Pediatric gliomas are also known as childhood gliomas. They’re a type of tumor that can develop in a child’s central nervous system (CNS), including their brain or spinal cord.
Gliomas are tumors that grow from glial cells, which are a type of cell that support and protect nerve cells in the brain and spinal cord. There are multiple types of gliomas that may start in different types of glial cells and in different parts of the brain or spinal cord.
Some gliomas are low grade, which means the tumor cells tend to grow slowly. Other gliomas are high grade, which means the tumor cells tend to grow quickly and are more likely to spread. Low grade gliomas are often easier to treat than high grade gliomas.
If your child develops a glioma, their doctor will order tests to learn what type of glioma they have and whether the tumor is low or high grade. Your child’s treatment plan and outlook will depend on multiple factors.
Here’s what to know about these types of childhood tumors.
Different types of childhood gliomas may start in different types of glial cells:
- Astrocytomas are gliomas that start in astrocytes, which are glial cells that help support and carry nutrients to nerve cells. Examples include pilocytic astrocytomas, which are often slow growing, and glioblastomas, which are often fast growing.
- Ependymomas are gliomas that start in ependymal cells, which are glial cells that line fluid-filled spaces in the brain and spinal cord. This type of tumor may cause hydrocephalus, which happens when cerebrospinal fluid builds up in cavities in your child’s brain.
- Oligodendrogliomas are gliomas that start in oligodendrocytes, which are glial cells that make the myelin sheath that wraps around nerve cells. The myelin sheath helps electrical signals travel more quickly between nerve cells.
Glioma tumors may also be classified according to:
- their grade, or the likelihood that they will grow and spread
- where they’re located in your child’s CNS
- whether they’re diffuse or not
- whether they have specific gene changes
Grade
Gliomas are typically classified into four grades, which describe how abnormal the tumor cells appear under a microscope, how quickly the tumor is likely to grow, and whether the tumor is likely to spread.
- Grade I and II gliomas are considered low grade: They tend to grow slowly and are less likely to spread from one area of your child’s brain or spinal cord to another, although they may press on healthy areas of the brain or spinal cord as they grow. Most low grade gliomas are treatable.
- Grade III and IV gliomas are considered high grade: They tend to grow quickly and are more likely to spread from one area of your child’s brain or spinal cord to another, which makes them harder to treat.
Location
A glioma may start in different parts of the CNS, such as the:
- cerebellum, which coordinates balance, movement, and other motor functions
- hypothalamus, which coordinates hormone systems and autonomic functions such as body temperature
- brain stem, which coordinates autonomic functions such as breathing, heart rate, and blood pressure
- optic nerve, which carries signals between the child’s eye and brain
- spinal cord, which carries signals between the brain and other parts of the body
Some gliomas may spread from one part of the CNS to another.
Low grade gliomas are less likely than high grade gliomas to spread.
Diffuse vs. non-diffuse
Diffuse glioma tumors have poorly defined edges, with cells that are spread throughout normal tissue.
Non-diffuse or focal glioma tumors have more clearly defined edges, with cells that are clustered together in one area of the brain or the spinal cord.
Gene changes
Glioma tumor cells have changes in one or more genes that help the cells divide and spread. Different gliomas may have changes in different genes, such as the BRAF, IDH1, or IDH2 genes.
If your child has a glioma, their treatment options and outlook may vary depending on whether the tumor cells have changes in specific genes.
A childhood glioma develops when changes in glial cells cause the cells to grow and divide more quickly than usual. Experts don’t know exactly what causes these cell changes.
The risk of childhood glioma is higher in children with certain inherited genetic disorders, such as neurofibromatosis type 1 and tuberous sclerosis.
Talk with your child’s doctor if they have an inherited genetic disorder that increases their risk of tumors. Their doctor can help you learn how to monitor your child’s condition for signs of glioma or other types of tumors.
The symptoms of childhood glioma vary based on:
- where the tumor forms
- how big the tumor is
- how fast it’s growing
- your child’s age and developmental stage
Potential signs and symptoms of childhood glioma include:
- headache
- nausea
- vomiting
- changes in energy levels or sleepiness
- changes to vision, hearing, or speech
- difficulties with balance or walking
- weakness or unusual sensations on one side of the body
- changes in behavior or personality
- changes in weight
- increased head size
Talk with a doctor if your child develops any of these signs or symptoms. They can help you learn whether a childhood glioma or another health condition is causing the symptoms.
However, in some cases, childhood glioma causes no noticeable symptoms.
If your child develops signs or symptoms of glioma, your child’s doctor will ask about their symptoms and their personal and family medical history.
