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Childhood Brain Tumors Treatment (PDQ®)
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Description
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What is childhood brain tumor?
Childhood brain tumors are a diverse group of diseases characterized by the
abnormal growth of tissue contained within the skull. Brain tumors can be
benign (without cancer cells) or malignant (contains cancer cells). The brain
controls vital functions such as memory and learning, the senses (hearing,
sight, smell, taste, and touch), and emotion. It also controls other parts of
the body, including muscles, organs, and blood vessels. Other than leukemia
and lymphoma, brain tumors are the most common type of cancer that occurs in
children.
This PDQ treatment information summary refers only to tumors that originate in
the brain (primary brain tumors). Metastatic brain tumors, which are secondary
tumors formed by cancer cells that begin in other parts of the body and spread
to the brain, are not included. Brain tumors can occur in both children and
adults; however, treatment may be different for adults than for children.
(Refer to the PDQ summary on Adult Brain Tumor Treatment for more information.)
If your child has symptoms that may be caused by a brain tumor, his or her
doctor may order a computed tomographic (CT) scan, a diagnostic test that uses
computers and x-rays to create pictures of the body. A magnetic resonance
imaging (MRI) scan, a diagnostic test similar to a CT scan but which uses
magnetic waves instead of x-rays, may also be performed.
Often, surgery is required to determine whether a brain tumor exists and what
type of tumor it is. A small sample of tumor tissue may be surgically removed
and examined under a microscope. This is called a biopsy. Sometimes a biopsy
is done by making a small hole in the skull and using a needle to extract a
sample of the tumor.
There are many types of brain tumors that occur in children. Treatment and
chance of recovery (prognosis) depend on the type of tumor, its location within
the brain, the extent to which it has spread, and your child’s age and general
health.
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Stage Explanation
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Types of childhood brain tumor
Once childhood brain tumor is detected, additional tests will be performed to
determine the type of tumor. If a biopsy specimen is taken, the tumor cells
will be examined carefully under a microscope to see how different they appear
from normal cells. This will determine the grade of the tumor. The grade of a
tumor is determined by microscopic examination of its cells to see how similar
the cells are to normal cells. Cells from higher-grade, more abnormal-looking
tumors usually grow faster and are more malignant than cells from lower-grade
tumors. Your child’s doctor needs to know the type and grade of tumor in order
to plan treatment.
There is no staging for childhood brain tumors. Brain tumors are grouped
according to their location within the brain and the appearance and behavior of
the tumor tissue. The following groupings are used for childhood brain tumors:
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Infratentorial tumors
Infratentorial tumors are those that occur in the lower part of the brain.
Tumors found in this region include:
Medulloblastoma
(Refer to the PDQ summary on Childhood Medulloblastoma Treatment for more
information.)
Cerebellar astrocytoma
(Refer to the PDQ summary on Childhood Cerebellar Astrocytoma Treatment for
more information.)
Infratentorial ependymoma
Ependymal tumors are tumors that begin in the ependyma, the cells that line the
hollow cavities within the brain (called ventricles) which are filled with
cerebrospinal fluid. The growth of ependymal tumors can obstruct the flow of
the cerebrospinal fluid through the brain and spinal cord. Infratentorial
ependymomas begin in the lower part of the brain. These tumors may spread via
the cerebrospinal fluid to other areas of the brain and spinal cord.
Brain stem glioma
(Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more
information.)
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Supratentorial tumors
Supratentorial tumors are those that occur in the upper part of the brain.
Common supratentorial tumors include:
Cerebral astrocytoma
(Refer to the PDQ summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more
information.)
Supratentorial ependymoma
Ependymal tumors are tumors that begin in the ependyma, the cells that line the
hollow cavities within the brain (called ventricles) which are filled with
cerebrospinal fluid. The growth of ependymal tumors can obstruct the flow of
the cerebrospinal fluid through the brain. Supratentorial ependymomas begin in
the upper part of the brain. These tumors may spread to other areas of the
brain and spinal cord, depending on their grade.
Craniopharyngioma
Craniopharyngiomas are tumors that generally occur just above the pituitary
gland. Located at the bottom of the brain, the pituitary gland is about the
size of a pea and controls many vital functions. Craniopharyngiomas do not
spread, but may interfere with important structures near them, causing serious
problems.
Central nervous system germ cell tumor
Germ cell tumors arise from the sex cells found in the brain. There are
different types of germ cell tumors, including germinomas, embryonal cell carcinomas, choriocarcinomas, and teratomas. These tumors usually occur in the
center of the brain, and can spread to other parts of the brain and spinal
cord.
Supratentorial primitive neuroectodermal tumors and pineoblastoma
(Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal
Tumors Treatment for more information.)
Visual pathway and hypothalamic glioma
(Refer to the PDQ summary on Childhood Visual Pathway and Hypothalamic Glioma
Treatment for more information.)
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Spinal Cord Tumors
Spinal cord tumors are rare benign or cancerous tumors in the spinal cord (the bundles of nerves that carry messages between the brain and the body). The diagnosis of spinal cord tumors depends on how the tumor looks under a microscope and its location. Spinal cord tumors compress the spinal cord and the surrounding nerves causing symptoms such as pain or numbness in the back, arms, or legs, decreased muscle strength, and in some cases, loss of bowel or bladder control. X-rays of the brain and the entire spine are done at the time of diagnosis to determine extent of disease.
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Recurrent brain tumor
Recurrent disease means that the cancer has come back (recurred) after it has
been treated. It may recur in its original location, in another part of the
central nervous system, or systemically (throughout the body).
