Brain and Spinal Cord Tumors

General Information | Treatment Options | Resources

 

General Information
  • About
  • Types
  • Signs & Symptoms
  • Detection
  • Stages

A childhood brain or spinal cord tumor is a disease in which abnormal cells form in the tissues of the brain or spinal cord.

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. Tumors may be benign (noncancerous) or malignant (cancerous).

Together, the brain and spinal cord make up the central nervous system (CNS).

The brain controls many important body functions.

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, which is in the lower back of the brain (near the middle of the back of the head), 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.

The spinal cord connects the brain with nerves in most parts of the body.

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 signal from the brain to cause muscles to move or from the skin to the brain about the sense of touch.

Brain and spinal cord tumors are a common type of childhood cancer.

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 treatment summary on Adult Brain Tumors for more information.)

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, which are tumors formed by cancer cells that begin in other parts of the body and spread to the brain or spinal cord, is not covered in this summary.

There are different types of childhood brain and spinal cord tumors.

Childhood brain and spinal cord tumors are named based on the type of cell they formed in and where the tumor first formed in the CNS.

Astrocytomas

Childhood astrocytomas are tumors that form in cells called astrocytes. They can be high-grade or low-grade tumors. The grade of the tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. High-grade astrocytomas are fast-growing, malignant tumors. Low-grade astrocytomas are slow-growing tumors that are less likely to be malignant. (See the PDQ summaries on Childhood Cerebellar Astrocytoma Treatment, Childhood Cerebral Astrocytoma/Malignant Glioma Treatment, and Childhood Visual Pathway and Hypothalamic Glioma Treatment for more information.)

Atypical Teratoid/Rhabdoid Tumor

Childhood atypical teratoid/rhabdoid tumors are fast-growing tumors that often form in the cerebellum. They may also form in other parts of the brain and in the spinal cord.

Brain Stem Glioma

Childhood brain stem gliomas form in the brain stem (the part of the brain connected to the spinal cord). (See the PDQ summary on Childhood Brain Stem Glioma Treatment for more information.)

Central Nervous System Embryonal Tumor

Childhood CNS embryonal tumors form in brain and spinal cord cells when the fetus is beginning to develop. They include the following types of tumors:

  • Ependymoblastoma
  • Medulloblastoma
  • Medulloepithelioma
  • Pineal parenchymal tumors
  • Pineoblastoma
  • Supratentorial primitive neuroectodermal tumors (SPNET)

(See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.)

Central Nervous System Germ Cell Tumor

Childhood CNS germ cell tumors form in germ cells, which are cells that develop into sperm or ova (eggs). There are different types of childhood germ cell tumors. These include germinomas, embryonal yolk sac carcinomas, choriocarcinomas, and teratomas. A mixed germ cell tumor has two types of germ cell tumors in it. Germ cell tumors can be either benign or malignant.

Germ cell brain tumors usually form in the center of the brain, near the pineal gland. The pineal gland is a tiny organ in the brain that makes melatonin, which is a substance that helps control the sleeping and waking cycle. Germ cell tumors can spread to other parts of the brain and spinal cord.

Craniopharyngioma

Childhood craniopharyngiomas are tumors that usually form just above the pituitary gland. The pituitary gland is found in the center of the brain behind the back of the nose. It is about the size of a pea and controls many important body functions including growth. Craniopharyngiomas rarely spread, but may affect important areas of the brain, such as the pituitary gland.

Ependymoma

Childhood ependymomas are slow-growing tumors formed in cells that line the fluid-filled spaces in the brain and spinal cord. (See the PDQ summary on Childhood Ependymoma Treatment for more information.)

Medulloblastoma

Childhood medulloblastomas form in the cerebellum. (See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.)

Spinal Cord 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 brain.

Supratentorial Primitive Neuroectodermal Tumor

Childhood supratentorial primitive neuroectodermal tumors (SPNET) form in immature cells in the cerebrum. (See the PDQ treatment summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.)

Visual Pathway and Hypothalamic Glioma

Childhood visual pathway and hypothalamic gliomas form in the visual pathway and the hypothalamus of the brain. The visual pathway includes the optic nerve, optic chiasm, and optic tract. The visual pathway sends messages from the eye to the brain and from the brain to the eye. The hypothalamus is an area of the brain that controls body temperature, hunger, and thirst. (See the PDQ summary on Childhood Visual Pathway and Hypothalamic Glioma Treatment for more information.)

The cause of most childhood brain and spinal cord tumors is unknown.The symptoms of childhood brain and spinal cord tumors are not the same in every child.

Headaches and other symptoms may be caused by childhood brain and spinal cord tumors. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

    Brain Tumors

  • 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.
  • Seizures.
  • Increase in the head size (in infants).

    Spinal Cord Tumors

  • 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 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.

Tests that examine the brain and spinal cord are used to detect (find) childhood brain and spinal cord tumors.

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.
  • 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.
  • 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).
  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
  • Angiogram: A procedure to look at blood vessels and the flow of blood in the brain. A contrast dye is injected into the blood vessel. As the contrast dye moves through the blood vessel, x-rays are taken to see if there are any blockages.
  • PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Most childhood brain tumors are diagnosed and removed in surgery.

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 tests may be done on the sample of tissue that is removed:

  • Immunohistochemistry study: A laboratory test in which a substance such as an antibody, dye, or radioisotope is added to a sample of cancer tissue to test for certain antigens. This type of study is used to tell the difference between different types of cancer.
  • Light and electron microscopy: A laboratory test in which cells in a sample of tissue are viewed under regular and high-powered microscopes to look for certain changes in the cells.
  • Cytogenetic analysis: A laboratory test in which cells in a sample of tissue are viewed under a microscope to look for certain changes in the chromosomes.

Some childhood brain and spinal cord tumors are diagnosed by imaging tests.

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.

Certain factors affect prognosis (chance of recovery).

The prognosis (chance of recovery) depends on the following:

  • Whether there are any cancer cells left after surgery.
  • The type of tumor.
  • The location of the tumor.
  • The child's age.
  • Whether the tumor has just been diagnosed or has recurred (come back).

In childhood brain and spinal cord tumors, treatment options are based on several factors.

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.

The information from tests and procedures done to detect (find) childhood brain and spinal cord tumors is used to determine the tumor risk group.

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.
  • 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.
  • Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
  • 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.

There are three ways that cancer spreads in the body.

The three ways that cancer spreads in the body are:

  • Through tissue. Cancer invades the surrounding normal tissue.
  • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
  • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Recurrent Childhood Brain and Spinal Cord Tumors

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 may 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 confirm the tumor has recurred.

Cancer information from the NCI PDQ service