What are brain tumors?

A brain tumor is a growth of abnormal cells in the brain. Brain tumors may be benign (noncancerous) or malignant (cancerous). Regardless of whether they are cancerous, all brain tumors can cause symptoms by producing inflammation and pressing on other parts of the brain. This pressure causes cerebral edema (brain swelling) and increased intracranial pressure (the pressure within the skull). Central nervous system tumors (tumors of the brain and spine) make up ~20 percent of all childhood cancers; they are the second most common form of childhood cancer after leukemia. Brain tumors are the most common solid tumor in children. Several of the more common types of brain tumors in children include medulloblastomas, gliomas and astrocytomas.

At Ochsner for Children, our Pediatric Oncologists work with a multidisciplinary team to provide state of the art care to children and young adults diagnosed with brain tumors. This includes pediatric oncologists, pediatric neurosurgeons, radiation oncologists, surgeons and physical therapists. We are very active in research and clinical trials designed to increase cure rates, decrease treatment-related side effects and improve care for long-term survivors.

How are brain tumors diagnosed?

Depending on the type and site of the tumor, a variety of techniques may be used to diagnose brain tumors. These include:

• Biopsy, in which a pediatric neurosurgeon performs a procedure to take a sample of the tumor in order to determine what type of tissue it is and to run special molecular tests.
• Magnetic resonance imaging (MRI), which uses strong magnets and a computer to produce detailed images of the brain and spine, is useful to help plan surgery and treatment of brain tumors.
• Computed tomography (CT) scan, which uses a combination of X-rays and computer to produce images of the body, is useful for evaluating both bones and soft tissues.
• Positron emission tomography (PET) scan, which uses radioactive sugar injected into a vein, is sometimes used to determine if the tumor has spread to other areas of the brain or spine.
• Lumbar puncture, in which a sample of fluid is taken from the base of the spine, is used for certain subtypes of tumors.
• Bone marrow biopsy, in which a small sample of bone marrow is obtained from the hip, is occasionally performed to determine if the tumor has spread to the bone marrow

How are brain tumors treated?

Treatment for brain tumors may involve a combination of therapies including surgery, radiation and/or chemotherapy. Treatment options may vary greatly, depending on your child's situation. Our pediatric oncologists work closely with a multidisciplinary team to create a personalized treatment plan that is best for your child.

• Surgery - Surgery is usually the first step in treating children with brain tumors. In some cases, only a biopsy is done. This is often necessary when the tumor is too close to critical structures in the brain, or when the neurosurgeon does not feel the tumor can In other cases, the tumor can be removed completely.
• Chemotherapy - To decrease the size of the tumor, kill tumor that has spread and prevent further tumor spread, your child may receive chemotherapy.
• Radiation therapy - High-energy X-rays or other types of radiation can kill cancer cells or stop them from growing. Radiation therapy is used in certain types of tumors to either shrink the tumor prior to surgery, or to try to prevent the tumor from coming back after surgery.
• Targeted therapy - Newer medicines are now available that target and attack specific cancer cells without harming normal cells. Many of these medicines are still considered experimental.
• Rehabilitation - Rehabilitation after surgery is an important part of your child’s care. Our team of physical and occupational therapists, along with our Child Life Specialists, will work to help your child optimize their function after surgery and adapt to whatever types of lifestyle changes may be necessary.

What is acute lymphoblastic leukemia?

Acute lymphoblastic leukemia (ALL) is a cancer that affects the white blood cells. These cells fight infection and help protect the body against disease. Patients with ALL have too many immature white blood cells in their bone marrow. These cells crowd out normal white blood cells. Without enough normal white blood cells, the body has a harder time fighting infections. ALL affects a type of white blood cell called lymphocytes, causing them to build up in the liver, spleen and lymph nodes. There are several different types of ALL, the most common of which is “Pre-B cell” ALL. Other types of ALL, such as T-cell and B-cell, can also occur, however they are less common in children.

How is acute lymphoblastic leukemia diagnosed?

