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Central Nervous System Tumors - Childhood - Overview

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Childhood Central Nervous System Tumor. To see other pages, use the menu on the side of your screen. Think of that menu as a roadmap to this full guide.  

A central nervous system (CNS) tumor begins when normal cells in the brain or the spinal cord change and grow uncontrollably, forming a mass. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can spread to other parts of the body. A benign tumor means the tumor will not spread.

A CNS tumor is especially problematic because a person’s thought processes and movements can be affected. This type of tumor also may be challenging to treat because the tissues surrounding the tumor may be vital to the body’s functioning.

The brain is the center of thought, memory, and emotion. It controls the five senses, which include smell, touch, taste, hearing, and sight. It also controls movement and other basic functions of the body, including heartbeat, circulation, and breathing. The spinal cord consists of nerves that carry information back and forth between the body and the brain.

Anatomy of the brain

The brain is made up of four major parts: the cerebrum, cerebellum, brain stem, and meninges.

The cerebrum, the largest part of the brain, contains two cerebral hemispheres and is divided into four lobes where specific functions occur.

  • The frontal lobe controls reasoning, emotions, problem solving, and parts of speech and movement
  • The parietal lobe controls the sensations of touch, pressure, pain, and temperature
  • The temporal lobe controls memory and the sense of hearing
  • The occipital lobe controls vision

The cerebellum, or "little brain," is located underneath the cerebrum. The cerebellum controls coordination and balance.

The brain stem, which is the lowest portion of the brain and connects to the spinal cord, controls involuntary functions essential for life, such as a person’s heartbeat and breathing.

The meninges are the membranes that surround and protect the brain and spinal cord. There are three meningeal layers, called the dura mater, arachnoid, and pia arachnoid.

Types of CNS tumors

There are many different types of CNS tumors. Some are cancerous and very likely to grow and spread. These are often called very aggressive or high grade. Other types are less aggressive, often called low grade, and others are noncancerous and are not likely to grow and spread. The following types of CNS tumors are most common among children:

This section covers CNS tumors diagnosed in children. Learn more about brain tumors in adults.

Looking for More of an Overview?

If you would like additional introductory information, explore these related items. Please note these links take you to other sections on Cancer.Net:

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Central Nervous System Tumors - Childhood - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find information about how many children learn they have a CNS tumor each year and some general survival information. Remember, survival rates depend on several factors. To see other pages, use the menu on the side of your screen.

Approximately 4,000 CNS tumors are diagnosed each year in children younger than 20. CNS tumors are the second most common childhood cancer, after leukemia. The five-year survival rate is the percentage of people who survive at least five years after the tumor is detected, excluding those who die from other diseases. The overall five-year survival rate of children with a CNS tumor is 75%.

Survival statistics should be interpreted with caution. These estimates are based on data from thousands of children with this type of tumor, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with a CNS tumor. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this tumor. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts and Figures 2014 and the American Cancer Society website.

To continue reading this guide, use the menu on the side of your screen to select another section.  

Central Nervous System Tumors - Childhood - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find out more about the factors that increase the chance of developing a CNS tumor. To see other pages, use the menu on the side of your screen.

A risk factor is anything that increases a person’s chance of developing a tumor. Although risk factors often influence the development of a tumor, most do not directly cause a tumor. Some people with several risk factors never develop a tumor, while others with no known risk factors do.

The cause of most CNS tumors in children is not known. Researchers are studying a variety of possible causes of CNS tumors, including viruses. Different types of CNS tumors occur in different age groups. For example, some types of CNS tumors are more common in children younger than three. Head injury does not appear to cause a CNS tumor.

A small number of CNS tumors occur in families. However, only a small percentage of children with a brain tumor have an identifiable genetic cause, usually in association with a familial disease called neurofibromatosis. Neurofibromatosis is an inherited disorder that causes noncancerous tumors called neurofibromas to form on peripheral nerves in the body, brown spots on the skin, and tissue and bone abnormalities. Neurofibromatosis is also called Recklinghausen’s disease or von Recklinghausen’s disease. Learn more about neurofibromatosis Type 1 and neurofibromatosis Type 2. Other, less common genetic conditions associated with a higher risk of a CNS tumor include Li-Fraumeni syndrome, tuberous sclerosis, nevoid basal cell syndrome, and Turcot syndrome.

To continue reading this guide, use the menu on the side of your screen to select another section.

