What is a brain tumour?

A brain tumour may arise from the brain itself or from the membranes surrounding the brain. There are over 100 different types of brain tumour and they can be named from the originating type of brain cell or from the location of the tumour or both. The prognosis is very variable between differing tumour types. In children more than 80% of brain tumours are one of the following types: Astrocytomas, Primitive Neuroectodermal tumours (PNET) or Ependymomas.

The symptoms of brain tumours in children depend on 3 main factors:

• age,
• tumour location; and
• absence/presence of raised intracranial pressure.

In this guidance symptoms are split in to general symptoms that any child with a brain tumour may have and symptoms related to the tumour’s location in the brain.

Whether a tumour can be cured will depend on how aggressive the tumour is (cell type and grade - see link at bottom of page), surgical accessibility and what treatment options are possible (determined by age of child and location of tumour). Generally high grade tumours have a worse prognosis than low grade ones but some high grade lesions have an excellent chance of cure (e.g. germinoma) and some low grade/ benign tumours may be life threatening and may cause significant disability.

This guidance will describe disabling effects that may arise as a result of the direct effect from the tumour in different parts of the brain and secondary effects as a result of morbidity/toxicity from the different treatment methods used (surgery, radiotherapy and chemotherapy). A list of brain tumours and their likely outcome in terms of survival is provided, although this can only provide a guide due to the complexity of prognostic factors (see link at bottom of page). Specific disabling effects and outcome of treatment can be anticipated if the tumour type, location and treatments used are known. Other effects such as fatigue and somnolence (drowsiness) may be more general and non-specific.

Medical evidence is likely to give the name of the tumour concerned and describe the location, treatment outline and resulting disabilities. Brain tumours very rarely spread to other organs unlike other cancers; however some tumour types (e.g. PNET, ependymoma) can spread within the central nervous system to other parts of the brain or spine. This means that children with primary CNS or brain tumours have a different pattern of disabling effects compared to children with other kinds of cancer. When a brain tumour progresses it gives rise to new symptoms/ signs and resulting disability by virtue of local extension, metastatic spread to other areas of the brain and possibly causing raised intracranial pressure.

What is the incidence/prevalence?

Brain and spinal cord tumours are the second most common form of cancer in childhood after leukaemia. These make up 20-25% of cancers in children and 350 to 400 new cases are diagnosed each year in Great Britain in those under 16 years of age. 5 year survival for this group as a whole is over 60%; however this figure hides the wide variability in cure rates with some tumour types having a poor prognosis. Over half of survivors have significant and enduring neurological, developmental and or growth problems related to their disease or its treatment.

World Health Organisation (WHO) classification of brain tumours