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. Together, the brain and spinal cord make up the central nervous system (CNS).
The tumors may be benign (not cancer) or malignant (cancer). Benign brain tumors grow and press on nearby areas of the brain. They rarely spread into other tissues. Malignant brain tumors are likely to grow quickly and spread into other brain tissue. When a tumor grows into or presses on an area of the brain, it may stop that part of the brain from working the way it should. Both benign and malignant brain tumors can cause symptoms and need treatment.
The brain controls many important body functions.
The brain has three major parts:
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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 low-grade or high-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 summary on Childhood Astrocytomas Treatment for more information.)
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 Tumors
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:
(See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.)
Central Nervous System Germ Cell Tumors
Childhood CNS germ cell tumors form in germ cells, which are cells that develop into sperm or ova (eggs). Germ cell tumors can be either benign or malignant. There are different types of childhood germ cell tumors:
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.
Central Nervous System Primitive Neuroectodermal Tumors
Childhood CNS primitive neuroectodermal tumors (PNETs) form in immature cells in the cerebrum. (See the PDQ treatment summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.)
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. (See the PDQ summary on Childhood Craniopharyngioma Treatment for more information.)
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.)
Ependymoblastoma
Ependymoblastomas are fast-growing, malignant tumors formed by cells that line the fluid-filled spaces in the brain and spinal cord. These are rare tumors that are most common in infants and young children. (See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.)
Malignant Glioma
Malignant gliomas are cancers of the brain that begins in glial cells (cells that surround and support nerve cells). Astrocytomas, oligodendrogliomas, and ependymomas are types of malignant gliomas. (See the PDQ summary on Childhood Astrocytomas 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.)
Medulloepithelioma
Medulloepitheliomas form in tissue made up of sensory cells that line tubelike spaces in the brain and spinal cord. These are rare tumors that are most common in infants and young children. They are usually malignant. (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. See the following PDQ summaries for more information:
Tumors of the Pineal Region
Pineal region tumors form in or near the pineal gland. The pineal gland is a tiny organ in the center of the brain. The gland makes melatonin, a substance that helps control our sleep cycle. (See the PDQ treatment summary on Childhood Central Nervous System Embryonal Tumors 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:
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:
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:
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:
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 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:
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There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
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.
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.
There are different types of treatment for children with brain and spinal cord tumors.
Different types of treatment are available for children with brain and spinal cord tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be considered. Clinical trials are taking place in many parts of the country. Some clinical trials are open only to patients who have not started treatment.
Children with brain or spinal cord tumors should have their treatment planned by a team of health care providers who are experts in treating childhood brain and spinal cord tumors.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other health care providers who are experts in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:
Childhood brain and spinal cord tumors may cause symptoms that begin before diagnosis and continue for months or years.
Childhood brain and spinal cord tumors may cause symptoms that continue for months or years. Symptoms caused by the tumor may begin before diagnosis. Symptoms caused by treatment may begin during or right after treatment.
Some cancer treatments cause side effects months or years after treatment has ended.
These are called late effects. Late effects of cancer treatment may include the following:
Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information).
Three types of standard treatment are used:
Surgery
Surgery may be used to diagnose and treat childhood brain and spinal cord tumors as discussed in the General Information section of this summary.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly in the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Anticancer drugs given by mouth or vein to treat brain and spinal cord tumors cannot cross the blood-brain barrier and enter the fluid that surrounds the brain and spinal cord. Instead, an anticancer drug is injected into the fluid-filled space to kill cancer cells there. This is called intrathecal chemotherapy.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
See the PDQ summary on Childhood Astrocytomas Treatment for more information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood astrocytoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Brain Stem Glioma Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood brain stem glioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood embryonal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Treatment of childhood central nervous system germ cell tumors may include:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood central nervous system germ cell tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ treatment summary on Childhood Central Nervous System Embryonal Tumors Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood supratentorial primitive neuroectodermal tumor. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Craniopharyngioma Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood craniopharyngioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Ependymoma Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with newly diagnosed childhood ependymoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood ependymoblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Astrocytomas Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood cerebral astrocytoma/malignant glioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with untreated childhood medulloblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood medulloepithelioma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Treatment of childhood spinal cord tumors depends on where the tumor forms in the spinal cord and what the cells look like under a microscope. See the following PDQ summaries for more information:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood spinal cord neoplasm. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
See the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for information.
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with childhood pineal parenchymal tumor and childhood pineoblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
For more information from the National Cancer Institute about childhood brain and spinal cord tumors, see the following:
For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:
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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.
Editorial changes were made to this summary.
Last Modified: 2011-03-10