Brain Tumors in Children: Causes, Symptoms, Diagnosis, and Treatment of Brain Tumors in Children, as well as Pediatric Cancer Research

Doctors refer to all benign and malignant growths that develop in the central nervous system (CNS) as brain tumors. The CNS consists of the brain and spinal cord. Accordingly, a brain tumor can occur in the brain or in the structures of the spinal cord and the surrounding meninges. While brain tumors are relatively rare in adults, they rank second in terms of frequency among children.

The most common brain tumors in children are astrocytomas. An astrocytoma develops from astrocytes—star-shaped cells that support nerve cells in their function.

An astrocytoma can be benign or malignant. Malignant medulloblastomas are less common in children. These fast-growing brain tumors originate in the cerebellum and account for about 20 percent of all brain and spinal cord tumors in children.

Ependymomas are among the slow-growing brain tumors. These tumors are often found in the posterior fossa.

The exact causes are still unknown, as no triggering factor is present in most patients. Genetic risk factors or radiation to the nervous system (in cases of acute leukemia) are among the risk factors.

Symptoms depend on the type of tumor, its location, and its size. The primary symptom is a headache with no apparent cause. Children also experience nausea and vomiting.

They appear apathetic and experience a decline in performance. A brain tumor may also manifest as changes in vision. For example, children may see double or experience blurred vision. Restricted visual fields and complete loss of vision are also possible symptoms of a brain tumor in children.

Other symptoms include:

• coordination problems
• Balance problems
• Gait disturbances
• Irritability
• Changes in behavior and personality

• Magnetic Resonance Imaging (MRI)

If a brain tumor is suspected in a child, magnetic resonance imaging (MRI) is the diagnostic method of choice. Using an MRI machine, the doctor can obtain very precise images, even of hard-to-reach areas such as the posterior fossa. Doctors also rely on an MRI when a CT scan does not reveal any abnormalities despite the presence of symptoms.

• Computed Tomography (CT)

A computed tomography (CT) scan can also be used to make a diagnosis. However, it is significantly less specific.

• Electroencephalogram (EEG)

In some cases, the doctor also uses an electroencephalogram (EEG) to make a diagnosis. With the help of an EEG, the treating physician can visualize the brain’s electrical activity. This allows for a rough localization of the tumor.

• Cerebrospinal Fluid (CSF) Analysis

A cerebrospinal fluid (CSF) analysis can provide further clues. To perform this test, the doctor draws a sample of cerebrospinal fluid from the child’s spinal canal. If the spinal cord or the meninges are affected by cancer, tumor cells will be found in the cerebrospinal fluid.

Various treatment methods are available for young cancer patients: surgery, radiation therapy, and chemotherapy.

The choice of treatment depends primarily on the patient’s age, overall health, and the type and size of the tumor. As a rule, several treatment methods are combined.

If possible, the first step is surgical removal of the tumor. In the second step, the children receive concurrent chemotherapy and radiation therapy. 

However, surgery is not always possible: for example, doctors can operate on tumors in the brainstem only in rare cases. The same applies to tumors located in the diencephalon or midbrain. In these cases, palliative care—aimed at alleviating the symptoms of cancer patients—is often the only option. Since the development of the central nervous system’s tissues is not yet fully complete in children under the age of 5, doctors refrain from using radiation therapy to protect them from long-term effects.

Supportive Treatment Methods

Many children with brain tumors have elevated intracranial pressure. This is also the main cause of the headaches that many patients experience. To prevent damage to brain tissue caused by the high pressure, the doctor may prescribe medications such as corticosteroids. These help reduce pressure in the brain. After brain surgery, patients are also often fitted with a catheter system or a shunt to reduce the pressure.

Depending on their location, brain tumors in children can cause neurological symptoms such as epileptic seizures or speech disorders. In such cases, medical professionals often aim to provide interdisciplinary care. For example, children may receive physical therapy for paralysis or see a speech-language pathologist for speech therapy.

If a brain tumor is suspected, those affected should see a specialist as soon as possible.

Pediatric oncologists specialize in the diagnosis and treatment of cancer in children. Pediatric oncology is a subspecialty within medicine and pediatrics. The technical term for this medical specialty is pediatric oncology. After completing medical school, a pediatric oncologist undergoes five years of training as a pediatrician. This is followed by further training in the field of oncology and hematology.

Neuroradiology also deals with the diagnosis and treatment of cancers of the central nervous system. The field of neuroradiology combines radiological imaging with neurology and neurosurgery. After completing medical school, a neuroradiologist has undergone further training to become a specialist in radiology.

The chances of a cure for brain tumors in children and adolescents depend on the type, size, and location of the tumor.

If, for example, the doctor is able to completely remove a benign astrocytoma, this is considered a cure. The prognosis in such cases is very good.

Malignant astrocytomas have a rather poor prognosis even with early treatment. The 10-year survival rate for children and adolescents is around 70 percent. This means that 10 years after diagnosis, 70 percent of patients are still alive.

Even when the brain tumor is completely removed, some damage may remain.

These include, among other things:

• Bladder control problems
• Emotional and psychological problems
• Hormonal imbalances
• Attention, concentration, and memory problems
• Behavioral problems
• Sleep disorders

In the first few years following completion of cancer treatment, follow-up consultations and examinations should be conducted at regular intervals with the treating physicians. For example, children may receive physical therapy, speech therapy, or occupational therapy to alleviate symptoms. Continued close monitoring is advisable to detect any relapses at an early stage.

Brain tumors in children are among the most common tumors of the central nervous system and pose a particular challenge for medicine and cancer research. The treatment of brain tumors in children has improved significantly in recent years, so that the chances of recovery for many affected children and adolescents are higher today than in the past. The German Cancer Research Center, in collaboration with international projects, is helping to better understand the causes of brain tumors and develop new therapies for children.

If a brain tumor in children or a pediatric brain tumor is detected early, a diagnosis of brain tumor can be made quickly and the most appropriate treatment can be initiated. The symptoms of brain tumors and the symptoms of brain tumors in children often depend on the type of tumor. Among the most common brain tumors in children are various types such as gliomas, medulloblastomas, and ependymomas. Childhood brain tumors can affect not only the brain and spinal cord but also other parts of the central nervous system.

Today, the treatment of children with brain tumors—including pediatric brain tumors—is conducted in an interdisciplinary manner. Treatment is typically managed by pediatric hematology and oncology specialists, pediatric oncologists and hematologists, as well as specialists in pediatric neurosurgery and pediatric oncology. This center specializes in pediatric neurosurgery, enabling optimal care for young patients. The interdisciplinary treatment of pediatric brain tumors is carried out in close coordination among all specialties, with treatment tailored to the individual needs of each child.

Children and adolescents with brain tumors benefit from modern imaging techniques that precisely visualize tumors in the brain and spinal cord. For children, the type of tumor is taken into account, as well as whether brain tumors can be classified, for example, as Grade 1. If a brain tumor is suspected, patients undergo a comprehensive examination. The treatment of children takes into account all aspects of tumor therapy, with the goal of providing the best possible care for young patients.