Cancers and Tumors
Brain and Spinal Cord Tumors
What are brain or spinal cord tumors?
The brain and spinal cord make up what is called the central nervous system (CNS). The CNS is the control center for thought, memory, coordination of movement, signals from the 5 senses, emotion and hormone activity.
A brain or spinal cord tumor is a lump formed by an abnormal growth of cells.
A tumor that starts in the central nervous system is called primary. When a tumor starts in another part of the body and travels to the brain, this is called a secondary brain tumor. Most brain tumors in children and adolescents are primary tumors.
CNS tumors are different from tumors of the spine or skull, which affect the bones and soft tissue.
Some tumors are considered “benign” (not cancer), and some tumors are considered “malignant” or “cancer” because they grow fast or spread to other areas.
Most children with brain and spinal cord tumors are treated successfully. But these tumors and their treatments may cause health problems and affect how your child’s central nervous system develops. It is important that your child be evaluated and treated by a medical team with expertise in child development and brain tumors, such as Seattle Children’s Brain Tumor Program.
Many different types of CNS tumors happen in children, teens and young adults. In most cases, doctors do not know exactly what causes these tumors. There is no known way to prevent them.
Most children who have a brain tumor have no clear risk factors. But the chance of these tumors is higher in children:
- With genetic disease such as neurofibromatosis, Li Fraumeni syndrome, Lynch syndrome or tuberous sclerosis
- Who received radiation treatment to the head for some other disease
Brain and Spinal Cord Tumors at Seattle Children’s
Seattle Children’s is the largest brain tumor program in the Northwest. We have an international reputation for comprehensive care of pediatric brain tumors. We are experienced in treating all types of CNS tumors in babies, children, adolescents and young adults through our Brain Tumor Program.
The Brain Tumor Program is part of our Cancer and Blood Disorders Center. Please contact us at 206-987-2106 for more information, a second opinion or to make an appointment.
Our Brain Tumor Program brings together doctors who are expert in the nervous system (neurology), brain surgery, cancer care (oncology) and related fields. Our pediatric neurosurgeons, neuro-oncologists and radiation oncologist all have focused training and experience in pediatric brain tumors far beyond what is required for board certification.
Once a week, the whole Brain Tumor team meets at our Brain Tumor Board meeting. We talk about each child’s case in great detail. We review all the information we have on your child. This includes health records, tests, images and pathology results. Combining our different skills lets us offer your child the safest and most effective treatment plan.
We don’t just treat your child’s tumor. We care for your whole child. Their team may include specialists in nutrition, pain management, social work, physical therapy, psychiatry and emotional health. Read more about the supportive care we offer.
Every year, our team sees more patients with a new diagnosis of pediatric brain or spinal cord tumor than any other hospital in our region (Washington, Wyoming, Alaska, Montana, Idaho and Oregon). We treat children with tumors that are cancerous and children with noncancerous tumors.
Children treated at Seattle Children’s have the option to take part in research studies of promising new treatments. Our doctors lead national clinical trials of new drugs and other new treatments that are available only to patients in studies. This is especially important if your child’s tumor returns after it is treated.
We offer advanced radiation therapies that help limit damage to the nervous system. These include proton beam therapy and precise ways to shape and focus X-rays.
Through our precision medicine program, we are always developing new clinical lab tests such as gene sequencing tests. We will give you all the information we can about your child’s tumor.
Seattle Children’s doctors and researchers are leaders in developing chimeric antigen receptor (CAR) T-cell immunotherapies to treat children and young adults with relapsed or refractory cancers. BrainChild-01 is a phase 1 trial testing CAR T-cell therapy in children and young adults with relapsed or refractory brain and CNS tumors that express the protein HER2.
Read more about cancer clinical trials at Seattle Children’s.
You can search by diagnosis for many clinical trials available through Seattle Children’s on ClinicalTrials.gov. Read our guide about searching for trials on ClinicalTrials.gov (PDF). You can search for bone marrow transplant clinical trials on Fred Hutch’s clinical trials page.