They will also conduct a neurologic exam, which may include questions and tests to check various functions, including:
- reflexes
- sensation
- muscle strength
- coordination
- balance
- alertness
- vision
This can help the doctor determine how well your child’s CNS is working.
Sometimes doctors find gliomas or other types of brain or spinal cord tumors that are causing no noticeable symptoms when they conduct medical tests for other health conditions.
Your child’s doctor may order one or more of the following tests if they suspect that your child has a glioma or another type of brain or spinal cord tumor.
Imaging tests
Your child’s doctor may order imaging tests such as magnetic resonance imaging (MRI) or a CT scan to check for tumors or other changes in your child’s brain or spinal cord.
A healthcare professional might inject a contrast agent into one of your child’s veins before an MRI or CT scan. A contrast agent is a chemical that helps structures such as cancer cells show up more clearly in pictures. Examples include gadolinium-based contrast agents for MRI and iodinated contrast agents for CT scans.
MRI tends to produce more detailed pictures of brain and spinal cord tumors than a CT scan.
Your child’s doctor might order a follow-up MRI if a CT scan shows signs of a tumor.
Tumor biopsy and analysis
Your child’s doctor may order a biopsy to collect a tissue sample from a tumor that appears on an MRI, CT scan, or other imaging tests.
Depending on where the tumor is located, they may order:
- Needle biopsy: A doctor inserts a needle into the tumor to collect a tissue sample.
- Excisional biopsy: A doctor uses surgery to remove the entire tumor.
If the doctor can conduct a biopsy, they will send the tissue sample that they collect to a laboratory for analysis. A pathologist will examine the tissue sample under a microscope to check for cancer cells. They may also use one or more of the tests below to learn more about the tissue sample and cancer cells.
Sometimes a glioma may develop in an area of the brain or spinal cord that a doctor can’t safely reach for biopsy. The doctor will make a diagnosis and recommend treatment based on other tests instead.
Immunohistochemistry
Immunohistochemistry can help pathologists learn whether tumors are cancerous and what specific type of cancer they are. To conduct this test, the pathologist uses antibodies to check for specific antigens in the tumor tissue. Antibodies are proteins that the immune system makes to help identify antigens, which are markers of disease.
The pathologist uses antibodies that are linked to a fluorescent dye or enzyme that gets activated when an antibody attaches to a specific antigen. This makes the antigen visible under a microscope.
Molecular testing
A molecular test can help a pathologist learn whether certain genes, proteins, or other molecules are present in tumor tissue. This can help them identify the best treatment approach.
Lumbar puncture
Your child’s doctor may order a lumbar puncture to collect a sample of cerebrospinal fluid to check for signs of cancer or other diseases. This procedure is also known as a spinal tap.
A doctor numbs an area on your child’s lower back and insert a small hollow needle between the bones of their spine to draw a sample of cerebrospinal fluid. Sometimes they may give your child medication to help them sleep during the procedure.
The doctor sends the sample of cerebrospinal fluid to a laboratory, where a pathologist may check it for markers of cancer and other types of disease.
Your child’s treatment plan will depend on multiple factors, such as:
- their overall health
- the grade of glioma they have
- the location and size of the glioma
- whether they have symptoms
- whether the glioma is newly diagnosed or has come back after prior treatment
Your child’s doctor might recommend observation without treatment if your child has a small glioma that isn’t causing symptoms. They will schedule regular visits to monitor your child’s condition and may recommend treatment if their condition changes.
Your child’s doctor might recommend one or more of the treatments below if your child has a glioma that’s causing symptoms or is likely to grow or spread quickly.
Surgery
Your child’s doctor may recommend surgery to remove all or part of the glioma if it’s located in an area of your child’s brain or spinal cord that a surgeon can safely reach. Surgery may not be an option if the tumor has grown or spread into parts of your child’s brain or spinal cord that are hard to reach without causing too much damage.
Your child’s doctor will order an MRI after surgery to learn whether any of the tumor remains.
Their doctor may recommend one or more of the following treatments if any of the tumor remains:
- radiation therapy
- chemotherapy
- targeted therapy
Sometimes the doctor may recommend observation without additional treatment after surgery.
Radiation therapy
Radiation therapy uses high energy X-rays or other forms of radiation to kill glioma cells or stop them from growing.
Radiation therapy to your child’s brain may affect its development, especially if your child is very young.
If your child is under 3 years old, their doctor might recommend other treatments instead of radiation therapy or encourage you to wait until your child is older before starting radiation therapy.
Chemotherapy
Chemotherapy drugs damage fast-dividing cells in your child’s body, including cancer cells. This treatment can help kill glioma cells or stop them from dividing.