Central Nervous System Tumors - Childhood - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu on the side of your screen.

Children with a CNS tumor may experience the following symptoms or signs. Sometimes, children with a CNS tumor do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not a tumor.

The symptoms of a CNS tumor can affect any of the brain’s functions and depend on where the tumor is located. A CNS tumor may cause the following symptoms:

  • A seizure or convulsion, which are sudden involuntary movements of a person’s muscles
  • Staring or repetitive automatic movements, such as a neck tilt or a squint
  • Unexplained, persistent nausea and projectile vomiting
  • Weakness or clumsiness, such as difficulty walking and balancing, that seems to get worse
  • Early or delayed puberty, or delayed or abnormal growth
  • Sleep apnea, which is when breathing stops periodically while asleep
  • Vision problems
  • Headache, which may wake a child up at night or develop early in the morning
  • Pain, especially back pain
  • Irritability, listlessness, or changes in personality

In a baby, the only symptom may be that the head is growing too fast. An infant’s skull can expand to make room for a growing tumor, so the baby may have a larger than normal head.

If you are concerned about one or more of the symptoms or signs on this list, please talk with your child’s doctor. Your doctor will ask how long and how often your child has been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If a tumor is diagnosed, relieving symptoms remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with the health care team about the symptoms your child experiences, including any new symptoms or a change in symptoms.

The next section helps explain what tests and scans may be needed to learn more about the cause of the symptoms. Use the menu on the side of your screen to select Diagnosis, or you can select another section, to continue reading this guide.

Central Nervous System Tumors - Childhood - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find a list of the common tests, procedures, and scans that doctors can use to find out what’s wrong and identify the cause of the problem. To see other pages, use the menu on the side of your screen.

Doctors use many tests to diagnose a tumor, determine if it is cancerous, and find out if it has spread to another part of the body, called metastasis. Some tests may also determine which treatments may be the most effective. For most types of tumors, a biopsy is the only way to make a definitive diagnosis. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the tumor has spread. This list describes options for diagnosing a CNS tumor, and not all tests listed will be used for every child. Your child’s doctor may consider these factors when choosing a diagnostic test:

  • Age and medical condition
  • Type of tumor suspected
  • Signs and symptoms
  • Previous test results

In addition to a physical examination, the following tests may be used to diagnose a CNS tumor:

Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill to swallow.

Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A special dye called a contrast medium is given before the scan to create a clearer picture. This dye can be injected into a patient’s vein or given as a pill to swallow.

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that a tumor is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. The type of biopsy performed depends on the location of the tumor.

After diagnostic tests are done, your child’s doctor will review all of the results with you. If the diagnosis is a tumor, these results also help the doctor describe the tumor; this is called staging and grading.

The next section helps explain how stages and grades are used for a CNS tumor. Use the menu on the side of your screen to select Stages and Grades, or you can select another section, to continue reading this guide.  

Central Nervous System Tumors - Childhood - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will learn about how doctors describe a tumor’s growth or spread. This is called the stage or grade. To see other pages, use the menu on the side of your screen.

Staging is a way of describing where the tumor is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the tumor's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient’s prognosis, which is the chance of recovery.

Several types of childhood CNS tumors can spread through the spinal fluid that surrounds the brain and the spine. For most types of CNS tumors, the tumor is described as either high-grade or low-grade, depending on how much of the tumor is left after surgery, the child’s age, and whether the tumor has spread. In general, a child with a low-grade tumor has a better prognosis.

A recurrent tumor is a tumor that comes back after treatment. If there is a recurrence, the tumor may need to be staged and graded again.

There are different stage descriptions for different types of tumors. Read more about staging for a specific type of CNS tumor. For example, review the Stages section in Cancer.Net’s guide to astrocytoma, if that is the specific diagnosis.

Information about the tumor’s stage and grade will help the doctor recommend a treatment plan.  The next section helps explain the treatment options for CNS tumors. Use the menu on the side of your screen to select Treatment Options, or you can select another section, to continue reading this guide.

Central Nervous System Tumors - Childhood - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will learn about the different ways doctors use to treat children with a CNS tumor. To see other pages, use the menu on the side of your screen.