For more than a decade, U.S. News & World Report has consistently ranked Seattle Children's Cancer Center among the best in the nation. In 2018, our program again ranked #1 in the Northwest.
At Seattle Children’s Cancer Center, our survival rates for a wide range of cancers are significantly better than the national average. This has held true for 20 years.
Through our partnership with Seattle Cancer Care Alliance (SCCA), our patients benefit from the work of physician-scientists at Fred Hutch and UW Medicine, as well as at Seattle Children’s. The National Cancer Institute has designated our partnership a comprehensive cancer center.
Our experience helps us recommend the right treatment at the right time to have the best results for your child and your family.
Children don’t react to illness, injury, pain and medicine in the same way as adults. They need – and deserve – care designed just for them. They need a healthcare team specially trained to understand and meet their needs.
Our cancer doctors have special training in how to diagnose and treat children with cancer. Our experts are focused on how treatments today affect growing bodies in the future. Their treatment plans draw from their years of experience and the newest research on what works best – and most safely – for children.
People who have been cured of cancer may be affected for months or years by their disease or treatment. Our Cancer Survivor Program provides long-term follow-up care to help children and young adults stay healthy after being treated for cancer in childhood.
Symptoms of Brain and Spinal Cord Tumors
The brain and spinal cord form the central nervous system, which controls all functions of the body. Tumors in the CNS can affect your child’s thoughts, senses (vision or hearing), learning, balance, coordination or movement.
Many children with brain tumors show general symptoms at first, like headache or vomiting. Unlike most regular childhood illnesses, symptoms related to a brain tumor do not go away without treatment.
Your child’s symptoms will depend on the tumor’s location and which structures of the brain or spinal cord it affects.
Usually, brain and spinal cord tumor symptoms develop slowly. But sometimes they start suddenly.
These are some of the symptoms that may happen in a child who has a brain or spinal cord tumor. They can also be caused by other health problems. If your child has symptoms like these, it is important to see a doctor to find out the cause.
- Trouble with movements, such as walking or writing
- Loss of balance
- Being numb or weak in part of the body or unable to move part of the body
- Slow speech or trouble speaking
- Changes in vision, hearing or other senses
- Nausea or vomiting
- Headache in the morning or headache that goes away after vomiting
- Feeling sleepy for no reason or having a change in energy
- Changes in personality, mood or behavior
- Weight loss or gain for no reason
Diagnosing Brain and Spinal Cord Tumors
Your doctor may want to take pictures of the inside of your child’s head or spine. These “imaging studies” help the doctor tell whether your child has a tumor:
- CT (computed tomography) scan
- MRI (magnetic resonance imaging) scan of the whole brain and spine
If a tumor is found, most children need surgery to find out exactly what type of tumor it is. Doctors may do just a biopsy or may remove the entire tumor.
Your child may also need these tests:
- EEG (electroencephalogram) to find problems with electrical activity in the brain
- Examination of cerebrospinal fluid (CSF) to look for tumor cells
Based on what they see, doctors may “grade” your child’s tumor. A higher-grade tumor grows faster. A lower-grade tumor grows more slowly. Even a lower-grade tumor can be serious.
“Staging” of a tumor includes testing to see whether the tumor is in one place (localized) or more than one place (metastatic). Staging includes:
- An MRI of your child’s whole brain and spine.
- A lumbar puncture for some types of tumors. This uses a needle to remove fluid from the spinal column so it can be checked for tumor cells. This is also called a spinal tap. The best time to do the lumbar puncture is usually 2 weeks after surgery.
Treating Brain and Spinal Cord Tumors
Our goal of treatment is to give your child or teen the best chance of a long and healthy life.
Your child’s healthcare team will suggest a treatment plan based on:
- Your child’s tumor
- Where the tumor is
- Whether the tumor is localized or metastatic
- Whether the tumor is safe to remove by surgery
- Your child’s age
- Your child’s overall health
- Your family’s preferences
The Brain Tumor team may recommend surgery, radiation therapy, medication (chemotherapy) or a combination of treatments. We review each new patient’s case at our weekly Brain Tumor Board to make sure the whole team sees all your information. That way we can coordinate the best care for your child.