Examples of chemotherapy drugs include:
- carboplatin (Paraplatin)
- irinotecan (Camptosar)
- lenalidomide (Revlimid)
- lomustine (Gleostine)
- procarbazine (Matulane)
- temozolomide (Temodar)
- thioguanine (Lanvis, Tabloid)
- vinblastine (Velban)
- vincristine (Oncovin)
Your child’s doctor may prescribe one or more chemotherapy drugs, on their own or with other treatments.
Targeted therapy
Targeted therapy helps block the action of certain proteins, enzymes, or other molecules that help cancer cells grow and spread.
Examples of targeted therapy drugs include:
- bevacizumab (Avastin)
- dabrafenib (Tafinlar)
- everolimus (Afinitor)
- larotrectinib (Vitrakvi)
- selumetinib (Koselugo)
- sirolimus (Rapamune)
- trametinib (Mekinist)
Your child’s doctor may prescribe targeted therapy in combination with surgery. Targeted therapy is also a treatment option for some childhood gliomas that cannot be removed by surgery, as well as some gliomas that return or start growing again after treatment.
Immunotherapy
Immunotherapy may help your child’s immune system identify and kill glioma cells.
Researchers are studying multiple types of immunotherapy for childhood gliomas, including:
- oncolytic virus therapy, which uses a virus to infect cancer cells and trigger an immune response
- chimeric antigen receptor (CAR) T-cell therapy, which modifies T-cells in the immune system to help them target and kill cancer cells
- immune checkpoint inhibitors, which block certain proteins that allow cancer cells to hide from the immune system
The FDA has not yet approved any of these immunotherapies for gliomas, which means they’re not widely available outside of clinical trials.
Your child’s doctor might encourage them to join a clinical trial for immunotherapy if they think it might be beneficial. A clinical trial is a research study that examines how safe and effective a treatment or other medical intervention is. Your child’s doctor and the clinical trial research team can help you and your family learn more about the potential benefits and risks of participating in a trial.
Other treatments
Your child’s doctor may recommend other treatments to manage symptoms or complications of glioma or side effects from treatment. For example, they might prescribe:
- pain medication to manage pain
- dietary changes to manage nausea or changes to your child’s appetite or weight
- anti-seizure medication if your child develops seizures from a glioma
- surgery to drain cerebrospinal fluid if your child has too much fluid building up in their brain or around their spinal cord
The doctor may also recommend rehabilitation if your child develops changes to their balance, muscle movements, speech, or other abilities due to a glioma or treatment side effects.
The outlook for those with childhood gliomas varies widely, depending on factors such as:
- your child’s age and overall health
- whether your child has a low grade or high grade glioma
- where the tumor is located, how fast it’s growing, and whether it’s spread
- whether the tumor has changes in certain genes, such as the BRAF gene
- whether the glioma is newly diagnosed or has come back after previous treatment
- how your child’s condition responds to treatment
The survival rates vary from one type of glioma to another. For example, the
The outlook for children with low grade gliomas is generally good if a surgeon can safely remove the tumor. The outlook for children with inoperable or high grade gliomas tends to be much less optimistic.
Researchers are continuing to develop and study new treatments to help improve the outlook for children with inoperable or high grade gliomas.
Sometimes gliomas come back after treatment. This is known as a recurrence. The tumor may grow back in the same area of the brain or spinal cord, or in a different area. Low grade gliomas sometimes come back as high grade gliomas.
Talk with your child’s doctor to learn more about their condition, treatment options, and outlook. The doctor will monitor your child’s condition during treatment. They may recommend changes if the glioma continues to grow, spreads, or causes new symptoms, or your child develops treatment side effects that are hard to manage.
Your child’s doctor will also schedule follow-up visits after treatment is finished to check for signs of recurrence or late side effects that may develop months or years after treatment. For example, late side effects may include changes to your child’s vision, memory, or other aspects of their health. Your child’s doctor can help you learn how to recognize and manage these types of potential side effects.
Childhood gliomas are tumors that begin in glial cells in a child’s brain or spinal cord.
Multiple types of gliomas may develop in children. Some types grow more quickly and are more likely to spread than other types. Some types are more treatable than others.
If your child develops a glioma, their treatment options and outlook will depend on the specific type of glioma they have, where the tumor is located, how large the tumor is, and how fast it’s growing. Your child’s age, development, and overall health may also affect their treatment or outlook.
Their doctor may recommend surgery, radiation therapy, medication, or a combination of these treatments to help kill tumor cells or stop them from dividing. They may also recommend treatments or strategies to manage symptoms, complications, or treatment side effects.
Talk with your child’s doctor to learn more about their condition, treatment options, and outlook. Let their doctor know if you notice changes to your child’s health or you’re interested in exploring other treatment options or clinical trials.
Your child’s doctor may also recommend support services to help you and your family manage the challenges of your child’s condition and care needs.