Brain and spinal cord tumors are usually found because of signs or symptoms a child is having. If a tumor is suspected, tests will be needed to confirm the diagnosis.

Symptoms of brain and spinal cord tumors

Symptoms from brain and spinal cord tumors may occur gradually and become worse over time, or they may happen suddenly.

General symptoms

In some children, seizures are the first symptom of a brain tumor. However, most seizures in children are not caused by brain tumors. Still, if your child has a seizure, your child's doctor may refer you to a neurologist (a doctor who specializes in brain and nervous system problems) to make sure it wasn't caused by a brain tumor.

Headache is often a major symptom of brain tumors. In very young children who can't complain of headache, a parent may notice an increase in head size, with or without bulging of the soft spots of the skull (fontanelles). This happens because the several bones that make up the skull haven't grown together yet, and increased pressure from a tumor can push them apart.

Tumors in any part of the brain may cause the pressure within the skull (known as intracranial pressure) to rise. This is because of the growing tumor and slowing or blockage of cerebrospinal fluid circulation. Increased pressure within the skull may cause headache, nausea, vomiting, or drowsiness. In some children, the increased pressure causes crossed eyes and blurred or double vision. A doctor can often tell if intracranial pressure is increased by looking in the child's eyes for swelling of the optic nerve (known as papilledema).

In the school-aged child, poor school performance, fatigue, personality changes, and complaints of headaches are common. In the first few years of life, symptoms can include irritability, vomiting, loss of appetite, developmental delay, and a drop in intellectual and physical abilities.

Symptoms of tumors in different parts of the central nervous system

Tumors in different parts of the central nervous system can cause different symptoms. But these symptoms can be caused by any disease in that particular location in the brain -- they do not always mean a brain tumor is present.

Brain and spinal cord tumors often cause problems with the specific functions of the region they develop in. For example:

• Spinal cord tumors often cause numbness and/or weakness in both legs.

• Tumors in parts of the brain that control movement or sensation may cause weakness or numbness in a part of the body.

• Tumors in an area of the brain called the basal ganglia typically cause abnormal movements and abnormal body positions.

• If the tumor is in the cerebellum, where coordination is controlled, the child may have trouble walking or with other normal functions, even eating.

• Tumors in or around the pituitary gland, the optic nerve, or certain other cranial nerves may cause vision problems.

• Tumors in other cranial nerves may lead to double vision, loss of hearing, balance problems, or weakness of some facial muscles.

Again, it's important to note that other disorders may also cause these symptoms, and they do not necessarily mean your child has a brain or spinal cord tumor. Still, if your child's symptoms suggest that a brain or spinal cord tumor may be present, make an appointment with a doctor so that the cause can be evaluated and treated, if needed.

Medical history and physical exam

If your child has symptoms that suggest a central nervous system tumor may be present, the doctor will take a complete medical history and do a physical exam to evaluate your child's brain function (known as a neurologic exam), if possible. Your child's pediatrician or primary care doctor may do this special type of exam. It commonly means testing reflexes, sensation, muscle strength, eye and mouth movement, coordination, alertness, and other functions. If the results are abnormal, a more detailed exam may be done by a doctor specializing in diagnosing and treating nervous system diseases (neurologist) or a surgeon who specializes in treating nervous system diseases (neurosurgeon).

Imaging tests

If your child's doctor thinks a brain problem may be present, he or she will probably order one or more imaging tests. These studies provide different types of pictures of internal organs such as the brain and spinal cord. The pictures may be looked at by doctors specializing in this field (neurosurgeons, neurologists, and neuroradiologists) as well as by your child's doctor.

Magnetic resonance imaging (MRI) scan

MRI scans are very good for looking at the brain and spinal cord and are considered the best way to look for tumors in these areas. The images they provide are usually more detailed than those from CT scans (described below).

MRI scans provide detailed images of soft tissues in the body. They use radio waves and strong magnets instead of x-rays, so they do not expose the child to radiation. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. A contrast material called gadolinium may be injected into a vein before the scan to better see details.