Surgery is an important part of diagnosing and treating most patients with tumors of the brain or spinal cord.
Our neurosurgical team uses advanced equipment and the most current and well-researched procedures. These include:
- Craniotomy: The neurosurgeon removes a part of your child’s skull (cranium), cuts the tough membrane (dura mater) that protects the brain and removes as much of the tumor as is safe. After closing the dura mater, the neurosurgeon puts back the piece of bone that was removed, if possible. Otherwise, the surgeon uses hardware such as micro plates, screws and wires to close your child’s skull.
- Laminectomy: This procedure is used to remove spinal cord tumors or to reach spinal nerve roots that need repair. The neurosurgeon removes parts of a few bones in the spine (vertebrae). Usually the neurosurgeon uses a microscope and other highly technical equipment to see and remove the tumor. Sometimes an endoscope, a wandlike tube with a light and camera, is used.
- Laser ablation surgery: For some slow-growing tumors deep in the brain, laser ablation surgery may be an option. This minimally invasive procedure uses light to heat and destroy unwanted cells. Seattle Children’s is the only pediatric hospital in the Pacific Northwest, and one of a few in the country, to offer laser ablation for brain tumors. Read more.
- Biopsy: At Seattle Children’s we can take tissue samples from (biopsy) tumors in parts of the brain that are difficult to reach, such as the brainstem. Not all hospitals can do this. We use stereotactic biopsy techniques. Using CT and MRI scans, neurosurgeons make a 3-D map of your child’s brain and tumor location. Then they make a small cut (incision) and small hole in the skull. They insert a thin needle into the tumor to remove a sample of cells for testing.
Read how we treat cancer with surgery. Learn more about our Neurosurgery Program.
Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. Tumors are very sensitive to radiation compared to healthy tissue. But radiation can harm healthy cells. It can damage the developing nervous system, especially in very young children. It is important that a radiation oncologist who is experienced in working with children decides whether and how radiation therapy should be used.
Children treated for brain tumors at Seattle Children’s have access to advanced radiation therapies that can help limit damage to the nervous system.
- Proton beam therapy, which uses positively charged atomic particles (protons). This reduces effects on healthy tissue, compared to the light particles (photons) used in X-rays.
- Different ways of focusing X-rays more exactly on the tumor: intensity-modulated radiation therapy (IMRT), fractionated stereotactic radiosurgery (also called gamma knife) and conformal radiation. These methods help prevent harm to healthy tissue.
Learn more about Seattle Children’s Radiation Therapy Service.
Chemotherapy means giving medicines to kill tumor cells. It is also called “chemo.”
It is important that a doctor experienced in the medical care of children with brain tumors (neuro-oncologist) decides whether and what type of medication should be used for your child’s tumor.
Your child’s doctors may suggest chemotherapy as your child’s main treatment. Or your child may get it along with surgery, radiation or both. Expert nurses and doctors will see your child often. They adjust your child’s treatment or supportive care based on how your child is doing.
Most children can get chemotherapy for brain and spinal cord tumors through a vein or by mouth. Sometimes chemo is given by lumbar puncture or a tube into the skull (ventricular catheter).
See more about getting chemotherapy at Seattle Children’s.
The doctors on our Brain Tumor team are leaders in pediatric cancer research. This means that they both care for children with CNS tumors and work on new treatments to improve the care of all children with brain tumors.
Children, adolescents and young adults treated at Seattle Children’s have the option to participate in research as part of their medical treatment. Research studies of new drugs and other new treatment approaches are called clinical or therapeutic trials.
Seattle Children’s has more than a dozen therapeutic trials at any time for various types of brain tumors. We can offer our patients treatments that are not available at all centers. Clinical trials are often conducted through groups such as:
One example of a new research treatment option only available at Seattle Children’s is BrainChild-01, a phase 1 trial testing T-cell therapy in children and young adults with relapsed or refractory brain and CNS tumors that express the protein HER2. Read more.
To see if there is a clinical trial for your child’s type of tumor, you or your child’s doctor can:
Read more about cancer clinical trials at Seattle Children’s.
