Pediatric Brain Tumors: Symptoms, Diagnosis and Treatment

Nothing can really prepare a parent for the diagnosis of a life-threatening illness in a child, but with modern medicine, there is reason to be optimistic. Pediatric brain tumor treatments are now extremely effective and more children are surviving than ever before. The prognosis for children with brain tumors is also much better as compared to adults with the same condition. Moreover, not all brain tumors are malignant or cancerous, with many being benign. However, whether benign or malignant, pediatric brain tumors should be diagnosed and treated swiftly as they can pose a serious risk depending on their size and location in the brain.

What Is A Pediatric Brain Tumor?

A tumor forms when there is a genetic change that causes abnormal growth and division of cells, resulting in a mass of abnormal cells. When this happens in children, affecting the brain cells it results in a brain tumor. This is true with both malignant and benign tumors.

Malignant brain tumors contain fast-growing cells that can rapidly invade surrounding tissue, but they rarely reach other parts of the body. Unfortunately, these types of brain tumors also pose a high risk of recurrence after treatment. Benign tumors, on the other hand, do not contain cancerous cells, do not spread, and are unlikely to recur. Nevertheless, benign tumors may be categorized as malignant if their size and location threatens vital brain functions.

Although brain tumors can affect us at any age, their cellular composition and responsiveness to treatment is different in children, as compared to adults.

Anatomy of the Brain

The brain is divided into three main regions and includes the following:

The Cerebrum

This is the frontal region of the brain and includes the right and left hemispheres. It regulates functions such as temperature sensitivity, touch, vision, hearing, movement, reasoning, emotions, and learning.

The Brainstem

Located towards the base of the brain, this region includes parts of the brain such as the medulla and midbrain. It plays an important role in relaying sensory messages, regulating eye and mouth movement, respiration, cardiac function, involuntary muscle movements, and other sensations or actions such as hunger, sneezing, and vomiting.

The Cerebellum

This is the region of the brain located towards the back of the head. Its main functions are connected to balance and coordination, as well as posture and equilibrium.

Types of Brain Tumors in Children

Pediatric brain tumors usually develop from glial cells that comprise the supportive tissue of the brain. These tumors are known as gliomas and they often develop in the cerebrum, but can also occur in the cerebellum. There are different types of gliomas and these include:

Astrocytoma – These tumors develop from astrocytes, which are a type of glial cell. This is the most common type of pediatric brain tumor.
Brain stem glioma – As the name suggests, this type of glioma develops in the brain stem and is difficult to treat as it usually cannot be removed surgically.
Oligodendroglioma – This type of glioma develops from oligodendrocytes, which are brain cells that produce a protective covering for nerve cells. Although a slow-growing type of brain tumor, it can be hard to remove with pediatric brain surgery as it often grows into brain tissue.
Ependymoma – This is a glioma that usually develops near the cerebellum in children, in the ventricles that hold cerebrospinal fluid (CSF). They can grow to block or restrict CSF flow, resulting in a buildup of pressure in the skull that is called intracranial pressure.
Optic nerve glioma – This type of glioma takes its name from its location, developing in or around the optic nerves that send signals from the eyes to the brain. As a consequence, optic nerve gliomas often affect vision, but they can also affect hormone levels.

Other Pediatric Brain Tumors

Although gliomas are the most common of all pediatric brain tumors, children can also have other types of brain tumors. These include:

Craniopharyngioma: This type of tumor develops near the pituitary gland, which is located at the base of the brain. This is a benign and slow-growing type of tumor, but it can cause symptoms as it presses against the pituitary gland or surrounding nerves.
Embryonal tumors: Located in the cerebellum, these tumors are more common in children as compared to adults. Although fast-growing and known to spread rapidly, treatments against embryonal tumors are highly effective.
Choroid plexus tumor: A rare condition, this type of tumor develops in ventricles of the brain. However, the tumor is benign and can be effectively treated with pediatric brain surgery.
Mixed glial and neuronal tumors: These are uncommon tumors that develop from both glial and nerve cells. In most cases, these tumors are benign.
Schwannoma: This is a rare type of tumor that develops in the myelin-making cells around certain nerves. Although usually benign, if left untreated they can cause nerve damage and muscle control loss.

Pediatric Brain Tumor Symptoms

Not every child experiences the same symptoms of brain tumors because of the great variation in tumor type, size, location, and rate of growth. Moreover, the early warning signs of a brain tumor may be hard to recognize because of their similarity to more mundane conditions. The most common pediatric brain tumor symptoms include:

Headaches that increase in frequency and severity
The feeling of pressure in the head
Uneasiness, nausea, or vomiting
Visual impairment with problems such as double vision

Other pediatric brain tumor symptoms will vary depending on the location and size of the tumor. These could include:

Loss of balance and poor coordination
Sudden onset of seizures
Slurring of speech
Appetite loss & difficulty swallowing
Reduced strength and sensation in any of the limbs
Difficulty with hearing
Irritability, loss of focus, and confusion

Pediatric Brain Tumor Causes

Almost all brain tumors develop as a result of genetic abnormalities that affect cell cycle control. This results in uncontrolled cell growth and the formation of abnormal cell mass or a tumor. Although there is still no identifiable cause for pediatric brain tumors, there are several risk factors that we recognize. These include the presence of genetic conditions such as neurofibromatosis and retinoblastoma. Some genetic changes that lead to tumor development may result from exposure to certain chemicals; past exposure of parents to chemicals such as pesticides and petroleum products may also play a role.

The risk of brain tumors is also higher for children who have undergone radiation therapy for the head to treat a previous malignancy.