MRI scans can take a long time to complete -- often up to an hour. Your child may have to lie inside a narrow tube, which is confining and can be distressing, so sedation is sometimes needed. Open MRI machines may be another option, though they may provide a less detailed image. The MRI machine makes loud buzzing and clicking noises that your child may find disturbing. Some places provide headphones or earplugs to help block this noise out.

In some cases, a special form of this test, known as a magnetic resonance angiogram (MRA), may be done to look at the blood vessels in the brain. This can be very useful before surgery to help the surgeon plan an operation.

Computed tomography (CT) scan

Although CT scans formerly were used quite often to find brain and spinal cord tumors, they have been largely replaced by MRI scans, which provide slightly more detailed images. One advantage of CT scans over MRIs, particularly for children who have trouble staying still, is that they take much less time. Secondly, CT scans provide greater detail of the bone structures near the tumor. Lastly, CT angiography (CTA) can provide better details of the blood vessels in and around a tumor than MRA in selected cases.

The CT scan is an x-ray test that can produce detailed cross-sectional images of your child's brain and spinal cord. Instead of taking one picture, like a regular x-ray, a CT scanner takes many pictures as it rotates around your child while he or she lies on a table. A computer then combines these pictures into images of slices of the part of the body being studied. Unlike a regular x-ray, a CT scan creates detailed images of the soft tissues in the body.

Before the scan, your child may get an injection of a contrast dye through an IV (intravenous) line. This helps better outline any tumors that are present. The contrast may cause some flushing (a feeling of warmth, especially in the face). Some people are allergic to the dye and get hives. Rarely, more serious reactions like trouble breathing or low blood pressure can occur. Be sure to tell the doctor if your child has any allergies or has ever had a reaction to any contrast material used for an imaging test.

CT scans take longer than regular x-rays. Your child will need to lie still on a table while they are being done. During the test, the table moves in and out of the scanner, a ring-shaped machine that completely surrounds the table. Some people feel a bit confined by the ring they have to lie in while the pictures are being taken. In some cases, your child may need to be sedated before the test to keep them as still as possible and help make sure the pictures come out well.

Spiral CT (also known as helical CT) is now available in many medical centers. This type of CT scan uses a faster machine. The scanner part of the machine rotates around the body continuously, allowing doctors to collect the images much more quickly than with a standard CT. This lowers the chance of blurred images occurring as a result of motion. It also lowers the dose of radiation received during the test. The biggest advantage may be that the image slices are thinner and give more detailed pictures.

Positron emission tomography (PET) scan

For a PET scan, glucose (a form of sugar) that contains a radioactive atom is injected into the blood. The amount of radioactivity used is very low. Because cancer cells in the body are growing quickly, they absorb larger amounts of the sugar than normal body tissues. A special camera can then create a picture of areas of radioactivity in the body. The picture is not finely detailed like a CT or MRI scan, but it can provide helpful information about whether abnormal areas seen on other tests (such as MRIs) are likely to be cancerous or not.

A PET scan is sometimes useful in diagnosing brain tumors and seeing how they respond to treatment. After treatment, abnormal areas may still show up on an MRI scan. PET scans can help determine if the abnormality is remaining tumor or if it is more likely to just be scar tissue.

Angiogram

This is another imaging test sometimes used to evaluate brain and spinal cord tumors. For this test, a special dye is injected into blood vessels near the tumor and the area then is viewed with x-rays. This helps doctors look at a tumor's blood supply. This test has largely been replaced by magnetic resonance angiography (MRA) or computerized tomographic angiography (CTA) in recent years.

The brain tumor team

If a brain tumor is diagnosed or strongly suspected, your child should be seen at a children's cancer center by a team of specialists. At first a neurosurgeon usually takes overall responsibility for your child's evaluation and then does the surgery. Before treatment, the team's social worker will help you, as a parent, understand the tests that will need to be done. The social worker will also counsel you about the problems you and your child may have during and after surgery, and may be able to help you find housing and financial aid if needed.

Other team members, such as a psychologist, endocrinologist, and specialists in rehabilitation, may also see your child before treatment begins. For example, if the tumor is slow growing and your child's condition is stable, he or she may be seen by a psychologist before treatment to assess any damage done by the tumor. Most of the work of these specialists takes place after treatment.

