Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®)
Topics in This Section
- General Information About Childhood Brain and Spinal Cord Tumors
- General Information About Staging Childhood Brain and Spinal Cord Tumors
- Treatment Option Overview
- Treatment of Newly Diagnosed and Recurrent Childhood Brain Tumors
- Table 1. Newly Diagnosed or Recurrent Tumor Type and Its Related PDQ Treatment Summary
- Treatment of Newly Diagnosed and Recurrent Childhood Spinal Cord Tumors
- To Learn More About Childhood Brain and Spinal Cord Tumors
- Changes to This Summary (10/07/2014)
- About This PDQ Summary
- About PDQ
- Purpose of This Summary
- Reviewers and Updates
- Clinical Trial Information
- Permission to Use This Summary
- Contact Us
- Get More Information From NCI
There are many types of childhood brain and spinal cord tumors. The tumors are formed by the abnormal growth of cells and may begin in different areas of the brain or spinal cord.
The tumors may be benign (not cancer) or malignant (cancer). Benign brain tumors grow and press on nearby areas of the brain. They rarely spread into other tissues. Malignant brain tumors are likely to grow quickly and spread into other brain tissue. When a tumor grows into or presses on an area of the brain, it may stop that part of the brain from working the way it should. Both benign and malignant brain tumors can cause signs or symptoms and need treatment.
Together, the brain and spinal cord make up the central nervous system (CNS).
The brain has three major parts:
- The cerebrum is the largest part of the brain. It is at the top of the head. The cerebrum controls thinking, learning, problem solving, emotions, speech, reading, writing, and voluntary movement.
- The cerebellum is in the lower back of the brain (near the middle of the back of the head). It controls movement, balance, and posture.
- The brain stem connects the brain to the spinal cord. It is in the lowest part of the brain (just above the back of the neck). The brain stem controls breathing, heart rate, and the nerves and muscles used in seeing, hearing, walking, talking, and eating.
Anatomy of the brain, showing the cerebrum, cerebellum, brain stem, and other parts of the brain.Anatomy of the inside of the brain, showing the pineal and pituitary glands, optic nerve, ventricles (with cerebrospinal fluid shown in blue), and other parts of the brain.
The spinal cord is a column of nerve tissue that runs from the brain stem down the center of the back. It is covered by three thin layers of tissue called membranes. These membranes are surrounded by the vertebrae (back bones). Spinal cord nerves carry messages between the brain and the rest of the body, such as a message from the brain to cause muscles to move or a message from the skin to the brain to feel touch.
Although cancer is rare in children, brain and spinal cord tumors are the third most common type of childhood cancer, after leukemia and lymphoma. Brain tumors can occur in both children and adults. Treatment for children is usually different than treatment for adults. (See the PDQ summary on Adult Brain Tumors Treatment for more information about the treatment of adults.)
This summary describes the treatment of primary brain and spinal cord tumors (tumors that begin in the brain and spinal cord). Treatment of metastatic brain and spinal cord tumors is not covered in this summary. Metastatic tumors are formed by cancer cells that begin in other parts of the body and spread to the brain or spinal cord.
Signs and symptoms depend on the following:
- Where the tumor forms in the brain or spinal cord.
- The size of the tumor.
- How fast the tumor grows.
- The child's age and development.
Signs and symptoms may be caused by childhood brain and spinal cord tumors or by other conditions, including cancer that has spread to the brain. Check with your child's doctor if your child has any of the following:
- Brain Tumor Signs and Symptoms
- Morning headache or headache that goes away after vomiting.
- Frequent nausea and vomiting.
- Vision, hearing, and speech problems.
- Loss of balance and trouble walking.
- Unusual sleepiness or change in activity level.
- Unusual changes in personality or behavior.
- Increase in the head size (in infants).
- Spinal Cord Tumor Signs and Symptoms
- Back pain or pain that spreads from the back towards the arms or legs.
- A change in bowel habits or trouble urinating.
- Weakness in the legs.
- Trouble walking.
In addition to these signs and symptoms of brain and spinal cord tumors, some children are unable to reach certain growth and development milestones such as sitting up, walking, and talking in sentences.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
- MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of the brain and spinal cord. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Serum tumor marker test: A procedure in which a sample of blood is examined to measure the amounts of certain substances released into the blood by organs, tissues, or tumor cells in the body. Certain substances are linked to specific types of cancer when found in increased levels in the blood. These are called tumor markers.
If doctors think there might be a brain tumor, a biopsy may be done to remove a sample of tissue. For tumors in the brain, the biopsy is done by removing part of the skull and using a needle to remove a sample of tissue. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor may remove as much tumor as safely possible during the same surgery. The pathologist checks the cancer cells to find out the type and grade of brain tumor. The grade of the tumor is based on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread.
