Brain Tumors in Children

Pediatric brain tumors are the second most common tumors in this age group (after leukemia) and the most common cause of mortality and morbidity.

Children with central nervous system (CNS) tumors usually have a longer time between the onset of symptoms and diagnosis as compared to other types of tumors. The reasons for delayed diagnosis are multifactorial, but the major contributing factors seem to be the non-specificity of presenting signs/symptoms and the lack of awareness about CNS tumors among the healthcare providers.

What are the symptoms of CNS tumors?

The signs and symptoms attributed to CNS tumors vary according to the age of the child. Younger children may have persistent /recurrent vomiting, walking or balance problems, abnormal eye movements/visual loss, behavioral changes - particularly lethargy, head tilt, increasing head circumference, and convulsions - or altered level of consciousness. Older children may have, in addition to the above, recurrent or persistent headaches, blurry or double vision, back pain/curved back, delayed or arrested puberty, and polyuria or polydipsia.

A proper clinical assessment with a detailed history and physical examination by the healthcare provider can determine if a CNS imaging such as a CT and/or an MRI scan is required.

How are CNS tumors treated?

Treatment of a CNS tumor depends on: the patient’s clinical status, tumor location, the radiological tumor characteristics, the presence or absence of metastasis, and the histological diagnosis (if a tumor biopsy is performed). Treatment may include surgical resection, chemotherapy, radiotherapy or any combination of these modalities based on the tumor diagnosis. In some occasions, new medications targeted to specific tumor mutations may be used. In all cases, the treatment plan needs to be discussed among a multidisciplinary team consisting, at minimum, of a pediatric oncologist, neurosurgeon, radiologist, radiation oncologist and a pathologist, preferably before the surgical intervention (in non-urgent cases) and definitely after surgery due to the expected long-term morbidities associated with the diagnosis of a CNS tumor.

The prognosis for children with CNS tumors depends mainly on the histological diagnosis and the tumor location which may determine the extent of the surgical resection. Unfortunately, compared to leukemia, there have been no major improvements in the outcomes for pediatric patients with CNS tumors for several decades. The overall prognosis is in the range of 60-70%, but some types of tumors have a dismal prognosis of <20%. Survivors of CNS tumors may have long term morbidities related to the tumor or its treatment. These may include physical morbidities, neurocognitive deficits, endocrine deficits, visual loss, or hearing deficits. These challenges often negatively affect the child’s academic performance and his/her social integration in the community. For these reasons, multidisciplinary team discussions are important to help minimize and treat these morbidities.