Brain tumor - children

UF Health Shands Children's Hospital ranked one of the nation's and region's top hospitals for
neurology & neurosurgery by U.S. News & World Report. 

 

USNWR recognized UF Health Children's Hospital as one of the best hospitals in Florida.


University of Florida Shands Children’s Hospital and its pediatric tumor program are ranked by U.S. News and World Report among the nation’s best. This recognition, combined with an overall mission to care for and support our patients and families, leads to advanced treatment with a personalized touch from our pediatric neuro-oncology team.

Our interdisciplinary clinical team includes pediatric experts from numerous departments throughout UF Health.  These include: neuro-oncology, neurosurgery, radiation oncology, neurology, neuroradiology, neuropathology, bone marrow transplant, anesthesiology, and neuropsychology.  The care of children at University of Florida Shands Children’s Hospital is aided greatly by the full range of pediatric services, including nursing, physical therapy, occupational therapy, speech therapy, social work, and child life.  The new UF Health Neuromedicine tower provides a welcoming clinic space for outpatient visits as well as intraoperative MRI.

The highly trained physicians and scientists at the Preston A. Wells Jr. Center for Brain Tumor Therapy take a patient-centered approach to care.  Because no two individuals respond in the same way to any treatment, the multidisciplinary team of specialists provides highly individualized diagnostics and treatment plans.  The ultimate goal is to provide the optimal patient experience.

Our team is experienced in formulating effective treatments for all types of brain tumors, including:

  • Institutional and multi-institutional clinical trials
  • First-in-human immunotherapy treatments for recurrent pediatric malignant tumors
  • Minimally invasive computer-guided biopsies or tumor removals
  • Advanced radiation oncology techniques, including intensity, modulated conformal therapy and proton beam therapy
  • Conventional and investigational chemotherapy/biological therapy options
  • Laser interstitial thermal therapy for brain tumors and lesions

Understanding treatment options

Every child and his or her family members will meet with a brain tumor specialist, usually at the neurosurgery outpatient practice. After a detailed discussion of the options and risks, treatment will be scheduled. If a surgical or radio-surgical procedure is needed, it will be performed at the patient's convenience within one week.

The case will be presented to our weekly brain tumor board when members of the clinical team will gather to review the case in detail and formulate the most personalized treatment plan for additional therapy.

Currently, there are several ongoing clinical trials for pediatric brain and spine tumors at UF. In addition, we are the only Southeast US member of the Pacific Pediatric Neuro-Oncology Consortium (PNOC). This network of 18 children's hospitals is dedicated to translating the latest findings in cancer biology and personalized medicine into better treatment for children with brain and spine tumors.

Leading the way in national brain tumor research

The Preston A. Wells Jr. Center for Brain Tumor Therapy is home to some of the most advanced neuro-oncology research in the world. The Lillian S. Wells Department of Neurosurgery at the University of Florida is one of the top-funded neurosurgery departments in the United States. Supported by the National Institutes of Health and other grant sources, the department is a destination for some of the top researchers in the area of neuro-oncology. The brain tumor research teams at the center include more than 20 scientists who are focused on finding a cure for brain cancer.

Florida Center for Brain Tumor Research

Since 2006, experts within the Florida Center for Brain Tumor Research, or FCBTR, at the Evelyn F. and William L. McKnight Brain Institute at UF have worked with hospitals statewide to collect tissue and disseminate data on brain tumors, creating a powerful tool to facilitate clinical trials, funding opportunities, and research collaborations.

FCBTR is a collaborative effort, sponsored by the state of Florida, and its Scientific Advisory Council includes top researchers from H. Lee Moffitt Cancer Center and Research Institute, Mayo Clinic, Cleveland Clinic Florida, Scripps Research Institute, Orlando Health UF Health Cancer Center - Orlando Health, University of Miami and a representative of neurosurgeons in private practice. FCBTR has sponsored annual statewide brain tumor biomedical technology summits to encourage collaboration.

Definition

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

This article focuses on primary brain tumors in children.

Alternative Names

Glioblastoma multiforme - children; Ependymoma - children; Glioma - children; Astrocytoma - children; Medulloblastoma - children; Neuroglioma - children; Oligodendroglioma - children; Meningioma - children; Cancer - brain tumor (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 to 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 (noncancerous) 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:

Older children with brain tumors may have the following physical signs or symptoms:

  • Headache
  • Vomiting
  • Vision changes
  • Change how the child walks (gait)
  • Weakness of a specific body part
  • Head tilt

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

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 or radiation therapy may also be necessary.
  • Brainstem gliomas: Surgery may not be possible because of the tumor's location deep in the brain. Radiation is used to shrink the tumor and prolong life. Sometimes targeted chemotherapy can be used.
  • 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 children with primary brain tumors include:

  • Corticosteroids to reduce brain swelling
  • Diuretics (water pills) to reduce brain swelling and pressure
  • Anticonvulsants to reduce or prevent seizures
  • Pain medicines
  • Chemotherapy to help shrink the tumor or prevent the tumor from growing back

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 feel less alone.

Outlook (Prognosis)

How well a child does depends on many things, including the type of tumor. In general, about 3 out 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, focus, 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 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

Images

Brain
Primary brain tumor

References

Ater JL, Kuttesch JF. Brain tumors in childhood. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 497.

Kieran MW, Chi SN, Manley PE, et al. Tumors of the brain and spinal cord. In: Orkin SH, Fisher DE, Ginsburg D, Look AT, Lux SE, Nathan DG, eds. Nathan and Oski's Hematology and Oncology of Infancy and Childhood. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 57.

National Cancer Institute website. PDQ Childhood Brain and Spinal Cord Tumors Treatment Overview. www.cancer.gov/cancertopics/pdq/treatment/childbrain/healthprofessional. Updated February 8, 2017. Accessed August 28, 2017.

Review Date: 
7/29/2017
Reviewed By: 
Adam S. Levy, MD, Division of Pediatric Hematology/Oncology, The Children's Hospital at Montefiore, Bronx, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Related Health Topics

Aftercare and more