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Treatment Option Overview
There are treatments for all children with brain tumors. Three kinds of
treatment are used:
More than one method of treatment may be used, depending on the needs of the
patient.
Experienced doctors working together may provide the best treatment for
children with brain tumors. Your child’s treatment will often be coordinated
by a pediatric oncologist, a doctor who specializes in cancer in children. The
pediatric oncologist may refer your child to other specialists, such as a
pediatric neurosurgeon (a specialist in childhood brain surgery), a pediatric
neurologist, a psychologist, a radiation oncologist, and other doctors who
specialize in the type of treatment your child requires.
Treatment options often depend on the type of tumor and its location within the
brain. Complete or near complete removal of the tumor is often possible. If
the tumor cannot be completely removed, radiation therapy and/or chemotherapy
may also be given.
Radiation therapy uses high-energy radiation from x-rays and other sources to
kill cancer cells and shrink tumors. Radiation therapy for childhood brain
tumors usually comes from a machine outside the body (external radiation
therapy). For some types of brain tumors, clinical trials are evaluating
radiation therapy given in several small doses per day (hyperfractionated
radiation therapy). Since radiation therapy can affect growth and brain
development, other clinical trials are testing ways to decrease or delay
radiation therapy, especially for younger children who have not yet achieved
full growth.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs may
be taken by mouth or injected into a vein (intravenous) or muscle.
Chemotherapy is called a systemic treatment because the drug enters the
bloodstream, travels through the body, and can kill cancer cells throughout the
body. Chemotherapy is being studied in clinical trials as a means of delaying,
modifying or eliminating the need for radiation therapy in younger patients, as
well as for use prior to or during radiation therapy.
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Treatment by type
Treatment for childhood brain tumor depends on the type and grade of the tumor,
its location within the brain, and your child’s age and overall health.
Your child may receive treatment that is considered standard based on its
effectiveness in a number of patients in past studies, or you may choose to
have your child enter a clinical trial. Not all patients are cured with
standard therapy and some standard treatments may have more side effects than
are desired. For these reasons, clinical trials are designed to test new
treatments and to find better ways to treat people with cancer. Clinical
trials are ongoing in most parts of the country for childhood brain tumors.
For more information, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237); TTY at 1-800-332-8615.
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Childhood Medulloblastoma
(Refer to the PDQ summary on Childhood Medulloblastoma Treatment for more
information.)
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Childhood Cerebellar Astrocytoma
(Refer to the PDQ summary on Childhood Cerebellar Astrocytoma Treatment for
more information.)
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Childhood Infratentorial Ependymoma
Treatment for childhood infratentorial ependymoma is usually surgery to remove
as much of the tumor as possible, followed by radiation therapy. For children
younger than 3 years of age, chemotherapy may be given to delay, modify, or
eliminate the use of radiation therapy.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood infratentorial ependymoma.
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Childhood Brain Stem Glioma
(Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more
information.)
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Childhood Cerebral Astrocytoma/Malignant Glioma
(Refer to the PDQ summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more
information.)
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Childhood Supratentorial Ependymoma
Treatment for childhood supratentorial ependymoma may be surgery followed by
radiation therapy. Clinical trials are evaluating surgery followed by
chemotherapy with or without radiation therapy. For children younger than 3
years of age, chemotherapy may be given to delay or modify the use of
radiation therapy. Clinical trials evaluating radiation therapy with or
without chemotherapy are ongoing.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood supratentorial ependymoma.
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Childhood Craniopharyngioma
Treatment for childhood craniopharyngioma may be surgery, radiation therapy, or
a combination of the two.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood craniopharyngioma.
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Childhood Central Nervous System Germ Cell Tumor
Treatment for childhood central nervous system germ cell tumor may be radiation
therapy. In some cases, chemotherapy may be given in addition to radiation
therapy.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood central nervous system germ cell tumor.
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Spinal Cord Tumors
Treatment for spinal cord tumors may be surgery with or without radiation therapy. In some cases, chemotherapy may be given in addition to radiation therapy.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood spinal cord tumors.
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Childhood Visual Pathway Glioma
(Refer to the PDQ summary on Childhood Visual Pathway and Hypothalamic Glioma
Treatment for more information.)
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Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma
(Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal Tumors Treatment for more information.)
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Recurrent Childhood Brain Tumor
Treatment for recurrent disease depends on the type of tumor, whether the tumor
recurs in the site in which it originated or elsewhere, the amount of time
between initial treatment and the recurrence, and the type of treatment
previously given.
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Recurrent low-grade glial tumors
Treatment options consist of surgery, radiation therapy, and chemotherapy.
Clinical trials are currently evaluating the role of chemotherapy for treatment
of these tumors.
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Recurrent infratentorial ependymomas
Treatment options include surgery and chemotherapy. Clinical trials are
currently evaluating the role of chemotherapy for treatment of these tumors.
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Recurrent supratentorial ependymoma
Treatment usually consists of chemotherapy. Clinical trials are currently
evaluating the role of chemotherapy for treatment of these tumors.
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Recurrent central nervous system germ cell tumors
Treatment usually consists of chemotherapy. Clinical trials are currently
evaluating the role of chemotherapy for treatment of these tumors.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood brain tumor.
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Changes to This Summary (07/23/2007)
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.
Links to the NCI Dictionary of Cancer Terms were added to this summary.
This information is provided from the PDQ® database in collaboration with the NCI.
