Brain tumor - children

Glioblastoma multiforme - children; Ependymoma - children; Glioma - children; Astrocytoma children; Medulloblastoma - children; Neuroglioma - children; Oligodendroglioma - children;
Meningioma - children; Cancer - brain tumor (children)
Last reviewed: October 18, 2013.

A brain tumor is a group (mass) of abnormal cells that start in the brain.
This article focuses on primary brain tumors in children.

Causes
The cause of primary brain tumors is unknown. Primary brain tumors may be:

Not cancerous (benign)

Invasive (spread to nearby areas)

Cancerous (malignant)

Brain tumors are classified based on:

The exact site of the tumor

The type of tissue involved

Whether it is cancerous

Brain tumors can directly destroy brain cells. They can also indirectly damage cells by pushing on
other parts of the brain. This leads to swelling and increased pressure inside the skull.
Tumors can occur at any age. Many tumors are more common at a certain age. In general, brain
tumors in children are very rare.
COMMON TUMOR TYPES
Astrocytomas are usually noncancerous, slow-growing tumors. They commonly develop in children
ages 5 through 8. Also called low-grade gliomas, these are the most common brain tumors in children.
Medulloblastomas are the most common type of childhood brain cancer. Most medulloblastomas
occur before age 10.
Ependymomas are a type of childhood brain tumor that can be benign (non-cancerous) or malignant
(cancerous). The location and type of ependymoma determine the type of therapy needed to control
the tumor.
Brainstem gliomas are very rare tumors that occur almost only in children. The average age at which
they develop is about 6. The tumor may grow very large before causing symptoms.

Symptoms
Symptoms may be subtle and only gradually become worse. Or they may occur very quickly.
Headaches are often the most common symptom. But only very rarely do children with headaches
have a tumor. Headache patterns that may occur with brain tumors include:

Headaches that are worse when waking up in the morning and go away within a few hours

Headaches that get worse with coughing or exercise, or with a change in body position

Headaches that occur while sleeping and with at least one other symptom such as vomiting or
confusion

Sometimes the only symptoms of brain tumors are mental changes, which may include:

Changes in personality and behavior

Unable to concentrate

Increased sleep

Memory loss

Problems with reasoning

Other possible symptoms are:

Gradual loss of movement or feeling in an arm or leg

Hearing loss with or without dizziness

Speech difficulty

Unexpected vision problem (especially if it occurs with a headache), including vision loss
(usually of peripheral vision) in one or both eyes, or double vision

Problems with balance

Weakness or numbness

Exams and Tests

The health care provider will perform a physical exam. Infants may have the following physical signs:

Bulging fontanelles

Enlarged eyes

No red reflex in the eye

Positive Babinski reflex

Separated sutures

The following tests may be used to detect a brain tumor and identify its location:

CT scan of the head

MRI of the brain

Examination of the cerebral spinal fluid (CSF)

Treatment
Treatment depends on the size and type of tumor and the child's general health. The goals of
treatment may be to cure the tumor, relieve symptoms, and improve brain function or the child's
comfort.

Surgery is needed for most primary brain tumors. Some tumors may be completely removed. In cases
where the tumor cannot be removed, surgery may help reduce pressure and relieve
symptoms. Chemotherapy or radiation therapy may be used for certain tumors.
The following are treatments for specific types of tumors:

Astrocytoma -- Surgery to remove the tumor is the main treatment. Chemotherapy

and/or radiation therapy may also be necessary.

Brainstem gliomas -- Surgery is usually not possible because of the tumor's location in the
brain. Radiation is used to shrink the tumor and prolong life.

Ependymomas -- Treatment includes surgery. Radiation and chemotherapy may be

necessary.

Medulloblastomas -- Surgery alone does not cure this type of tumor. Chemotherapy with or
without radiation is often used in combination with surgery.

Medicines used to treat primary brain tumors in children include:

Corticosteroids to reduce brain swelling

Diuretics (water pills) to reduce brain swelling and pressure

Anticonvulsants to reduce or prevent seizures

Pain medicines

Comfort measures, safety measures, physical therapy, occupational therapy, and other such steps
may be required to improve quality of life.

Support Groups
You can ease the stress of illness by joining a cancer support group. Sharing with others who have
common experiences and problems can help you and your child not feel alone.

Outlook (Prognosis)
How well the child does depends on many things, including the exact type of tumor. In general, about
3 of 4 children survive at least 5 years after being diagnosed.
Long-term brain and nervous system problems may result from the tumor itself or from treatment.
Children may have problems with attention, concentration, or memory. They may also have problems
processing information, planning, insight, or initiative or desire to do things.
Children younger than age 7, especially younger than age 3, seem to be at greatest risk of these
complications.
Parents need to make sure that children receive support services at home and at school.

