Brain & Spinal tumors

From the 'American Cancer Society'

Brain and spinal cord tumors in children

Brain and spinal cord tumors are masses of abnormal cells that have grown out of control. In most other parts of the body, it is very important to distinguish between benign (non-cancerous) and malignant (cancerous) tumors. Benign tumors in other parts of the body do not invade nearby tissues or spread to distant areas, so they are almost never life threatening. One of the main reasons malignant tumors are so dangerous is because they can spread throughout the body and interrupt the way normal organs function.

Although brain tumors rarely spread to other parts of the body, most of them can spread through the brain and spinal cord tissue. Even so-called benign tumors can, as they grow, press on and destroy normal brain tissue, causing damage that is often disabling and can sometimes cause death. This is why doctors usually speak of “brain tumors” rather than “brain cancers.” The main concerns with brain and spinal cord tumors are how readily they spread through the rest of the brain or spinal cord and whether they can be removed and not come back. But both benign and malignant tumors can be life threatening.

Brain and spinal cord tumors are different in adults and children. They often form in different places, develop from different cell types, and may have a different treatment and prognosis (outlook). This document refers only to children’s tumors. Brain and spinal cord tumors in adults are discussed in our separate document, Brain and Spinal Cord Tumors in Adults.

The central nervous system

To understand brain and spinal cord tumors, it helps to know about the normal structure and function of the central nervous system (CNS), which is the medical name for the brain and spinal cord.

The brain is the center of thought, feeling, memory, speech, vision, hearing, movement, and much more. The spinal cord and special nerves in the head called cranial nerves carry messages between the brain and the rest of the body. These messages tell our muscles how to move, transmit information gathered by our senses, and help coordinate the functions of our internal organs.

The brain is protected by the skull. Likewise, the spinal cord is protected by the bones (vertebrae) of the spinal column.

The brain and spinal cord are surrounded and cushioned by a liquid called cerebrospinal fluid (CSF). Cerebrospinal fluid is made by the choroid plexus, which is located in spaces in the brain called ventricles. The ventricles and the spaces around the brain and spinal cord are filled with CSF.

Parts of the brain and spinal cord

The main areas of the brain include the cerebrum, cerebellum, and brain stem. Each area has a special function.

Cerebrum: The cerebrum is the large, outer part of the brain. It is made up of 2 hemispheres (halves) and controls reasoning, thought, emotion, and language. It is also responsible for planned (voluntary) muscle movements (throwing a ball, walking, chewing, etc.) and for taking in and interpreting sensory information such as vision, hearing, smell, touch, and pain.

The symptoms caused by a tumor in a cerebral hemisphere depend on where the tumor develops. Common symptoms include:

  • Seizures
  • Trouble speaking
  • A change of mood such as depression
  • A change in personality
  • Weakness or paralysis in a part of the body
  • Changes in vision, hearing, or other senses

Cerebellum: The cerebellum lies under the cerebrum at the back part of the brain. It helps coordinate movement.

Tumors of the cerebellum can cause problems with coordination in walking; trouble with precise movements of hands, arms, feet, and legs; problems with swallowing or synchronized eye movements; and changes in speech rhythm.

Brain stem: The brain stem is the lower part of the brain that connects to the spinal cord. It has bundles of very long nerve fibers that carry signals controlling muscles and sensation or feeling between the cerebrum and the rest of the body. Special centers in the brain stem also help control breathing and the beating of the heart. In addition, most cranial nerves (which carry signals directly between the brain and the face, eyes, tongue, mouth, and some other areas) start in the brain stem.

The brain stem is divided into 3 main parts: the midbrain, pons, and medulla oblongata. 

Tumors in this critical area of the brain can cause weakness, stiff muscles, or problems with sensation, facial or eye movement, hearing, or swallowing. Double vision is a common early symptom of brain stem tumors, as are problems with coordination in walking. Because the brain stem is a small area that is so essential for life, it might not be possible to surgically remove tumors in this area.

Spinal cord: The spinal cord has bundles of very long nerve fibers that carry signals that control muscles, sensation or feeling, and bladder and bowel control.

Spinal cord tumors may cause weakness, paralysis, or numbness. The spinal cord is a narrow structure, so tumors that develop there usually cause symptoms on both sides of the body (for example, weakness or numbness of both legs). This is different from most tumors of the brain, which often affect only one side of the body.