In general, tumors in children are uncommon, so it can be hard for doctors to plan treatments unless they know what has been most effective in other children. That’s why more than 60% of children are treated as part of a clinical trial. Clinical trials are research studies that compare standard treatments (the best proven treatments available) with newer approaches to treatments that may be more effective. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. Studying new treatments involves careful monitoring using scientific methods, and all participants are followed closely to track their health and progress.

To take advantage of these newer treatments, all children with a CNS tumor should be treated at a specialized cancer center. Doctors at these centers have extensive experience in treating children and have access to the latest research. A doctor who specializes in treating children with a tumor is called a pediatric oncologist. In many cases, a team of doctors works with a child and the family to provide care; this is called a multidisciplinary team. Pediatric cancer centers often have extra support services for children and their families, such as child life specialists, nutritionists, physical and occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available.

Treatment overview

Descriptions of the most common treatment options for a CNS tumor are listed below. Treatment options and recommendations depend on several factors, including the type of CNS tumor, whether it is cancerous, the stage and/or grade of the tumor, possible side effects, the family’s preferences, and the child’s age and overall health. For instance, radiation therapy is often limited in children younger than three years old, because extensive radiation therapy can cause learning and memory problems in the future. Your child’s care plan may also include treatment for symptoms and side effects, an important part of medical care. Take time to learn about all of your child’s treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your child’s doctor and what you can expect during the treatment.

Type of CNS Tumor

Treatment Commonly Used

Astrocytoma

Low-grade astrocytoma: Surgery alone, or surgery plus radiation therapy, or radiation therapy alone for older children; surgery plus chemotherapy or limited radiation therapy for younger children

High-grade astrocytoma: Surgery plus radiation therapy and chemotherapy

Brain stem glioma

Radiation therapy, with or without chemotherapy

Ependymoma

Surgery and radiation therapy; possibly chemotherapy

Germ cell tumor

Surgery and radiation therapy, with or without chemotherapy

Medulloblastoma

Surgery, radiation therapy, and chemotherapy

Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and surrounding tissue during an operation. It is almost always used to find out the type of tumor, either through a biopsy or during treatment when the tumor can be removed without significant damage to the brain. A neurosurgeon is a doctor who specializes in treating a tumor in the brain or spine with surgery. Sometimes, a tumor spreads and grows between normal nerve cells, making surgery difficult. In certain situations, surgery can damage parts of the brain near the tumor, affecting arm and leg movement, breathing, swallowing, eye movement, or consciousness. Learn more about surgery. Some tumors cannot be removed by surgery because of their location. These tumors are called inoperable or unresectable. In these instances, the doctor will recommend other treatment options.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy tumor cells. A doctor who specializes in giving radiation therapy to treat a tumor is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Stereotactic radiosurgery is a way to deliver high doses of radiation therapy directly to a tumor and not to healthy tissue. This technique makes detailed, three-dimensional maps of the brain and tumor, so doctors can pinpoint where to direct the radiation treatment. It works best for certain noncancerous tumors and a tumor that is only in one part of the brain.

Another type of radiation therapy used for a CNS tumor is proton therapy. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy tumor cells. Proton therapy is becoming more widely used in the United States.

Learn more about radiation therapy. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, headaches, and loose bowel movements. Most side effects go away soon after treatment is finished. However, in the long term, radiation therapy can sometimes cause problems with the growth and development of the child’s brain. Therefore, the doctor may choose to treat the tumor in another way.

Chemotherapy

Chemotherapy is the use of drugs to destroy tumor cells, usually by stopping the tumor cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating a tumor with medication.

Systemic chemotherapy is delivered through the bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally). A chemotherapy regimen usually consists of a specific number of cycles given over a set period time. A patient may receive one drug at a time or combinations of different drugs at the same time.

Chemotherapy is effective for many cancerous types of brain tumors. Depending on the tumor type, chemotherapy may be given immediately after a biopsy or surgery or after radiation therapy. In some instances, chemotherapy is used at the same time as radiation therapy.

Chemotherapy may also be given directly into the spinal canal, in a procedure called intrathecal chemotherapy, to treat tumor cells on the surface of the brain and spine. This procedure is still being researched in clinical trials and may not be available everywhere.

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about chemotherapy and preparing for treatment. The medications used to treat a tumor are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, their purpose, and their potential side effects or interactions with other medications. Learn more about your child’s prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

A CNS tumor and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the disease, an important part of care is relieving a child’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the child with his or her physical, emotional, and social needs.

