Brain and Spinal Cord Tumors
What are brain and spinal cord tumors?
The brain and spinal cord make up the central nervous system (CNS). CNS tumors may be benign (not cancer) or malignant (cancer). But even benign tumors can cause severe problems or death.
Tumors that begin in the brain are called primary brain tumors. They may spread to other areas of the brain or spinal cord, but they do not usually spread to other parts of the body.
Brain tumors may also come from tumor cells that have spread from other parts of the body. These are called metastatic or secondary brain tumors. These tumors are named for the part of the body where they began. Secondary brain tumors are rare in children.
Brain and spinal cord tumors are the 2nd most common type of cancer in children after leukemia. About 20% (1 in 5) of childhood cancers begin in the brain or spinal cord. There are about 5,900 new cases of CNS tumors in children and teens in the United States each year. Brain and spinal cord tumors are the leading cause of pediatric cancer deaths.
About half of all pediatric brain tumors are gliomas that form from glial cells that make up the supportive tissue of the brain. Gliomas may be high-grade or low-grade and can occur in different areas of the brain and the spinal cord. The most common malignant brain tumor in children is medulloblastoma. This cancer forms in the cerebellum, in a region of the brain known as the posterior fossa.
Symptoms of brain and spinal tumors
Many types of tumors form in the brain and spinal cord. Symptoms can vary widely. The symptoms depend on where the tumor is located, its size, how fast it grows, and the child’s age and stage of development.
Many childhood CNS tumors grow slowly. The symptoms may be mild. They may come and go. They might not follow a typical or predictable pattern.
Brain tumor signs and symptoms include:
- Headaches, especially in the morning
- Nausea and vomiting, especially in the morning
- Vision problems
- Crossed-eyes (strabismus or squint)
- Problems in speech or hearing
- Loss of balance, coordination problems, or difficulty walking
- Weakness in the arms or legs
- Seizures
- Feeling tired or changes in activity level
- Unexplained weight gain or loss
- Symptoms related to endocrine problems or changes in hormones such as increased thirst or early puberty
- Personality changes
- Changes in school performance
- Problems with thinking or memory
- Weakness, numbness, tingling, or changes in feeling on one side of the body (arm or leg or both)
- Chronic back pain (spinal cord tumors)
- Tilting the head to one side
- Increased head size in infants
Spinal cord tumor signs and symptoms include:
- Scoliosis (curving of the backbone)
- Back or neck pain
- Weakness in arms or legs
- Difficulty walking
- Problems going to the bathroom
In some cases, a child with a brain or spinal cord tumor may have problems reaching early developmental milestones for their age. Talk to your child’s care team if you have questions about your child’s development.
The Central Nervous System
Signs and symptoms depend on where the tumor is located in the brain or spinal cord. The CNS controls important body functions. These include thinking, learning, emotions, speech, vision, movement, pain, breathing, and heart rate.
The brain has 3 main parts: the cerebrum, cerebellum, and brain stem.
- The cerebrum is the largest area of the brain. It controls thinking, learning, speaking, memory, and emotions.
- The cerebellum is in the back of the brain. It controls motor function such as movement, balance, and coordination.
- The brain stem is the area that connects the brain and spinal cord. It controls vital life functions such as breathing, heart rate, and blood pressure.
Messages travel back and forth from the brain to the rest of the body through the spinal cord and nerves.
Diagnosis of brain and spinal tumors
Symptoms of brain and spinal cord tumors can be mild and hard to recognize at first. Early symptoms are often similar to other childhood illnesses. Depending on the type of tumor and how fast it grows, diagnosis can sometimes take a while. Diagnosis usually includes:
- Physical exam and medical history to learn about symptoms, general health, past illnesses, and risk factors
- Neurological exam to look at brain and nervous system function
- Imaging tests such as magnetic resonance imaging (MRI) and computerized tomography (CT)
- Lumbar puncture to get a sample of spinal fluid to check for signs of cancer
- Biopsy of the tumor to look at a tissue sample under a microscope
- Molecular testing of the tumor sample. Health care teams use genetic tests to look for changes in the tumor’s genes. These tests help doctors confirm the diagnosis, plan treatment, and predict the prognosis.