When to Contact a Medical Professional

Call a health care provider if a child develops headaches that do not go away or other symptoms of a
brain tumor.
Go to the emergency room if a child develops any of the following:

Physical weakness

Change in behavior

Severe headache of unknown cause

Seizure of unknown cause

Vision changes

Speech changes

References
1. Kuttesch JF Jr, Rush SA, Ater JL. Brain tumors in childhood. In: Kliegman RM, Stanton BF, St.
Geme JW III, et al., eds.Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Elsevier
Saunders; 2011:chap 491.
2. National Cancer Institute: PDQ Childhood Brain and Spinal Cord Tumors Treatment
Overview. Bethesda, Md: National Cancer Institute. Date last modified 05/29/2013. Available
at: http://www.cancer.gov/cancertopics/pdq/treatment/childbrain/healthprofessional. Accessed
October 18, 2013.
3. Wilne S, Koller K, Collier J, Kennedy C, Grundy R, Walker D. The diagnosis of brain tumours
in children: a guideline to assist healthcare professionals in the assessment of children who
may have a brain tumour. Arch Dis Child. 2010;95:534-539. [PubMed]

Brain tumor - primary - adults

Glioblastoma multiforme - adults; Ependymoma - adults; Glioma - adults; Astrocytoma adults; Medulloblastoma - adults; Neuroglioma - adults; Oligodendroglioma - adults;
Lymphoma - adults; Vestibular schwannoma (acoustic neuroma) - adults; Meningioma - adults;
Cancer - brain tumor (adults)
Last reviewed: October 30, 2013.

A primary brain tumor is a group (mass) of abnormal cells that start in the brain.

Causes
Primary brain tumors include any tumor that starts in the brain. Primary brain tumors can start from
brain cells, the membranes around the brain (meninges), nerves, or glands.
Tumors can directly destroy brain cells. They can also damage cells by producing inflammation,
placing pressure on other parts of the brain, and increasing pressure within the skull.
The cause of primary brain tumors is unknown. There are many risk factors that could play a role:

Radiation therapy used to treat brain cancers increases the risk of brain tumors up to 20 or 30
years later.

Some inherited conditions increase the risk of brain tumors, including neurofibromatosis, Von
Hippel-Lindau syndrome, Li-Fraumeni syndrome, and Turcot syndrome.

Lymphomas that begin in the brain in people with a weakened immune system are sometimes
linked to infection by the Epstein-Barr virus.

Exposure to radiation at work or to power lines, as well as head injuries, smoking, and
hormone therapy have not been proven to be risk factors.

Studies have found that cell phones, cordless phones, and wireless devices are safe and do
not increase the risk.

SPECIFIC TUMOR TYPES

Brain tumors are classified depending on:

Location of the tumor

Type of tissue involved

Whether they are noncancerous (benign) or cancerous (malignant)

Other factors

Sometimes, tumors that start out less aggressive can change their biologic behavior and become
more aggressive.
Tumors can occur at any age, but many types are most common in a certain age group. In adults,
gliomas and meningiomas are the most common.
Gliomas come from glial cells such as astrocytes, oligodendrocytes, and ependymal cells. Gliomas
are divided into three types:

Astrocytic tumors include astrocytomas (can be noncancerous), anaplastic astrocytomas, and

glioblastomas.

Oligodendroglial tumors. Some primary brain tumors are made up of both astrocytic and
oligodendrocytic tumors. These are called mixed gliomas.

Glioblastomas are the most aggressive type of primary brain tumor.

Meningiomas and schwannomas are two other types of brain tumors. These tumors:

Occur most often between ages 40 and 70.

Are usually noncancerous, but can still cause serious complications and death from their size
or location. Some are cancerous and aggressive.

Other primary brain tumors in adults are rare. These include:

Ependymomas

Craniopharyngiomas

Pituitary tumors

Primary (central nervous system - CNS) lymphoma

Pineal gland tumors

Primary germ cell tumors of the brain

Symptoms
Some tumors do not cause symptoms until they are very large. Other tumors have symptoms that
develop slowly.
Symptoms depend on the tumor's size, location, how far it has spread, and whether there is brain
swelling. The most common symptoms are:

Changes in the person's mental function

Headaches

Seizures (especially in older adults)

Weakness in one part of the body

Headaches caused by brain tumors may:

Be worse when the person wakes up in the morning, and clear up in a few hours

Occur during sleep

Occur with vomiting, confusion, double vision, weakness, or numbness

Get worse with coughing or exercise, or with a change in body position

Other symptoms can include:

