A primary brain tumor is a group (mass) of abnormal cells that start in the brain. This article focuses on primary brain tumors in children.

See also:

• Brain tumor - metastatic (cancer that has spread to the brain)
• Brain tumor - adults

The cause of primary brain tumors is unknown. Primary brain tumors may be:

• Located in only a small area
• Invasive (spread to nearby areas)
• Benign (not cancerous)
• Malignant (cancerous)

Brain tumors are classified depending on the exact site of the tumor, the type of tissue involved, and whether or not it is cancerous. Brain tumors can directly destroy brain cells. They may also indirectly damage cells by pushing on other parts of the brain. This leads to swelling and increased pressure within the skull.

Tumors may occur at any age, but many specific tumors are more common at a specific age. However, most brain tumors are rare in the first year of life. Some of the most common childhood brain tumors include:

• Astrocytomas
• Brain stem gliomas
• Ependymomas
• Medulloblastomas

SPECIFIC TUMOR TYPES

Astrocytomas are usually non-cancerous, slow-growing cysts. They most commonly develop in children ages 5 to 8. The main treatment is surgery to remove the tumor.

Brainstem gliomas occur almost exclusively in children. The average age of development is about 6 years old. The tumor may grow very large before triggering symptoms. Surgery is usually not possible because of the tumor's location in the brain. Radiation and chemotherapy are used to shrink the tumor and prolong life. The 5-year survival rate is low.

Ependymomas make up about 8-10% of pediatric brain tumors. The tumors are located in tiny passageways (ventricles) in the brain, and block the flow of cerebrospinal fluid (CSF). Treatment may include surgery, radiation therapy, and chemotherapy.

Medulloblastomas are the most common type of childhood brain cancer. They occur more often in boys than girls, usually around age 5. Most medulloblastomas occur before the age of 10. Surgery alone does not cure this type of cancer. Chemotherapy and radiation are often used in combination with surgery.

See also: Craniopharyngioma

The specific symptoms vary, but may include:

• Headache -- continues and is worse when the child wakes up
• Vomiting -- more severe in the morning
• Nausea
• Personality and behavior changes
• Mood wings (emotional changes)
• Loss of memory
• Judgment problems
• Seizures
• Reduced alertness
• Vision problems, including double vision and decreased vision
• Hearing loss
• Decreased sensation of a body area
• Weakness of a body area
• Speech difficulties
• Decreased coordination -- can cause falls
• Fever (sometimes)
• Weakness, lethargy
• General ill feeling
• Decerebrate posture
• Decorticate posture

Infants may have the following signs and symptoms:

• Bulging fontanelles
• Separated sutures
• Opisthotonos
• Increased head circumference
• No red reflex in the eye

Additional symptoms that may be associated with primary brain tumors:

• Tongue problems
• Swallowing difficulty
• Problems with the sense of smell
• Obesity
• Uncontrollable movement
• Dysfunctional movement
• Absent menstruation
• Hiccups
• Hand tremor
• Facial paralysis
• Eye problems, including different sized pupils, uncontrollable eye movements, and eyelid drooping
• Confusion
• Breathing problems

The health care provider will perform a physical exam. The child may have a positive Babinski's reflex. The physical exam can often identify signs and symptoms that are specific to the location of the tumor. However, some tumors may not cause symptoms until they are very large and cause a rapid decline in the child's mental function.

The following tests may be used to detect a brain tumor and identify its location:

• CT scan of the head
• MRI of the head
• EEG
• CT-guided biopsy (may confirm the exact type of tumor)
• Examination of the cerebral spinal fluid (CSF)