Childhood Brain Tumours

What is childhood brain tumour?

Childhood brain tumours are a diverse group of diseases characterized by the abnormal growth of tissue contained within the skull. Brain tumours 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 leukaemia and lymphoma, brain tumours are the most common type of cancer that occurs in children.

This treatment information summary refers only to tumours that originate in the brain (primary brain tumours). Metastatic brain tumours, which are secondary tumours formed by cancer cells that begin in other parts of the body and spread to the brain, are not included. Brain tumours can occur in both children and adults; however, treatment may be different for adults than for children. (Refer to the summary on Adult Brain Tumour Treatment for more information.)

If your child has symptoms that may be caused by a brain tumour, 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 tumour exists and what type of tumour it is. A small sample of tumour 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 tumour.

There are many types of brain tumours that occur in children. Treatment and chance of recovery (prognosis) depend on the type of tumour, its location within the brain, the extent to which it has spread, and your child’s age and general health.

Stage Explanation

Types of childhood brain tumour

Once childhood brain tumour is detected, additional tests will be performed to determine the type of tumour. If a biopsy specimen is taken, the tumour cells will be examined carefully under a microscope to see how different they appear from normal cells. This will determine the grade of the tumour. The grade of a tumour 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 tumours usually grow faster and are more malignant than cells from lower-grade tumours. Your child’s doctor needs to know the type and grade of tumour in order to plan treatment.

There is no staging for childhood brain tumours. Brain tumours are grouped according to their location within the brain and the appearance and behaviour of the tumour tissue. The following groupings are used for childhood brain tumours:
Infratentorial tumours

Infratentorial tumours are those that occur in the lower part of the brain. Tumours found in this region include:
Medulloblastoma

(Refer to the summary on Childhood Medulloblastoma Treatment for more information.)
Cerebellar astrocytoma

(Refer to the summary on Childhood Cerebellar Astrocytoma Treatment for more information.)
Infratentorial ependymoma

Ependymal tumours are tumours 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 tumours 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 tumours may spread via the cerebrospinal fluid to other areas of the brain and spinal cord.
Brain stem glioma

(Refer to the summary on Childhood Brain Stem Glioma Treatment for more information.)
Supratentorial tumours

Supratentorial tumours are those that occur in the upper part of the brain. Common supratentorial tumours include:
Cerebral astrocytoma

(Refer to the summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more information.)
Supratentorial ependymoma

Ependymal tumours are tumours 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 tumours can obstruct the flow of the cerebrospinal fluid through the brain. Supratentorial ependymomas begin in the upper part of the brain. These tumours may spread to other areas of the brain and spinal cord, depending on their grade.
Craniopharyngioma

Craniopharyngiomas are tumours 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 tumour

Germ cell tumours arise from the sex cells found in the brain. There are different types of germ cell tumours, including germinomas, embryonal cell carcinomas, choriocarcinomas, and teratomas. These tumours usually occur in the center of the brain, and can spread to other parts of the brain and spinal cord.
Supratentorial primitive neuroectodermal tumours and pineoblastoma

(Refer to the summary on Childhood Supratentorial Primitive Neuroectodermal Tumours Treatment for more information.)
Visual pathway and hypothalamic glioma

(Refer to the summary on Childhood Visual Pathway and Hypothalamic Glioma Treatment for more information.)
Spinal Cord Tumours

Spinal cord tumours are rare benign or cancerous tumours in the spinal cord (the bundles of nerves that carry messages between the brain and the body). The diagnosis of spinal cord tumours depends on how the tumour looks under a microscope and its location. Spinal cord tumours 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.
Recurrent brain tumour

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).

Treatment Option Overview

There are treatments for all children with brain tumours. Three kinds of treatment are used:

  • Surgery (removing the tumour in an operation)
  • Radiation therapy (using high-dose x-rays to kill tumour cells)
  • Chemotherapy (using drugs to kill tumour cells)

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 tumours. Your child’s treatment will often be coordinated by a paediatric oncologist, a doctor who specializes in cancer in children. The paediatric oncologist may refer your child to other specialists, such as a paediatric neurosurgeon (a specialist in childhood brain surgery), a paediatric 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 tumour and its location within the brain. Complete or near complete removal of the tumour is often possible. If the tumour 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 tumours. Radiation therapy for childhood brain tumours usually comes from a machine outside the body (external radiation therapy). For some types of brain tumours, 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.
Treatment by type

Treatment for childhood brain tumour depends on the type and grade of the tumour, 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 tumours. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Childhood Medulloblastoma

(Refer to the summary on Childhood Medulloblastoma Treatment for more information.)

Childhood Cerebellar Astrocytoma

(Refer to the summary on Childhood Cerebellar Astrocytoma Treatment for more information.)

Childhood Infratentorial Ependymoma

Treatment for childhood infratentorial ependymoma is usually surgery to remove as much of the tumour 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.

Childhood Brain Stem Glioma

(Refer to the summary on Childhood Brain Stem Glioma Treatment for more information.)

Childhood Cerebral Astrocytoma/Malignant Glioma

(Refer to the summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more information.)

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.

Childhood Craniopharyngioma

Treatment for childhood craniopharyngioma may be surgery, radiation therapy, or a combination of the two.

Childhood Central Nervous System Germ Cell Tumour

Treatment for childhood central nervous system germ cell tumour may be radiation therapy. In some cases, chemotherapy may be given in addition to radiation therapy.

Spinal Cord Tumours

Treatment for spinal cord tumours may be surgery with or without radiation therapy. In some cases, chemotherapy may be given in addition to radiation therapy.

Childhood Visual Pathway Glioma

(Refer to the summary on Childhood Visual Pathway and Hypothalamic Glioma Treatment for more information.)

Childhood Supratentorial Primitive Neuroectodermal Tumours and Pineoblastoma

(Refer to the summary on Childhood Supratentorial Primitive Neuroectodermal Tumours Treatment for more information.)

Recurrent Childhood Brain Tumour

Treatment for recurrent disease depends on the type of tumour, whether the tumour 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.
Recurrent low-grade glial tumours

Treatment options consist of surgery, radiation therapy, and chemotherapy. Clinical trials are currently evaluating the role of chemotherapy for treatment of these tumours.
Recurrent infratentorial ependymomas

Treatment options include surgery and chemotherapy. Clinical trials are currently evaluating the role of chemotherapy for treatment of these tumours.
Recurrent supratentorial ependymoma

Treatment usually consists of chemotherapy. Clinical trials are currently evaluating the role of chemotherapy for treatment of these tumours.
Recurrent central nervous system germ cell tumours

Treatment usually consists of chemotherapy. Clinical trials are currently evaluating the role of chemotherapy for treatment of these tumours.


© Medic8 ® All Rights Reserved.