Change in alertness (including sleepiness, unconsciousness, and coma)

Changes in hearing, taste, or smell

Changes that affect touch and the ability to feel pain, pressure, different temperatures, or
other stimuli

Confusion or memory loss

Difficulty swallowing

Difficulty writing or reading

Dizziness or abnormal sensation of movement (vertigo)

Eye problems such as eyelid drooping, pupils of different sizes, uncontrollable eye movement,
vision difficulties (including decreased vision, double vision, or total loss of vision)

Hand tremor

Lack of control over the bladder or bowels

Loss of balance or coordination, clumsiness, trouble walking

Muscle weakness in the face, arm, or leg (usually on just one side)

Numbness or tingling on one side of the body

Personality, mood, behavior, or emotional changes

Trouble speaking or understanding others who are speaking

Other symptoms that may occur with a pituitary tumor:

Abnormal nipple discharge

Absent menstruation (periods)

Breast development in men

Enlarged hands, feet

Excessive body hair

Facial changes

Low blood pressure

Obesity

Sensitivity to heat or cold

Exams and Tests

The following tests may confirm the presence of a brain tumor and find its location:

CT scan of the head

EEG

Examination of tissue removed from the tumor during surgery or CT-guided biopsy (may
confirm the type of tumor)

Examination of the cerebral spinal fluid (CSF) (may show cancerous cells)

MRI of the head

Treatment
Treatment can involve surgery, radiation therapy, and chemotherapy. Brain tumors are best treated by
a team that includes:

Neuro-oncologist

Neurosurgeon

Medical oncologist

Radiation oncologist

Other health care providers, such as neurologists and social workers

Early treatment often improves the chance of a good outcome. Treatment depends on the size and
type of tumor and your general health. Goals of treatment may be to cure the tumor, relieve
symptoms, and improve brain function or comfort.
Surgery is often needed for most primary brain tumors. Some tumors may be completely removed.
Those that are deep inside the brain or that enter brain tissue may be debulked instead of removed.
Debulking is a procedure to reduce the tumor's size.
Tumors can be hard to remove completely by surgery alone. This is because the tumor invades
surrounding brain tissue much like roots from a plant spread through soil. When the tumor cannot be
removed, surgery may still help reduce pressure and relieve symptoms.
Radiation therapy is used for certain tumors.
Chemotherapy may be used with surgery or radiation treatment.
Other medicines used to treat primary brain tumors in children may include:

Medicines to reduce brain swelling and pressure

Anticonvulsants to reduce seizures

Pain medicines

Comfort measures, safety measures, physical therapy, and occupational therapy may be needed to
improve quality of life. Counseling, support groups, and similar measures can help people cope with
the disorder.
You may consider enrolling in a clinical trial after talking with your treatment team.
Legal advice may be helpful for creating advance directives such as a power of attorney.

Possible Complications

Brain herniation (often fatal)

Loss of ability to interact or function

Permanent, worsening, and severe loss of brain function

Return of tumor growth

Side effects of medications, including chemotherapy

Side effects of radiation treatments

When to Contact a Medical Professional

Call your health care provider if you develop any new, persistent headaches or other symptoms of a
brain tumor.
Call your provider or go to the emergency room if you start having seizures, or suddenly
develop stupor (reduced alertness), vision changes, or speech changes.

References
1. Dorsey JF, Hollander AB, Alonso-Basanta M, et al. Cancer of the central nervous system. In:
Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed.
Philadelphia, Pa: Elsevier Churchill Livingstone; 2013:chap 66.
2. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology
(NCCN Guidelines): Central nervous system cancers. Version 2.2013. Available at:
http://www.nccn.org/professionals/physician_gls/pdf/cns.pdf. Accessed November 11, 2013.

Metastatic brain tumor

Brain tumor - metastatic (secondary); Cancer - brain tumor (metastatic)
Last reviewed: March 23, 2014.

A metastatic brain tumor is cancer that started in another part of the body and spread to the brain.

Causes
Many tumor or cancer types can spread to the brain. The most common are:

Bladder cancer

Breast cancer

Certain sarcomas

Germ cell tumors

Kidney cancer

Leukemia

Lung cancer

Lymphoma

Melanoma

Some types of cancer rarely spread to the brain, such as colon cancer and prostate cancer. In other
rare cases, a tumor can spread to the brain from an unknown location. This is called cancer of
unknown primary (CUP) origin.
Growing brain tumors can place pressure on nearby parts of the brain. Brain swelling due to these
tumors also causes increasedpressure within the skull.
Brain tumors that spread are classified based on the location of the tumor in the brain, the type
of tissue involved, the original location of the tumor, and other factors. In rare cases, doctors do not
know the original location. This is called cancer of unknown primary (CUP) origin.
Metastatic brain tumors occur in about one-fourth (25%) of all cancers that spread through the body.
They are much more common than primary brain tumors (tumors that start in the brain).