The diagnosis of acute lymphoblastic leukemia in children is based on a complete medical history and physical examination and on the following diagnostic tests:

• Complete blood count (CBC). Blood drawn is used to look at the white blood cell number, as well as platelets. Blood tests may be done to evaluate the liver and kidneys and how the blood is clotting.
• Bone marrow aspirate and biopsy. Bone marrow aspirates and biopsies involve inserting a needle into a bone in the pelvis and removing about 2 teaspoons of marrow for examination. Bone marrow studies usually require sedation or general anesthesia.
• Lumbar puncture (spinal tap). Spinal taps involve inserting a needle into the lower back, between the bones of the spinal column or backbone, to remove the fluid that surrounds the brain and spinal cord. The same needle can be used to insert medicines to prevent or treat leukemia in the brain or spinal cord (intrathecal chemotherapy). Lumbar punctures are often done under sedation.
• Chest X-ray. Chest X-rays are taken to see if there is a mass of cells in the thymus that may affect breathing.

How is acute lymphoblastic leukemia treated?

ALL treatment includes three phases:

• Induction — The purpose of this phase, which often occurs in the hospital, is to kill the leukemia cells in the blood and bone marrow and put the disease into remission (a return to normal blood cell counts)
• Consolidation/intensification — The purpose of this phase is to rid the body of any remaining cells that could begin to grow and cause the leukemia to relapse
• Maintenance — to destroy any cancer cells that might have survived the first two phases

Four types of treatment may be used during any of these treatment phases:

• Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells.
• Stem cell transplant — This involves destroying the blood forming cells in the bone marrow with high-dose chemotherapy and radiation, then replacing them with cells from a donor
  • A stem cell transplant gives the patient new blood cells and a new immune system from a donor’s blood or bone marrow.
  • Some types of stem cell transplants may be called “bone marrow transplants” because the cells come from the donor’s bone marrow.
• Radiation therapy — While infrequently used, high-energy X-rays or other types of radiation can kill cancer cells or stop them from growing.
• Targeted therapy — Newer medicines are now available that target and attack specific cancer cells without harming normal cells. Many of these medicines are still considered experimental.

Pediatric Acute Myeloblastic Leukemia (AML)

Acute myeloblastic leukemia (AML) is the 2^nd most common form of leukemia found in children, accounting for about 5 percent of all pediatric cancers. Around 500 children in the United States are affected by AML each year. At Ochsner for Children, our Pediatric Hematologists and Oncologists work with a multidisciplinary team to provide state of the art care to children and young adults diagnosed with AML. We are very active in research and clinical trials designed to increase cure rates, decrease treatment-related side effects and improve care for long-term survivors.

Diagnosis & Staging

The diagnosis of acute myeloblastic leukemia in children is based on a complete medical history and physical examination and on the following diagnostic tests:

• Complete blood count (CBC). Blood drawn is used to look at the white blood cell number, as well as platelets. Blood tests may be done to evaluate the liver and kidneys and how the blood is clotting.
• Bone marrow aspirate and biopsy. Bone marrow aspirates and biopsies involve inserting a needle into a bone in the pelvis and removing about 2 teaspoons of marrow for examination. Bone marrow studies usually require sedation or general anesthesia.
• Lumbar puncture (spinal tap). Spinal taps involve inserting a needle into the lower back, between the bones of the spinal column or backbone, to remove the fluid that surrounds the brain and spinal cord. The same needle can be used to insert medicines to prevent or treat leukemia in the brain or spinal cord (intrathecal chemotherapy). Lumbar punctures are often done under sedation.
• Chest X-ray. Chest X-rays are taken to see if there is a mass of cells in the thymus that may affect breathing.

How is acute myeloblastic leukemia treated?

AML treatment includes two phases:

• Induction — The purpose of this phase, which often occurs in the hospital, is to kill the leukemia cells in the blood and bone marrow and put the disease into remission (a return to normal blood cell counts).
• Consolidation/intensification — The purpose of this phase is to rid the body of any remaining cells that could begin to grow and cause the leukemia to relapse. Stem cell transplant may also be considered in some cases during this phase.

