Gliomas in children

A glioma is a tumour that grows in the glial cells of the brain or spinal cord. Glial cells surround nerve cells and help them work well.

Gliomas can be benign (not cancerous) or malignant (cancerous). In children, they can grow in:

• the cerebrum (the front part of the brain)
• the cerebellum (the back part of the brain)
• the brain stem (the part of the brain connected to the spinal cord)
• the optic nerves (the nerves that control eyesight)

Gliomas can grow slowly (called 'low grade') or quickly (aggressive or 'high grade'). If the tumour is Grade 1 or 2 it is low grade; if it is Grade 3 or 4 it is high grade.

There are different types of gliomas.

Astrocytomas

The terms 'astrocytoma' and 'glioma' are often used interchangeably. These can be high or low grade.

The different types of astrocytoma include:

• juvenile pilocytic astrocytoma (JPA), the most common low-grade tumour in children, which usually grows in the back part of the brain
• glioblastoma multiforme (GBM), a high-grade tumour that usually grows in the upper part of the brain
• anaplastic astrocytoma, a high-grade tumour that usually grows in the upper part of the brain

Diffuse midline gliomas (DMG)

Diffuse midline gliomas include tumours that are sometimes called diffuse intrinsic pontine gliomas (DIPGs).

These are tumours that grow in the brain stem, which controls heart rate and breathing.

Optic pathway gliomas

These are gliomas that grow in the optic nerve. The optic nerve connects the brain with the eyes.

The symptoms of a glioma will depend on:

• where the tumour is
• how fast it is growing
• the age of the child with the tumour

Symptoms can happen because of the pressure of the growing tumour on the brain and include:

• headaches, especially in the morning — the headache often goes away after vomiting
• nausea or vomiting
• problems with vision, hearing or speech
• problems with balance and coordination, or trouble walking
• weakness or numbness in a part of the body, especially only on one side
• back pain
• changes in behaviour

Other symptoms can include:

• weight loss or weight gain for no reason
• seizures
• drowsiness or coma

In babies, symptoms may include:

• loss of appetite
• developmental delays
• loss of physical or mental abilities they had before
• swelling of the head
• irritability
• slow weight gain (Opens in new tab) (sometimes called 'failure to thrive')

Remember that all these symptoms can be due to other conditions and don't necessarily mean your child has a glioma.

Doctors don't know why some children develop gliomas.

Gliomas are more common in children who:

• have a family history of brain cancer
• have had exposure to radiation
• have some genetic conditions

If you are worried about your child's symptoms, see your doctor.

Your doctor will ask about your child's symptoms and examine them.

If your doctor thinks that your child may have a glioma, your child will need medical tests.

These may include:

• blood tests
• urine (wee) tests
• scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET)
• a biopsy
• a lumbar puncture to sample the fluid from around the spinal cord

If your child has a glioma, they will be looked after by a team of health professionals, known as a multidisciplinary team.

Specialists your child might see include:

• paediatric oncologist (doctor who specialises in childhood cancer)
• paediatric surgeon (doctor who specialises in operating on children)
• neurologist (specialist in diseases of the brain and spine)
• radiation oncologist (doctor who specialises in using radiotherapy to treat cancer)
• endocrinologist (doctor who specialises in hormones and body development)
• paediatric oncology nurses (nurses who specialise in caring for children with cancer)

Other healthcare professionals your child might see include:

• your child's regular doctor
• social workers
• rehabilitation therapists
• psychologists or other mental health professionals
• cancer care coordinators
• physiotherapists
• speech therapists

Your child's treatment will depend on:

• their age
• the type of glioma
• where the glioma is in the brain or spinal cord
• how quickly the glioma is growing
• how your child reacts to the treatment

Your doctor will suggest treatment options based on your child's situation. Most children have a mix of treatments. Treatment can last for several years.

Surgery

Surgical treatment will attempt to remove as much of the glioma as possible. Surgery might not always be possible, for example if the tumour is in a very delicate part of the brain (such as the brain stem) or if the tumour has spread to other brain tissue.

Surgery might be the only treatment needed, especially if it is a slow-growing (low-grade) tumour.

Radiotherapy (radiation treatment) and chemotherapy (cancer medicine) can shrink the tumour. Radiotherapy is not usually suitable for children aged under 3 years due to its effects on the developing brain.

New treatments

There have been many advances in treating brain cancer recently.

Some centres in Australia now offer advanced radiotherapy techniques such as:

• radiosurgery
• gamma knife
• proton beam therapy
• precise surgery techniques, such as cyberknife therapy

There are also targeted therapies that attack cancer cells without harming healthy cells.