The following test may be done on the sample of tissue that is removed:
- Immunohistochemistry: A test that uses antibodies to check for certain antigens in a sample of tissue. The antibody is usually linked to a radioactive substance or a dye that causes the tissue to light up under a microscope. This type of test may be used to tell the difference between different types of cancer.
Sometimes a biopsy or surgery cannot be done safely because of where the tumor formed in the brain or spinal cord. These tumors are diagnosed based on the results of imaging tests and other procedures.
The prognosis (chance of recovery) depends on the following:
- Whether there are any cancer cells left after surgery.
- The type of tumor.
- Where the tumor is in the body.
- The child's age.
- Whether the tumor has just been diagnosed or has recurred (come back).
Staging is the process used to find how much cancer there is and if cancer has spread within the brain, spinal cord, or to other parts of the body. It is important to know the stage in order to plan cancer treatment.
In childhood brain and spinal cord tumors, there is no standard staging system. Instead, the plan for cancer treatment depends on several factors:
- The type of tumor and where the tumor formed in the brain.
- Whether the tumor is newly diagnosed or recurrent. A newly diagnosed brain or spinal cord tumor is one that has never been treated. A recurrent childhood brain or spinal cord tumor is one that has recurred (come back) after it has been treated. Childhood brain and spinal cord tumors may come back in the same place or in another part of the brain, or spinal cord. Sometimes they come back in another part of the body. The tumor may come back many years after first being treated. Tests and procedures, including biopsy, that were done to diagnose and stage the tumor may be done to find out if the tumor has recurred.
- The grade of the tumor. The grade of the tumor is based on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment. The grade of the tumor is not used to plan treatment for all types of brain and spinal cord tumors.
- The tumor risk group. Risk groups are either average risk and poor risk or low, intermediate, and high risk. The risk groups are based on the amount of tumor remaining after surgery, the spread of cancer cells within the brain and spinal cord or to other parts of the body, where the tumor has formed, and the age of the child. The risk group is not used to plan treatment for all types of brain and spinal cord tumors.
After the tumor is removed in surgery, some of the tests used to detect childhood brain and spinal cord tumors are repeated to help determine the tumor risk group (see the General Information section). This is to find out how much tumor remains after surgery.
Other tests and procedures may be done to find out if cancer has spread:
Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. Lumbar puncture is usually not used to stage childhood spinal cord tumors. This procedure is also called an LP or spinal tap.
Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). The fluid may be sent to a laboratory for testing.
- Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient’s hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.
A recurrent childhood brain or spinal cord tumor is one that has recurred (come back) after it has been treated. Childhood brain and spinal cord tumors may come back in the same place or in another part of the brain. Sometimes they come back in another part of the body. The tumor may come back many years after first being treated. Diagnostic and staging tests and procedures, including biopsy, may be done to make sure that the tumor has recurred.
Different types of treatment are available for children with brain and spinal cord tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Some clinical trials are open only to patients who have not started treatment.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:
- Radiation oncologist.
- Rehabilitation specialist.
- Social worker.
- Nurse specialist.
Childhood brain and spinal cord tumors may cause signs or symptoms that continue for months or years. Signs or symptoms caused by the tumor may begin before diagnosis. Signs or symptoms caused by treatment may begin during or right after treatment.
These are called late effects. Late effects of cancer treatment may include the following:
- Physical problems.
- Changes in mood, feelings, thinking, learning, or memory.
- Second cancers (new types of cancer).
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).
Surgery may be used to diagnose and treat childhood brain and spinal cord tumors. See the General Information section of this summary.
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Anticancer drugs given by mouth or vein to treat brain and spinal cord tumors cannot cross the blood-brain barrier and enter the fluid that surrounds the brain and spinal cord. Instead, an anticancer drug is injected into the fluid-filled space to kill cancer cells there. This is called intrathecal chemotherapy.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
The brain is made of different kinds of cells. Childhood brain tumors are grouped and treated based on the type of cell the cancer formed in and where the tumor began growing in the CNS. Some types of tumors are divided into subtypes based on how the tumor looks under a microscope. See Table 1 for a list of tumor types and staging and treatment information for newly diagnosed and recurrent childhood brain tumors.
Tumors of many different cell types may form in the spinal cord. Low-grade spinal cord tumors usually do not spread. High-grade spinal cord tumors may spread to other places in the spinal cord or to the brain. See the following PDQ summaries for more information on staging and treatment of newly diagnosed and recurrent childhood spinal cord tumors:
- Childhood Astrocytomas Treatment
- Childhood Central Nervous System Embryonal Tumors Treatment
- Childhood Ependymoma Treatment
For more information about childhood brain and spinal cord tumors, see the following:
For more childhood cancer information and other general cancer resources, see the following:
- Late Effects of Treatment for Childhood Cancer
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
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