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Brain and spinal cord tumors represent the most common solid tumors seen in children and second most common group of pediatric cancers after the leukemias. Approximately 3000 children will be diagnosed with a brain or spinal tumor in the United States each year. Since the brain is made up of many different types of cells, many different types of brain tumors can occur.Most children who develop a brain tumor have no apparent risk factors for the development of a tumor. There are a small number of children who appear to have specific genetic risks for certain types of brain tumors.
The specific symptoms that a child may have can be quite variable and depend on the location of the brain tumor, how quickly the brain tumor has grown, whether the brain tumor is pushing on normal brain structures, or blocking the flow of spinal fluid from the brain down to the spine.
Some of the symptoms that can occur include:
• Nausea or vomiting
• Neck or back pain
• Problems with eye or face movements
This is only a small listing of the types of symptoms that might be seen
The diagnosis of a brain or spinal cord tumor usually is made when a child presents with symptoms that are concerning for a possible brain tumor. The first step is a good history and physical examination with particular attention to the examination of the nervous system and the visual system. If the history and physical are concerning, your doctor may order a scan of the brain or spine. Often a CAT scan is done first but the best study for making the diagnosis is an MRI of the brain and/or spine.
One a scan is done and it is determined that there is a mass in the brain or spine, the child is usually referred to a center that specializes in the care of children with brain and spinal cord tumors (see section on the Johns Hopkins Pediatric Neuro-Oncology program). In most cases, an operation is required to try and remove the tumor and to determine what type of tumor is growing.
If an operation is required then tumor tissue will be sent to the pathologist who will look at the tumor under the microscope to make a diagnosis. There are many different types of brain tumors but some of the common tumors seen in children include:
Embryonal tumors (sometimes called neuronal tumors or PNETs)
d. Atypical Teratoid/Rhadboid Tumors
a. Pilocytic astrocytomas (the most common brain tumor seen in children)
b. Pilomyxoid astrocytoma (PMA) (More on the Johns Hopkins Pilomyxoid Astrocytoma (PMA) Registry)
c. Fibrillary (infiltrating or diffuse) astrocytomas
i. Low-grade fibrillary astrocytomas
ii. Anaplastic astrocytoma (AA)
iii. Glioblastoma multiforme (GBM)
Choroid plexus tumors
b. Non-germinomatous germ cell tumors (NG-GCT)
Certain tumors that occur commonly in adults (for example meningiomas and central nervous system lymphomas) almost never occur in children.
The other tests that may be required depend on the type of tumor and the location. In some cases, aside from the MRI of the tumor, no further studies may be necessary. In other cases, further imaging studies may be required. In some cases, a spinal tap (also called a lumbar puncture) may be necessary to see if there are tumor cells floating in the spinal fluid. Usually it is unnecessary to get scans of other parts of the body besides the brain and spinal cord.
The approach to the treatment of a brain or spinal cord tumor depends on a number of issues including:
• How much of the tumor was removed at the time of surgery
• What type of tumor
• Whether the tumor has spread elsewhere
• Whether the tumor likes to spread elsewhere
• The age of the child
The three major types of treatment utilized include:
• Radiation therapy
Information about the treatment of any specific tumor is beyond the scope of this summary. What is recommended is that all children with a brain or spinal cord tumor receive treatment at a center that is expert in the management of these tumors in children.
Johns Hopkins experts were the first to identify a class of brain cancers in children called pilomyxoid astrocytoma or PMA. Kenneth J. Cohen, MD, MBA, director of pediatric neuro-oncology, coordinates the Pilomyxoid Astrocytoma (PMA) Registry to gather information to help refine treatments and develop new ones.