Biopsies to obtain tissue samples

A biopsy is the removal of a sample of tissue to see whether cancer cells are present. Different kinds of biopsies may be used to diagnose a brain tumor or to help determine how far it may have spread.

Brain or spinal cord tumor biopsy

Imaging tests such as MRI and CT scans may show that a brain or spinal cord tumor is present (or very likely). But usually a definite diagnosis of the type of tumor can be made only by removing some of the tumor tissue and having a neuropathologist (a doctor who specializes in diagnosing diseases of the nervous system by lab tests) look at it under a microscope.

In some cases, such as for many brain stem gliomas, it may not be possible to remove the tumor, and the diagnosis may be made based only on how the tumor looks on imaging tests (without getting a tumor sample).

Biopsies may be done in different ways.

Craniotomy: In most cases, the sample is obtained during a surgical procedure called a craniotomy that will remove as much of the tumor as possible. (A craniotomy is described in more detail in "How are brain and spinal cord tumors in children treated?")

Stereotactic biopsy: This type of biopsy may be used in cases where the risks of craniotomy might be too high (such as with some tumors deep within the brain) but a sample is still needed to make a diagnosis.

For this procedure, the surgeon injects a local anesthetic into areas of skin over the skull to numb them. (The skull and brain itself do not feel pain.) A rigid frame may then be fixed onto the child's head. This helps make sure the surgeon will target the tumor precisely. A small incision is made in the scalp and a small hole is drilled in the skull. An MRI or CT scan is used along with the frame to help the neurosurgeon guide a hollow needle into the tumor to remove a small piece of tissue. Another approach is to attach markers to the scalp, have an MRI or CT scan, and then use an image-guidance system to direct the needle into the tumor. In selected cases the procedure may be done under general anesthesia (where the child is asleep).

The biopsy samples are then looked at under a microscope by a neuropathologist. The doctor can usually tell exactly what type of tumor it is. This helps determine the best course of treatment and the prognosis (outlook).

Lumbar puncture (spinal tap)

This test is used to look for cancer cells in the cerebrospinal fluid (CSF), which is the liquid that bathes the brain and spinal cord. For this test, the doctor first numbs an area in the lower part of the back over the spine. The doctor may also recommend that the child be given something to make them sleep so the child won't squirm during the procedure. Squirming may keep the spinal tap from being done cleanly. A small, hollow needle is then placed between the bones of the spine to withdraw some of the fluid.

The fluid is looked at under a microscope for cancer cells. Tests can be also done on the CSF to check for certain substances released by some germ cell tumors.

Bone marrow aspiration and biopsy

Because some tumors (especially medulloblastomas) can spread beyond the nervous system, in some instances the doctor may recommend looking at cells in your child's bone marrow to see if the tumor has spread there.

The bone marrow aspiration and biopsy are often done at the same time. The samples are usually taken from the back of the pelvic (hip) bone, although in some cases they may be taken from the sternum (breastbone) or other bones.

In bone marrow aspiration, the skin over the hip and the surface of the bone are cleaned and numbed with local anesthetic. In most cases, the child is also given other medicines to reduce pain or even be asleep during the procedure. A thin, hollow needle is then inserted into the bone, and a syringe is used to suck out (aspirate) a small amount of liquid bone marrow.

A bone marrow biopsy is usually done just after the aspiration. A small piece of bone and marrow is removed with a slightly larger needle that is twisted as it is pushed down into the bone. Once the biopsy is done, pressure is applied to the site to help stop any bleeding

The specimens are then looked at under a microscope for tumor cells.

Blood and urine tests

These lab tests are rarely used to diagnose brain and spinal cord tumors, but if your child has been sick for some time they may be done to check how well the liver, kidneys, and some other organs are working. This is especially important before any planned surgery. If your child is getting chemotherapy, blood tests will be done routinely to check blood counts and to see if the treatment is affecting other parts of the body.

Last Medical Review: 04/07/2008
Last Revised: 05/13/2009