The nerves that reach the arms leave the spinal cord at the level of the neck (cervical spine). Most tumors of the spinal cord develop below the neck (in the thoracic or lumbar spine), so they only affect the lower body (the legs and bowel and bladder function).

Cranial nerves: The cranial nerves extend directly out of the base of the brain (as opposed to coming out of the spinal cord).

The most common cranial nerve tumors in children are called optic gliomas, which are tumors of the optic nerve (the large nerve that runs between the brain and each eye). These tumors cause vision problems. Tumors starting in other cranial nerves may cause trouble swallowing; hearing loss in one or both ears; or facial paralysis, numbness, or pain.

Types of cells and body tissues in the brain and spinal cord

The brain and spinal cord have many kinds of tissues and cells, which can develop into different types of tumors. These tumors can have different outlooks and may be treated differently.

Neurons (nerve cells): These are the most important cells in the brain. They transmit chemical and electric signals that determine thought, memory, emotion, speech, muscle movement, and just about everything else that the brain and spinal cord do. Neurons send these signals through their nerve fibers (axons). Axons in the brain tend to be short, while those in the spinal cord can be as long as several feet.

Unlike many other types of cells that can grow and divide to repair damage from injury or disease, neurons in the brain and spinal cord largely stop dividing about a year after birth (with a few exceptions). Neurons do not usually form tumors, but they can be damaged by tumors that start nearby.

Glial cells: Glial cells are the supporting cells of the brain. Most brain and spinal cord tumors develop from glial cells. These tumors are sometimes referred to as a group called gliomas.

There are 3 types of glial cells – astrocytes, oligodendrocytes, and ependymal cells. A fourth cell type called microglia is part of the immune system and is not truly a glial cell.

  • Astrocytes help support and nourish neurons. When the brain is injured, astrocytes form scar tissue that helps repair the damage. The main tumors starting in these cells are called astrocytomas or glioblastomas.
  • Oligodendrocytes make myelin, a fatty substance that surrounds and insulates the nerve cell axons of the brain and spinal cord. This helps neurons send electric signals through the axons. Tumors starting in these cells are called oligodendrogliomas.
  • Ependymal cells line the ventricles (fluid-filled areas) within the central part of the brain and form part of the pathway through which CSF flows. Tumors starting in these cells are called ependymomas.
  • Microglia are the immune (infection fighting) cells of the central nervous system.

Neuroectodermal cells: These are very early forms of nervous system cells that are probably involved in brain cell development. They are found throughout the brain. The most common tumors that come from these cells are called medulloblastomas, which start in the cerebellum.

Meninges: These are layers of tissue that line and protect the brain and spinal cord. The meninges help form the spaces through which CSF travels. The most common tumors that start in these tissues are called meningiomas.

Choroid plexus: The choroid plexus is the area of the brain within the ventricles that makes CSF, which nourishes and protects the brain. Tumors that start here include choroid plexus papillomas and choroid plexus carcinomas.

Pituitary gland and hypothalamus: The pituitary is a small gland at the base of the brain. It is connected to a part of the brain called the hypothalamus. Both make hormones that help regulate the activity of several other glands in the body. For example, they control the amount of thyroid hormone made by the thyroid gland, the production and release of milk by the breasts, and the amount of male or female hormones made by the testicles or ovaries. They also make growth hormone, which stimulates body growth, and vasopressin, which regulates water balance by the kidneys.

The growth of tumors in or near the pituitary or hypothalamus, as well as surgery and/or radiation therapy in this area, can affect these functions. For example, tumors starting in the pituitary gland sometimes make too much of a certain hormone, which can cause problems. On the other hand, a child may have low levels of one or more hormones after treatment and may need to take hormones to correct any deficiencies.

Pineal gland: The pineal gland is not really part of the brain. It is a small endocrine gland that sits between the cerebral hemispheres. It makes melatonin, a hormone that regulates sleep, in response to changes in light. The most common tumors of the pineal gland are called pineoblastomas.

Blood-brain barrier: The inner lining of the small blood vessels (capillaries) in the brain and spinal cord creates a very selective barrier between the blood and the tissues of the central nervous system. This barrier normally helps maintain the brain’s metabolic balance and keeps harmful toxins from getting into the brain. Unfortunately, it also keeps out most chemotherapy drugs that are used to kill cancer cells, which in some cases limits their usefulness.




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