Brain Tumors

Few things are more frightening than finding out your child has a brain tumor. Yet it's a fear many parents have had to face. Brain tumors are now the second most common group of childhood cancers, after leukemia, affecting approximately 2,300 children each year.

Some can be cured relatively easily; others have a poorer outlook. All require a very specialized treatment plan involving a team of medical specialists, and all are likely to take a tremendous physical and emotional toll on the kids and their families.

What Is a Brain Tumor?

A tumor is any mass caused by abnormal or uncontrolled growth of cells. Tumors in the brain are categorized according to several factors, including where they're located, the type of cells involved, and how quickly they're growing.

Medical terms doctors may use to describe brain tumors include:

• Primary vs. secondary: Primary brain tumors originate in the brain. Secondary brain tumors are made up of cells that have spread (metastasized) to the brain from somewhere else in the body. In children, most brain tumors are primary. The opposite is true in adults.
• Benign vs. malignant: Benign tumors are slow-growing, noncancerous, and do not spread to surrounding tissue. Malignant tumors, on the other hand, are cancerous. Fast-growing and aggressive, they can invade nearby tissue and also are more likely to recur after treatment. Though malignancies are generally associated with a worse outlook, in the brain, benign tumors can be just as serious, especially if they're in a critical location (such as the brain stem, which controls breathing) or grow large enough to press on vital brain structures.
• Localized vs. invasive: A localized tumor is confined to one area and is generally easier to remove, as long as it's in an accessible part of the brain. An invasive tumor has spread to surrounding areas and is more difficult to remove completely.
• Grade: The grade of a tumor indicates how aggressive it is. Today, most medical experts use a system designed by the World Health Organization (WHO) to identify brain tumors and help make a prognosis. The lower the grade, the less aggressive the tumor and the greater the chance for a cure. The higher the grade, the more aggressive the tumor and the harder it may be to cure.

What Causes a Brain Tumor?

Most brain tumors in children originate when a normal cell begins to grow abnormally and reproduce too rapidly. Eventually these cells develop into a mass called a tumor. The exact cause of this abnormal growth is unknown, though research continues on possible genetic and environmental causes.

Some kids are more susceptible to developing brain tumors due to certain genetic conditions. Diseases such as neurofibromatosis, von Hippel-Lindau disease, Li-Fraumeni syndrome, and retinoblastoma are all associated with a higher risk of brain tumors.

Signs and Symptoms

A brain tumor can cause symptoms in a number of ways: by directly destroying brain cells, by causing swelling at the tumor site, by causing a buildup of fluid in the brain (hydrocephalus), and by increasing pressure within the skull. A range of symptoms can develop as a result.

Signs or symptoms vary depending on a child's age and the location of the tumor, but may include:

• seizures
• weakness of the face, trunk, arms, or legs
• slurred speech
• difficulty standing or walking
• poor coordination
• headache
• in babies, a rapidly enlarging head

Because early warning signs can be gradual and may mimic those of other common childhood conditions, brain tumors can be difficult to diagnose. So it's always wise to discuss any symptoms that concern you with your child's doctor.

Diagnosis

A doctor who suspects that a child has a brain tumor will order imaging studies of the brain: a CT scan or MRI, possibly both. These procedures let doctors see inside the brain and pinpoint the area of the tumor. Although both are painless, they do require children to be very still. Kids usually don't require sedation for CT scans, which can be done fairly quickly. Most, however, do need to be sedated for an MRI scan.

If imaging studies reveal a brain tumor, then surgery is likely to be the next step. A pediatric neurosurgeon will try to remove the tumor; if complete removal is not possible, then partial removal — or at least a biopsy (removal of a sample for microscopic examination) — may be done to confirm the diagnosis.

A pediatric pathologist (a doctor who helps diagnose diseases in children by looking at body tissues and cells under a microscope) and a neuropathologist (a pathologist who specializes in diseases of the nervous system) then review the tissue to classify and grade the tumor.