brain or spinal cord tumor.