Symptoms
Symptoms may include any of the following:

Decreased coordination, clumsiness, falls

Fever (sometimes)

General ill feeling or lethargy

Headache -- new or more severe than usual

Memory loss, poor judgment, difficulty solving problems

Numbness, tingling, pain, and other changes in sensation

Personality changes

Rapid emotional changes or strange behaviors

Seizures that are new

Speech difficulties

Vision changes -- double vision, decreased vision

Vomiting -- with or without nausea

Weakness of a body area

Specific symptoms vary. The symptoms commonly seen with most types of metastatic brain tumor are
those caused by increased pressure in the brain.

Exams and Tests

A neurologic examination can show brain and nervous system changes based on where the tumor is
in the brain. Signs of increased pressure in the skull are also common. Some tumors may not show
signs until they are very large. Then, they can cause a very quick decline in nervous system function.
The original (primary) tumor may be found by examining tumor tissues from the brain.
Tests may include:

Cerebral angiography

Chest x-ray; mammogram; CT scans of the chest, abdomen, and pelvis to find the original
tumor site

CT scan or MRI of the brain to confirm the diagnosis and identify the tumor location (MRI is
usually more sensitive for finding tumors in the brain)

EEG

Examination of tissue removed from the tumor during surgery or CT scan-guided biopsy to
confirm the type of tumor

Lumbar puncture (spinal tap)

Treatment
Treatment depends on the size and type of the tumor, from where in the body it spread, and the
patient's general health. The goals of treatment may be to relieve symptoms, improve functioning, or
provide comfort.
Radiation to the whole brain is often used to treat tumors that have spread to the brain, especially if
there is more than one tumor.
Surgery may be used when there is a single tumor and the cancer has not spread to other parts of the
body. Some tumors may be completely removed. Tumors that are deep or that extend into
brain tissue may be reduced in size (debulked).
Surgery may reduce pressure and relieve symptoms in cases when the tumor cannot be removed.
Chemotherapy for metastatic brain tumors is usually not as helpful as surgery or radiation. Some
types of tumors, though, do respond to chemotherapy.

Stereotactic radiosurgery may also be used. This form of radiation therapy focuses high-power x-rays
on a small area of the brain.
Medicines for brain tumor symptoms include:

Antacids or antihistamines to control stress ulcers

Anticonvulsants such as phenytoin or levetiracetam to reduce or prevent seizures

Corticosteroids such as dexamethasone to reduce brain swelling

Osmotic diuretics such as urea or mannitol to reduce brain swelling

Pain medicines

When the cancer has spread, treatment may focus on relieving pain and other symptoms. This is
called palliative or supportive care.
Comfort measures, safety measures, physical therapy, occupational therapy, and other treatments
may improve the patient's quality of life. Some people may want to seek legal advice to help them
create an advance directive and power of attorney for health care.

Support Groups
You can ease the stress of illness by joining a cancer support group. Sharing with others who have
common experiences and problems can help you not feel alone.

Outlook (Prognosis)
For many people with metastatic brain tumors, the cancer is not curable. It will eventually spread to
other areas of the body. Prognosis depends on the type of tumor and how it responds to treatment.

Possible Complications

Brain herniation (fatal)

Loss of ability to function or care for self

Loss of ability to interact

Permanent, severe loss of nervous system function that gets worse over time

When to Contact a Medical Professional

Call your health care provider if you develop a persistent headache that is new or different for you.
Call your provider or go to the emergency room if you or someone you know suddenly
develops stupor, vision changes, or speech impairment, or has seizures that are new or different.

References
1. Dorsey JF, Hollander AB, Alonso-Basanta M, et al. Cancer of the central nervous system. In:
Niederhuber JE, Armitage JO, Doroshow JH, et al., eds. Abeloff's Clinical Oncology. 5th ed.
Philadelphia, Pa: Elsevier Churchill Livingstone; 2013:chap 66.
2. National Cancer Institute: PDQ Adult Brain Tumors Treatment. Bethesda, Md: National
Cancer Institute. Date last modified: Feb. 28, 2014. Available at:

http://cancer.gov/cancertopics/pdq/treatment/adultbrain/HealthProfessional. Accessed: March

23, 2014.
3. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology:
Central Nervous System Cancers. Version 1.2014. Available at:
http://www.nccn.org/professionals/physician_gls/pdf/cns.pdf. Accessed: March 23, 2014.