Palliative care can help a child at any stage of illness. Children often receive treatment for the tumor and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and families report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, and other therapies. Your child may also receive palliative treatments similar to those meant to eliminate the tumor, such as chemotherapy, surgery, and radiation therapy. Talk with your child’s doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your child’s health care team about the possible side effects of your child’s specific treatment plan and supportive care options. And during and after treatment, be sure to tell your doctor or another health care team member if your child is experiencing a problem so it is addressed as quickly as possible. Learn more about palliative care.

Remission and the chance of recurrence

A remission is when the tumor cannot be detected in the body and there are no symptoms. This may also be called “no evidence of disease” or NED. 

A remission can be temporary or permanent. This uncertainty leads to many survivors feeling worried or anxious that the tumor will come back. While many remissions are permanent, it’s important to talk with the doctor about the possibility of the tumor returning. Understanding the risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.

If the tumor does return after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence, including whether the tumor’s grade has changed. After testing is done, you and your child’s doctor will talk about the treatment options. Often the treatment plan will include the therapies described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your child’s doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent tumor.

For a recurrent CNS tumor, the next phase of treatment depends on three factors:

  • The type of tumor
  • Whether the tumor recurred where it originally began or in another part of the brain or body
  • The type of treatment given for the original tumor

Depending on your child’s situation, the doctor may recommend surgery, radiation therapy, chemotherapy, and/or stem cell/bone marrow transplantation.

A recurrent tumor may bring up emotions such as disbelief or fear. You and your family are encouraged to talk with the health care team about these feelings and ask about support services to help you cope. Learn more about dealing with a tumor recurrence.

If treatment fails

Although treatment is successful for the majority of children with a tumor, sometimes it is not. If a child’s tumor cannot be cured or controlled, this is called an advanced or terminal tumor. This diagnosis is stressful, and it may be difficult to discuss. However, it is important to have open and honest conversations with your child’s doctor and health care team to express your family’s feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families.

Parents or guardians are encouraged to think about where the child would be most comfortable: at home, in a home-like setting elsewhere, in the hospital, or in a hospice environment. Hospice care is a type of palliative care for people who are expected to live less than six months. It is designed to provide the best possible quality of life for people who are near the end of life. Nursing care and special equipment can make staying at home a workable alternative for many families. Some children may be happier if they can arrange to attend school part-time or keep up other activities and social connections. The child’s health care team can help parents or guardians decide on an appropriate level of activity. Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced care planning.

The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child.

The next section helps explain clinical trials, which are research studies. Use the menu on the side of your screen to select About Clinical Trials, or you can select another section, to continue reading this guide.  

Central Nervous System Tumors - Childhood - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu on the side of your screen.

Doctors and scientists are always looking for better ways to treat children with a CNS tumor. To make scientific advances, doctors create research studies involving volunteers, called clinical trials.

Many clinical trials are focused on new treatments, evaluating whether a new treatment is safe, effective, and possibly better than the current (standard) treatment. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Children who participate in clinical trials are often among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.

There are also clinical trials that study new ways to ease symptoms and side effects during treatment and managing the late effects that may occur after treatment. Talk with your child’s doctor about clinical trials regarding side effects. In addition, there are ongoing studies about ways to prevent the disease.

People decide to participate in clinical trials for many reasons. For some children, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are the only way to make progress in treating a childhood CNS tumor. Even if they do not benefit directly from the clinical trial, their participation may benefit future children with a CNS tumor.

Sometimes people have concerns that, by participating in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials is rare. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

To join a clinical trial, parents and children must participate in a process known as informed consent. During informed consent, the doctor should list all of the options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different from the risks of standard treatment. Finally, the doctor must explain what will be required of each person in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

For specific topics being studied for CNS tumors, learn more in the Latest Research section.

People who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with the doctor and researchers about who will be providing their child’s treatment and care during the clinical trial, after the clinical trial ends, and/or if the person chooses to leave the clinical trial before it ends.

Cancer.Net offers a lot of information about clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of tumor.

The next section helps explain the areas of research going on today about CNS tumors. Use the menu on the side of your screen to select Latest Research, or you can select another section, to continue reading this guide.  

Central Nervous System Tumors - Childhood - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will read about the scientific research being done now to learn more about this CNS tumors and how to treat them. To see other pages, use the menu on the side of your screen.