Your child might also be able to take part in a clinical trial, giving them access to new medicines. Ask your oncologist for more information on this.

Other treatments

Your child might receive other medicines, such as:

• steroids, to reduce swelling and improve symptoms
• hormones, if the treatment has affected their hormone balance
• medicines to stop seizures
• medicines to manage pain

After treatment finishes, your child will need regular check-ups and scans. Gliomas can come back again. If this happens, the medical team might suggest different treatments.

For more information on coping with a cancer diagnosis in childhood, see:

• Support for children with cancer
• Support for parents of children with cancer

Due to advances in the treatment of children's cancer, many children with cancers survive into adulthood. Talk to your doctor about your child's diagnosis and prognosis (expected outcome).

Your child's prognosis will depend on:

• their age at diagnosis
• the type of glioma they have
• where the tumour is and whether it is slow or fast growing
• how the glioma responds to treatment

Living with a glioma can be challenging for both children and their families. Treatment and recovery may take time, and the effects of the tumour or its treatment can vary for each child.

Some children may experience changes in movement, speech, vision, learning or mood.

Support from your health team can help your child adapt and continue to grow and learn.

Regular follow-up appointments are important to check your child's health and watch for any signs that the tumour has come back. Many children continue to live full and active lives after treatment, but some may need ongoing therapies or educational support.

Emotional wellbeing is also important. Counselling, support groups, and organisations that help children and families living with cancer can provide comfort, guidance, and practical help.

Talk to your doctor or care team about the support available for your child and family during and after treatment.

Gliomas can cause a range of complications depending on the child's age, the type and grade of the tumour, and where it is located in the brain or spinal cord. Because gliomas grow within delicate brain tissue, they can interfere with vital functions that control movement, speech, vision and other body systems.

Complications caused by the tumour

Gliomas may lead to a range of complications:

• Increased pressure inside the skull (raised intracranial pressure) can cause headaches, nausea, vomiting or drowsiness.
• Seizures (fits) can happen due to abnormal electrical activity in the brain.
• Your child may experience weakness or paralysis on one side of the body, or problems with balance, coordination or walking.
• They may have changes to their vision or hearing (particularly in optic pathway gliomas, which can cause partial or complete vision loss).
• Behavioural or personality changes may occur, including irritability or difficulty concentrating.
• There may be hormonal or growth problems, especially if the tumour affects the hypothalamus or pituitary gland.

Complications related to treatment

Treatments such as surgery, radiotherapy, and chemotherapy can also cause side effects.

These may be short-term or long-term and can include:

• fatigue or nausea during or after treatment
• learning and memory difficulties that may affect school performance
• endocrine (hormonal) changes, leading to problems with growth, puberty, or fertility
• hearing or vision problems due to radiation exposure
• infection or bleeding after surgery
• second cancers or tissue damage later in life — these are rare

Long-term and serious complications

While many children now survive into adulthood, some gliomas, particularly high-grade tumours such as glioblastoma or diffuse midline glioma, can be life-threatening. These cancers can grow quickly, spread within the brain, and are often difficult to remove completely. The expected outcome depends on:

• the child's age at diagnosis
• the tumour's location and grade
• how much of the tumour can be safely removed
• how the tumour responds to treatment

Because of these risks, children with glioma need long-term follow-up care. Doctors will check for tumour recurrence, late effects of treatment, and their wellbeing. Support from a broad range of health services can help children and families manage ongoing challenges and maintain quality of life.

Doctors don't fully understand what causes some brain tumours in children. If a child develops cancer, it's never because of something they or their parents did to cause it. No one is to blame if a child develops cancer.

For more information on gliomas in children and for support, try the following resources.

Information about childhood cancer

Cancer Australia (Opens in new tab) has information on children's cancer and links to support organisations for children with cancer and their families.

Cancer Council (Opens in new tab) has information on childhood cancers (Opens in new tab).

Camp Quality's (Opens in new tab) Kids' Guide to Cancer app (Opens in new tab) provides age-appropriate cancer education for children up to 15 years old.

Family and financial support

The Canteen (Opens in new tab) and Camp Quality (Opens in new tab) provides free advice, support and counselling for parents of children with cancer.

Canteen has a guide for young cancer patients (Opens in new tab), translated into languages other than English.

The Children's Cancer Foundation (Opens in new tab) provides family support and information about the latest treatments.

Kids with Cancer Foundation Australia (Opens in new tab) provides financial help to children with cancer and their families.

Brain Tumour Alliance Australia (Opens in new tab) has a support line (1800 857 221) and offers multicultural support (Opens in new tab).

Redkite (Opens in new tab) is a national organisation that provides emotional support, financial help, information and resources to families who have a child with cancer.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.