Pediatric Brain Tumor Diagnosis and Tests

In case your child displays symptoms of a brain tumor, you should seek a thorough evaluation from your pediatrician or a pediatric neurologist. These specialists will perform a thorough physical examination and will study your child’s medical history before making any decision. If their evaluation confirms any suspicion of a brain tumor, diagnostic tests that can be recommended include:

Neurological exams – This is used to test physical reflexes and muscle strength, eye-mouth movement, coordination, and alertness. Findings can provide insights into the region of the brain affected by a tumor.
Imaging tests: Imaging tests can include X-rays, computed tomography scans or CT scans, and magnetic resonance imaging or MRIs. These imaging tools can help to pinpoint the brain tumor location and reveal its size, with CT scans and MRIs providing particularly detailed images. In some cases, other imaging tests such as angiograms, myelograms, and positron emission tomography or PET may also be used.
Biopsy: A lumbar puncture or stereotactic needle biopsy may be used to extract and examine a tissue sample, depending on the location of the brain tumor. This procedure is performed by a pediatric neurosurgeon and the findings can help identify the type of tumor and its aggressiveness. The tissue can also be tested for genetic mutations, which will allow for targeted drug therapy.
Doctors may also recommend further testing if they suspect that the brain tumor is a result of cancer that originated elsewhere in the body.

Treatment for Pediatric Brain Tumors

Brain tumor treatment options and outlook can vary significantly depending on the type of tumor and its location. The main approaches to pediatric brain tumor treatment involve surgical removal of the tumor.

Pediatric Brain Surgery

Surgery is typically the first step in pediatric brain tumor treatment, whether dealing with infants or children. Neurosurgeons will perform pediatric brain surgery to remove the tumor as safely as possible while preserving neurological function. Pediatric brain surgery is critical as it is the only way to relieve intracranial pressure, which is the main cause of most pediatric brain tumor symptoms. If a tumor is not removed, intracranial pressure can increase to cause brain herniation. Brain tumor surgery Treatment and cost in the United Arab Emirates can vary depending on the individual case, the skill and experience of neurosurgeons and other specialists involved, and the facilities at the operation theater. The benefits of treatment far outweigh the risks or costs, however, as pediatric brain surgery is often the only required intervention when dealing with low-grade or slow-growing tumors.

Follow-up Care After Surgery

Post-operative treatments and recovery timelines will vary again depending on various factors such as the stage of diagnosis and type of tumor. In cases where a brain tumor is diagnosed early, children tend to respond well to treatment and recover from surgery faster. In some cases, children may experience neurological deficits, such as reduced muscle strength, but these effects are temporary and resolve soon after surgery. In cases where the brain tumor was diagnosed at a later stage, after there is significant and lasting damage to the brain, recovery from neurological deficits can take much longer. Rehabilitative treatments after Pediatric Brain Tumor Surgery such as physical therapy and speech therapy also play an important role in recovery and can help reduce recovery time.

Radiation Therapy

High-energy radiation beams are directed at the tumor tissue and some amount of surrounding tissue to destroy tumor cells. The therapy may be administered with a machine, but in rare cases could involve brachytherapy, a procedure in which the radiation source is placed inside the body in close proximity to the brain tumor. Although radiation is usually targeted only at the tumor site, doctors may need to use whole-brain radiation if the brain tumor is a result of cancer that has spread from another part of the body.

Doctors will only recommend radiation therapy if necessary, as infants and toddlers still have growing brains.

Chemotherapy

Chemotherapy involves the use of drugs to kill tumor cells but is used mainly for aggressive and high-grade brain tumors. Although chemotherapy can be administered orally, treatment is usually administered intravenously when dealing with pediatric brain tumors. Like radiation therapy, chemotherapy is used sparingly because of side effects such as nausea, vomiting, hair loss, and reduced blood cell production.

The Takeaway

As is the case with any major illness, early diagnosis, swift treatment, and intensive therapy are critical for the best prognosis. When dealing with pediatric brain tumors, consistent post-operative follow-up is essential to monitor neurological function and to also protect against the risk of tumor recurrence.

Pediatric Brain Tumor FAQs

Are pediatric brain tumors curable?

Although various factors such as the age of the child, type of tumor, tumor location, and responsiveness to treatment affect outcomes, most children respond well to treatment and pediatric brain tumors can be cured.

Is pediatric brain surgery really necessary for brain tumor treatment?

In most cases, brain surgery is the best treatment option for pediatric brain tumors as it is used to remove the tumor. Without the procedure, intracranial pressure would increase with growth of the tumor and this could result in life-threatening complications.

What is the risk of radiation therapy for pediatric brain tumors?

Radiation therapy is only recommended if absolutely necessary and if the risks outweigh the benefits. Radiation therapy is generally avoided if the child is under 3 years of age as it poses a risk of developmental retardation.

What is the most common brain tumor in children?

Pilocytic astrocytoma, which is a type of glioma, is the most common pediatric brain tumor. This is a slow-growing tumor that usually develops in the cerebellum. In most cases, surgical removal is the only treatment that is needed.

What are the survival rates for pediatric brain tumors?

With proper treatment, brain tumor survival rates in children are quite high, especially when diagnosed early. The 5-year survival rate for the most common type of pediatric brain tumor - pilocytic astrocytoma is about 95%.

Your AsterDM Team

At AsterDM Healthcare, our pediatric brain tumor surgery team is comprised of leading specialists who collaborate to provide comprehensive and individualized treatment plans for children. As part of our comprehensive pediatric care center, our specialists in pediatric neuro-oncology lead the charge in treating brain tumors, while working closely with other specialists such as pediatric neurology, neurosurgery, neuroradiology, endocrinology, neuropathology, radiation oncology, oncology, psychology, and rehabilitation to deliver the best possible outcome for your child.