Types of tumors
Brain stem tumors
- 10– 20% of tumors
- The most vicious and malignant tumors in childhood
- 80% of these tumors are malignant astrocytomas (glioblastoma) and grow
rapidly, particularly those occurring in the part of the brain known as the
pons
Symptoms
- One eye turning inward, facial droop, difficulty to swallow
- Weakness of extremities
- Ataxia (poor muscular coodination)
- One-third of patients have hydrocephalus
Unfortunately, a great majority of tumors in the pons
(mid-portion of the brain stem) are not surgically resectable. Total resection
may be attempted in those occurring in other parts of the brain stem.
Treatment
- Radiation and chemotherapy together for pontine tumor, but prognosis
is extremely poor (two-year survival: 8%)
- Mid-brain or medulla oblongata tumors may be resected without further
therapy
Cerebellar astrocytomas
- One of the most benign and favorable tumors among pediatric brain tumors
- Hydrocephalus in 90%
Possible symptoms
- Morning headaches
- Nausea
- Progressive unsteadiness of gait, (if patient has hydrocephalus)
- Head tilt and pain in the back of the head (if patient does not have
hydrocephalus)
Treatment
- Surgical resection. Once tumor is completely removed, approximately 95%
of patients are cured without further treatment
Cerebral PNET / glioblastoma
- One of the most primitive and malignant tumors among CNS tumors in
pediatrics
- Tumors tend to be large and have many blood vessels
Symptoms
- Morning headaches
- Nausea
- Progressive unsteadiness of gait
- Seizures
- Visual disturbances
Treatment
- Attempt resection, then radiation and chemotherapy—even if total
resection
- Radiation may be required to the spine because of the tumor's tendency to
spread
Choroid plexus papilloma
- Usually benign
- 4% of brain tumors
- Formed within the ventricle
- two-thirds of patients are under two years of age
Symptoms
- Headaches and emesis
- Lethargy (related to hydrocephalus)
Treatment
- Surgical resection
- Seizures or hydrocephalus may be a problem post-operatively
Craniopharyngioma
- 5–13 % of tumors
- Arises in embryonically misplaced cells in the base of the brain
- A large number are surgically resectable, however, endocrine function is
often disturbed post-operatively
The most common endocrine problems are lack of growth hormone production,
adrenocordicoidal hormone, sex and thyroid hormone, and diabetes insipidus (too
much urine output and extreme thirst).
Symptoms
- Visual disturbance
- Possible hydrocephalus
Treatment
- Surgical resection
- Possible radiation to any residual tumor
- Frequent endocrine abnormalities following radical tumor resection,
needing hormone replacement therapy
Ependymomas
- 10% of brain tumors
- May invade the brainstem
- Histologically benign, but behaves malignant
- Recurrence rates are much higher than even medulloblastomas
- Hydrocephalus in 85%
Symptoms
- Morning headaches
- Nausea
- Progressive unsteadiness of gait
Treatment
- Surgical resection followed by radiation if only a partial resection was
possible
- If totally resected, no further therapy with close surveillance MRIs
- Extent of surgical resection is the major factor for outcome
- Recurrent tumor is difficult to treat: treatment is resection followed by
chemotherapy
- Currently, the five-year survival rate is as low as 40% for posterior
fossa ependymoma tumors
Hypothalamic Tumors
- Most are benign astrocytomas and are slow growing.
Symptoms
- Endocrine problems such as precocious puberty and diencephalon syndrome
(loss of weight, poor subcutaneous fat development despite good appetite and
increasing height).
Treatment
- Surgical removal of part of the tumor is possible but not a total
resection. First choice is chemotherapy, then radiation if no response to
chemotherapy.
Medulloblastomas
- 15–20% of tumors
- Often presents in the cerebellum and fourth ventricle—resulting in
hydrocephalus
- Is malignant and grows rapidly
- Tends to spread through CSF circulation
Although malignant, this is a pediatric brain tumor in
which marked improvement of survival and quality of life have
been observed. Decades ago the five year survival rate
was approximately 20%. The five-year survival rate now is 70–80%.
Survival is influenced by multiple factors. Other than medical and biological
factors, the institution (a university-affiliated hospital like Children's
Memorial Hospital vs. a community hospital) may make a large difference in
patient's prognosis.
Symptoms
- Morning headaches
- Nausea
- Progressive unsteadiness of gait
Treatment
- Surgical removal followed by radiation and chemotherapy.
Optic chiasm and hypothalamic gliomas
- A majority of these tumors are benign astrocytomas and are slow growing
30% of optic gliomas are associated with neurofibromatosis
- More aggressive if they occur during the first two years of life
Symptoms
- Visual acuity changes
- Nystagmus (involuntary rapid and rhythmic movement of the eyeball)
- Failure to thrive
- Hydrocephalus
Treatment
- Because they are unresectable, the first choice of treatment is
chemotherapy. Radiation is used if tumor progresses. Surgical resection is
rarely recommended.
Pineal Region Tumor
- Malignant in 80% of cases
- 3–8% of tumors
- Almost invariably present with hydrocephalus
- Tumors may secrete specific tumor markers, named Beta HCG Alpha
fetoprotein
Treatment
- Some tumors may be resected, but it is difficult
- Surgery/radiation/chemotherapy are needed for most malignant pineal tumors
- Malignant germ cell tumors respond to chemotherapy so that treatments
usually start with chemotherapy
Thalamic Tumor
- Most are benign astrocytomas, though some are malignant
- 80% of patients have hydrocephalus
- May be resectable, but motor weakness and speech difficulty may occur
Symptoms
- Hand tremors
- Weakness of extremities
- Headaches and nausea (related to hydrocephalus)
Treatment
- Surgical resection for benign tumor
- Radiation if unresectable
- Radiation and chemotherapy if tumor is malignant