Doctors are working to learn more about CNS tumors, ways to prevent them, how to best treat them, and how to provide the best care to children diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your child’s doctor about the diagnostic and treatment options best for your child.

New medications. Doctors are examining new types of drugs that may better control tumor growth.

Improved imaging techniques. Imaging techniques are being developed and refined that help surgeons pinpoint the tumor’s location, to reduce or prevent tissue damage to the healthy parts of the brain during treatment.

  • Functional MRI (fMRI) is an imaging technique that identifies the parts of the brain that control speech, hearing, vision, touch, and movement. The specific locations of these functions are slightly different in every person, so fMRI allows surgeons to plan surgery around these areas.
  • Image-guided stereotaxis allows surgeons to visualize and operate on the brain using three-dimensional outlines of the brain and the tumor. Along with specialized software, these images help guide the surgeon to the tumor. Many tumors that were once considered inoperable can now be removed with this technique.
  • Magnetic resonance spectroscopy (MRS) and positron emission tomography (PET) scans are also being used to examine tumor metabolic activity. Whether these techniques will improve a doctor’s ability to predict how a tumor will grow and spread is still being researched.

Improved methods of delivering radiation treatment. Doctors are experimenting with new techniques for delivering radiation therapy to certain types of tumors. These methods make detailed, three-dimensional maps of the brain and tumor, so doctors can focus the radiation on the tumor and avoid damage to the nearby healthy tissue. This can reduce a child’s exposure to radiation and lessen the long-term side effects.

Targeted therapy. Recent research has found specific genes, proteins, and other factors unique to different types of CNS tumors. Treatments aimed at these factors, called targeted therapy, are now being studied. Targeted therapy is a treatment that targets the tumor’s specific genes, proteins, or the tissue environment that contributes to its growth and survival. This type of treatment blocks the growth and spread of tumor cells while limiting damage to healthy cells.

Immunotherapy. Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight the tumor. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Researchers are studying how well these drugs work and how safe they are for children with CNS tumors.

Supportive care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current CNS tumor treatments in order to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding childhood cancers, explore these related items that take you outside of this guide:

  • Visit ASCO’s CancerProgress.Net website to learn more about the historical pace of research for childhood cancer. Please note this link takes you to a separate ASCO website.

The next section addresses how to cope with the symptoms of the disease or the side effects of its treatment. Use the menu on the side of your screen to select Coping with Side Effects, or you can select another section, to continue reading this guide.  

Central Nervous System Tumors - Childhood - Coping with Side Effects

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find out more about steps to take to help cope with physical, social, and emotional side effects. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu on the side of your screen.

Fear of treatment side effects is common after a diagnosis of a CNS tumor, but it may help to know that preventing and controlling side effects is a major focus of your child’s health care team. This is called palliative or supportive care, and it is an important part of the overall treatment plan, regardless of the stage of disease.

Common side effects from each treatment option for a CNS tumor are described in detail within the Treatment Options section. Learn more about the most common side effects of a tumor and different treatments, along with ways to prevent or control them. Side effects depend on a variety of factors, including the type of tumor, its grade, the length and dosage of treatment(s), and your child’s overall health.

Before treatment begins, talk with your child’s doctor about possible side effects of each type of treatment your child will be receiving. Ask which side effects are most likely to happen, when they are likely to occur, and what can be done to prevent or relieve them. And, ask about the level of caregiving your child may need during treatment and recovery, as family members and friends often play an important role in the care of a child with a CNS tumor. Learn more about caregiving.

In addition to physical side effects, there may be emotional and social effects as well. Families are encouraged to share their feelings with a member of their health care team who can help with coping strategies, including concerns about managing the cost of your child’s medical care

During and after treatment, be sure to tell the health care team about the side effects your child experiences, even if you feel they are not serious. Sometimes, side effects can last beyond the treatment period, called a long-term side effect. A side effect that occurs months or years after treatment is called a late effect. Treatment of both types of effects is an important part of survivorship care. Learn more by reading the After Treatment section or talking with your child’s doctor.

The next section helps explain medical tests and check-ups needed after finishing treatment. Use the menu on the side of your screen to select After Treatment, or you can select another section, to continue reading this guide.

Central Nervous System Tumors - Childhood - After Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will read about your child’s medical care after treatment is finished and why this follow-up care is important. To see other pages, use the menu on the side of your screen.

After treatment for a CNS tumor ends, talk with your child’s doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your child’s recovery for the coming months and years. All children treated for a CNS tumor should have life-long, follow-up care.