Follow-up care is important after treatment ends. The follow-up routine will depend on your child’s type of tumor and their treatments. Most children visit the Brain Tumor Clinic at Seattle Children’s for follow-up care several times a year in the first few years after tumor treatment. They visit less often until adulthood. Your doctor will let you know the schedule that is right for you.
During follow-up visits your child will be checked for any signs that their tumor is returning. Your doctor also will check for effects that may happen months or years after treatment.
Our Cancer Survivor Program provides long-term follow-up care to help young people stay healthy after being treated for cancer in childhood.
Treatment by Type of Tumor
Hundreds of types of tumors may start in the brain or spinal cord, and we treat them all. Some common ones are described here. Your doctors will discuss more detailed information about your child’s tumor.
Low-grade glioma (pronounced glee-OH-muh) is the most common type of tumor found in children. Low-grade means slow-growing.
Types of LGG include:
- Pilocytic astrocytoma
- Pilomyxoid astrocytoma
- Diffuse astrocytoma
It is very rare for a low-grade glioma to become life-threatening once it is properly diagnosed and treated. Treatment is aimed at preventing the tumor from affecting how your child’s brain works.
Low-grade glioma may be treated by surgery alone, depending on where it is in the brain.
Treatment options also include:
- Radiation therapy using very focused beams.
- Chemotherapy for children who need treatment other than surgery.
- Observation or “watchful waiting”: Some LGG may not require any treatment. If that is the case for your child, the Brain Tumor Clinic team will keep a close watch.
High-grade gliomas (pronounced glee-OH-muhs) include:
- Anaplastic astrocytoma
- Glioblastoma multiforme (GBM)
HGGs can happen in any part of the CNS. Usually they are found in the upper part or front of the brain (cerebrum).
Surgery, radiation therapy and newer medical therapies have improved survival for children with HGG.
Diffuse intrinsic pontine glioma starts in a central part of the brainstem called the pons. It is pronounced dih-FYOOS in-TRIN-sik PON-teen glee-OH-muh.
The pons controls important functions such as breathing and heart rate. DIPG can put pressure on the nerves that control movement of the face, eyes, speech and swallowing. Because of the location, it is currently not possible to remove all of the tumor by surgery. DIPGs are always considered high-grade.
Treatment with radiation and sometimes chemotherapy can usually improve symptoms a great deal and prolong life. Still, most DIPG will eventually grow back. This tumor remains a focus of research for better therapies.
Embryonal tumors (pronounced em-BRY-uh-nul TOO-mers) include:
- Medulloblastoma (pronounced MED-you-low-blast-OH-ma)
- Primitive neuro-ectodermal tumor (PNET)
- Atypical teratoid/rhabdoid tumors (ATRT)
These are high-grade tumors that may grow quickly and always require treatment.
Embryonal tumors are often successfully treated with a combination of surgery, radiation therapy and chemotherapy.
Ependymoma (pronounced eh-PEN-di-moh-ma) may occur in any area of the CNS.
Locations may include:
- The upper part of the brain (supratentorial)
- The lower part of the brain (infratentorial)
- The spinal cord
Most children with ependymoma are treated successfully with surgery and radiation therapy. Sometimes ependymoma may be treated with surgery alone. Sometimes chemotherapy is useful.
Tumors near or in the pituitary (pronounced pit-TOO-i-tary) gland happen most often in teens or young adults. These tumors may cause hormonal changes or pressure on the nerves that control vision. Sometimes, pituitary tumors are noticed on an MRI (magnetic resonance imaging) for an unrelated reason such as headaches.
Pituitary tumors are almost never life threatening once properly diagnosed and treated. Your child’s doctor may recommend:
- Observation or “watchful waiting.” This means checking your child’s tumor regularly to see if it causes problems that need treatment.
Contact the Cancer and Blood Disorders Center at 206-987-2106 for an appointment, a second opinion or more information.
To make an appointment, you can call us directly or get a referral from your child’s primary care provider. We encourage you to coordinate with your pediatrician or family doctor when coming to Seattle Children's.
If you are a provider, see how to refer a patient.