Childhood Cancer

The brain and spinal cord make up the central nervous system (CNS). These organs coordinate all of the functions necessary for life, including breathing, regulating heart rate, thinking, and moving. Tumors of the brain and spinal cord begin with the transformation of a single cell. This renegade cell reproduces, creating more abnormal cells. Eventually, this collection of abnormal cells forms a tumor in the brain or spinal cord. The location of the tumor (also called a mass), its rate of growth, and the associated swelling determine the signs and symptoms that develop in a child. Chapter 3, Types of Tumors, provides in-depth descriptions of the various types of brain and spinal cord tumors.

Parents are usually the first to notice that something is wrong with their child. Occasionally, a pediatrician notices a problem during a well-baby visit, or the tumor is discovered by chance on a scan or other test. Unfortunately, some of the signs and symptoms of brain and spinal cord tumors mimic common childhood illnesses, which can make diagnosis difficult.

The following are some of the signs and symptoms that may indicate the presence of a childhood brain tumor:

  • Headaches (often with early morning vomiting)
  • Dizziness
  • Seizures (convulsions)
  • Staring spells
  • Loss of peripheral vision
  • Double vision
  • Nystagmus (jiggling of an eyeball from side to side)
  • Inability to look up
  • One eye turns inward or outward
  • Weakness in hands on one or both sides of the body
  • Unsteady gait
  • Change in speech
  • Trouble swallowing
  • Drowsiness
  • Facial drooping or asymmetry
  • Nausea relieved by vomiting
  • Hormonal or growth problems
  • Hearing loss
  • Changes in appetite or thirst
  • Behavior changes
  • Change in school performance

The following are signs and symptoms that may indicate the presence of a spinal cord tumor in a child:

  • Back or neck pain, which may awaken the child from sleep
  • Scoliosis (curvature of the spine, resulting in leaning of shoulders to one side or a noticeable hump in the back)
  • Torticollis (tilting of the head and upper spine to one side)
  • Weakness or sensory changes in arms or legs
  • Changes in bowel and bladder control

These symptoms can be present for a long or short period of time, depending on the location and growth rate of the tumor. A child with a brain or spinal cord tumor usually has more than one symptom.

Most parents react to their concerns by taking their child to a doctor. Sometimes the symptoms are attributed to a normal childhood illness, and parents bring their child in for more visits before a brain tumor is suspected. This is easier to understand when you consider that, in their entire careers, most pediatricians see only one or two children with brain or spinal cord tumors. Ultimately, the doctor orders a scan or refers the child to a specialist, such as a pediatric neurologist, for further tests (see Chapter 6, Coping with Procedures.)

Alannah was 4 years old when she was diagnosed with a brainstem glioblastoma. On December 23, my daughter’s school called my wife to have her pick up Alannah because she had vomited, although she appeared fine afterward.

On Christmas Eve, Alannah woke up, and after playing for awhile, began complaining of a headache. We assumed she had picked up some sort of virus at her school. Later that day, we went to my parents’ house for a traditional Christmas Eve gathering. Alannah began having trouble walking, and appeared to be looking at everything with her eyes shifted to the left. We laid her down in the guest room and a few minutes later, she threw up again. We still figured that we were dealing with a “bug,” so we cleaned her up and went home. The following morning, she seemed fine except that her eyes were still fixed to the left. Later in the day, she started to have trouble with her balance and walking again. We took her to our local urgent care, still expecting to be told that she had a virus.

First, she was examined by a nurse practitioner. After checking Alannah’s eyes, she quickly called in the doctor on duty. After a brief examination, he told me that he wanted to send her to the hospital by ambulance for a CT [computed tomography] scan. He said that while it might be a virus affecting her brain, he wanted the scan done to be sure that nothing else was wrong. Once we arrived at the hospital, several doctors examined Alannah. After waiting for about 2 hours, the CT scan was performed. Shortly thereafter, the physician called my wife and I out of the room and showed us the scan. She showed us what she called a “mass” on Alannah’s brainstem, and told us that she would admit Alannah to the hospital and order an MRI. After another couple of hours in the ER we were transferred to a room on the fifth floor, in shock and disbelief, waiting for them to discover their mistake, and send us home.

The diagnosis of a brain or spinal cord tumor is sometimes not as quick as Alannah’s:

The first signs were so subtle: the slight but constant inward turn of our son’s left eye became apparent to us within the first few months of life. By the time he was 7 months old, we were concerned enough to bring it to our pediatrician’s attention. He felt it was just normal uncoordinated eye movement. Every well-baby visit we brought the same problem to his attention. When our son was a year old, we were finally referred to an eye specialist—a pediatric ophthalmologist. Another year of visits began: the specialist insisted his eye was fine. We were just as certain the eye wasn’t right, and we thought we could now see the eyeball jiggling. Then the ophthalmologist referred us to a pediatric orthoptist at a local Lions’ Club clinic. She listened to our concerns, examined our son’s eyes, and wrote a letter for our pediatrician verifying the abnormalities. Based on her report, our pediatrician agreed to schedule an MRI. Our son was 2 years and 2 months old by the time he was diagnosed with a moderately large optic glioma.