Based on the type of treatment your child received, the doctor will determine what examinations and tests are needed to check for long-term side effects and the possibility of secondary tumors. For example, radiation therapy to the head and spine can cause cognitive (thought-process) and hormonal symptoms over time, although the severity can vary greatly depending on the dose given and the age of the child. Similarly, the risks and potential side effects of surgery vary widely, depending on the location of the tumor and how it grew. Likewise, the risks of chemotherapy and the likelihood of secondary tumors also strongly depend on the drugs and doses used. Your child’s doctor can recommend the necessary screening tests. Follow-up care should also address your child’s quality of life, including any developmental or emotional concerns.

The child’s family is encouraged to organize and keep a record of the child’s medical information. That way, as the child enters adulthood, he or she has a clear, written history of the diagnosis, the treatment given, and the doctor’s recommendations about the schedule for follow-up care. The doctor’s office can help you create this. This information will be valuable to doctors who care for your child during his or her lifetime. ASCO offers treatment summary forms to help keep track of the treatment your child received and develop a survivorship care plan once treatment is completed.

Children who have had a CNS tumor can also enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating a balanced diet, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child’s needs. Learn more about the next steps to take in survivorship

The next section offers a list of questions you may want to ask. Use the menu on the side of your screen to select Questions to Ask the Doctor, or you can select another section, to continue reading this guide.

Central Nervous System Tumors - Childhood - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find some questions to ask your child’s doctor or other members of the health care team, to help you better understand your child’s diagnosis, treatment plan, and overall care. To see other pages, use the menu on the side of your screen.

Talking often with the doctor is important to make informed decisions about your child’s health care. These suggested questions are a starting point to help you learn more about your child’s care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your child’s next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your child’s care.

  • What type of tumor has been diagnosed?
  • Where exactly is the tumor located?
  • Can you explain my child’s pathology report (laboratory test results) to me?
  • Is the tumor cancerous?
  • What is the tumor’s grade? What does this mean?
  • What is the tumor’s molecular subtype (if applicable)? What does this mean?
  • Are other tests needed to confirm this diagnosis?
  • What is your familiarity with my child’s tumor type and its treatment?
  • What are the treatment options?
  • What clinical trials are open to my child? Where are they located, and how do I find out more about them?
  • What treatment plan do you recommend? Why?
  • What is the goal of each treatment? Is it to eliminate the tumor, help my child feel better, or both?
  • What are the chances for success with the planned therapy?
  • Who is part of the treatment team, and what does each team member do?
  • Who will be coordinating my child’s overall treatment and follow-up care?
  • What are the possible side effects of each treatment option, both in the short term and long term?
  • How will this treatment affect my child’s daily life? Will he or she be able to attend school and perform his or her usual activities?
  • Could this treatment affect my child’s ability to become pregnant or have children in the future? If so, should I talk with a fertility specialist before treatment begins?
  • If I’m worried about managing the costs related to my child’s medical care, who can help me with these concerns?
  • What is the chance that the tumor will recur?
  • What follow-up tests will my child need, and how often will he or she need them?
  • What support services are available to my child? To my family?
  • Whom should I call for questions or problems?

The next section offers some more resources that may be helpful to you. Use the menu on the side of your screen to select Additional Resources, or you can select another section, to continue reading this guide.  

Central Nervous System Tumors - Childhood - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 05/2014

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Childhood Central Nervous System Tumor. To go back and review other pages, use the menu on the side of your screen.

Cancer.Net includes many other sections about the medical and emotional aspects of a tumor, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond. Here are a few sections that may get you started in exploring the rest of Cancer.Net:

- Search for a specialist in your local area using this free database of doctors from the American Society of Clinical Oncology.

- Review dictionary articles to help understand medical phrases and terms used in medical care and treatment.

- Read more about the first steps to take when newly diagnosed with a tumor.

- Find out more about clinical trials as a treatment option.

- Learn more about coping with the emotions that a tumor can bring, including those within a family or a relationship.

- Find a national, not-for-profit advocacy organization that may offer additional information, services, and support for children with a CNS tumor and their families.

- Explore next steps a person can take after active treatment is complete.

This is the end of the Cancer.Net’s Guide to Childhood Central Nervous System Tumor. Use the menu on the side of your screen to select another section, to continue reading this guide.