Treatment of brain and spinal tumors
Surgery is a main treatment for brain and spinal cord tumors. Other treatments include chemotherapy, radiation therapy, and targeted therapy.
Treatments depend on the tumor type and location, the child’s age, and how much of the tumor can be removed with surgery.
Most patients who have brain surgery take steroid medicines to reduce brain swelling. Some patients may take anti-seizure medicines.
In some cases, surgeons place a shunt in the brain to prevent fluid build-up (hydrocephalus). The shunt may be temporary or permanent.
Your child may need services to help with recovery after surgery. These may include rehabilitation and supportive care including help with vision, speech, hearing, strength, and movement. Psychology and school support services can help with emotional, social, developmental, and learning needs.
Prognosis for brain and spinal tumors
The prognosis for brain and spinal cord tumors depends on many factors. These include:
- Tumor type and grade
- Molecular features of the tumor
- The child’s age
- Whether the tumor is new or has returned
- Whether the cancer has spread to other areas
- If the tumor can be removed with surgery
- How well the tumor responds to treatments
The average survival rate for pediatric cancers of the brain and spinal cord is about 75% in the United States. But the prognosis can vary widely based on cancer type. Talk to your child's care team about your child’s prognosis.
Support for patients with brain and spinal tumors
The impact of a brain tumor on a child’s quality of life varies widely. Some patients have few lasting effects on health and function after treatment. Other children may have long-term problems in physical, cognitive, and emotional functioning. These problems may be due to the tumor or the late effects of treatment.
Rehabilitation services and supportive care
Rehabilitation services can help improve daily living skills after a brain tumor. These services may include physical therapy, occupational therapy, speech therapy, vision assistance, and hearing care.
Patients treated for brain tumors should be monitored for changes or problems in functioning. These may include the onset of seizures or changes in:
- Strength, balance, and coordination
- Thinking, learning, memory, attention, and processing information
- Behavior, emotions, and social function
- Speech, hearing, and vision
- Hormones and endocrine function
Psychological services can help with emotional, social, developmental, and cognitive needs. Patients often need extra support for return to school. A neuropsychological assessment before and after treatment can help families identify education needs. Talk to your child’s care team about testing and academic needs.
Healthy behaviors
Simple lifestyle habits can help brain health and improve overall health.
- Eat healthy
- Be physically active
- Get enough sleep
- Manage stress
Late effects of treatment
Childhood cancer survivors should get long-term follow-up health care. Some treatments can cause late effects. These are health problems that happen months or years after treatment has ended.
It is important to have regular checkups and screenings by a primary health care provider. Your child should get a survivorship care plan after completing treatment. This plan includes guidance on health screenings, disease risk factors, and how to improve health. Survivors should share this plan with their health care providers.
Questions to ask your care team
- What type of brain tumor does my child have?
- Are there certain treatment centers that specialize in this type of pediatric brain tumor?
- What are the treatment options for this type of brain tumor?
- Can surgery completely remove the tumor?
- What are the possible side effects of treatment?
- Should we consider treatment through a clinical trial?
- What is the long-term outlook or prognosis for this type of brain tumor?
- What support services are available for my child and family?
Key points about brain and spinal tumors
- Brain and spinal cord tumors may be benign (not cancer) or malignant (cancer).
- Tumors that begin in the brain do not usually spread beyond the brain and spinal cord.
- Symptoms of brain tumors can vary widely and depend on the tumor size and location.
- Surgery is usually a main treatment for brain and spinal cord tumors when possible.
- Treatments for brain tumors may also include chemotherapy, radiation therapy, or targeted therapy.
- Prognosis depends on the type of tumor, your child's age, and whether the tumor can be fully removed with surgery. Your care team is the best source of information about your child's case.