Four types of treatment may be used during any of these treatment phases:

• Chemotherapy (“chemo”)—uses powerful medicines to kill cancer cells or stop them from growing (dividing) and making more cancer cells.
• Stem cell transplant — This involves destroying the blood forming cells in the bone marrow with high-dose chemotherapy and radiation, then replacing them with cells from a donor
  • A stem cell transplant gives the patient new blood cells and a new immune system from a donor’s blood or bone marrow.
  • Some types of stem cell transplants may be called “bone marrow transplants” because the cells come from the donor’s bone marrow.
• Radiation therapy — While infrequently used, high-energy X-rays or other types of radiation can kill cancer cells or stop them from growing.
• Targeted therapy — Newer medicines are now available that target and attack specific cancer cells without harming normal cells. Many of these medicines are still considered experimental.

What clinical trials does Ochsner Hospital for Children offer for leukemia treatment?

• As part of the Children’s Oncology Group, Ochsner Hospital for Children is an active participant in children’s cancer research. We currently have multiple clinical trials available to treat children and young adults with leukemia.

FAQs

What is acute lymphoblastic leukemia?

Acute myeloblastic leukemia (AML) is a cancer that affects the white blood cells. These cells fight infection and help protect the body against disease. Patients with AML have too many immature white blood cells in their bone marrow. These cells crowd out normal white blood cells. Without enough normal white blood cells, the body has a harder time fighting infections. AML affects a type of white blood cell called myelocytes, causing them to build up in the liver, spleen and lymph nodes. There are several different types of AML, some of which require different treatment than others.

What are the symptoms of acute myeloblastic leukemia?

Symptoms of AML include:

• Fever
• Easy bruising or bleeding that is hard to stop
• Flat, dark-red skin spots (petechiae) due to bleeding under the skin
• Pain in the bones or joints
• Lumps in the neck, underarm, stomach or groin
• Weakness, fatigue, paleness or loss of appetite
• Shortness of breath

How common is acute myeloblastic leukemia?

AML is the 2^nd most common type of childhood blood cancer. It affects about 1 in 200,000 children, and about 500 children younger than age 20 are found to have AML each year in the United States. AML is much more common in adults.

What are the survival rates for acute myeloblastic leukemia?

• About 90 percent of children with AML go into remission after induction treatment.
• 5 year survival rates for AML range from 65-75%
• Certain types of AML may have significantly higher or lower cure rates.

What is neuroblastoma?

Neuroblastoma is a cancer that occurs almost exclusively in children. Though the name can be confusing, neuroblastoma is not a brain tumor. It is the most common solid tumor in children under the age of 2 years, and the most common non-brain solid tumor in children. Neuroblastoma develops from neuroectoderm cells found in the adrenal gland located just above the kidneys or in parts of the nervous system called sympathetic ganglia which are located in the neck, chest and abdomen.

At Ochsner for Children, our Pediatric Hematologists and Oncologists lead a multidisciplinary team to provide state of the art care to children and young adults diagnosed with neuroblastoma. We are very active in research and conduct clinical trials designed to increase cure rates, decrease treatment-related side effects and improve care for long-term survivors.

What are the treatment options?

Your child’s physician, in conjunction with a multidisciplinary team of specialists, will determine a specific course of treatment for your child’s neuroblastoma based on the tumor risk group and other factors. The types of treatment that are used in neuroblastoma may include:

• Surgery: To remove the tumor either at diagnosis or after using chemotherapy or radiation to make the tumor smaller.
• Chemotherapy: To decrease the size of the tumor, kill tumor that has spread and prevent further tumor spread.
• Radiation: To kill neuroblastoma cells left behind after chemotherapy and/or surgery. It is also sometimes used for patients who need immediate treatment of a tumor that is pressing on an important nerve or the spinal cord.
• Stem cell transplant: High-risk patients may require stem cell transplant as part of their treatment. This involves replacing blood-forming cells in the bone marrow that have been killed by chemo and/or radiation therapy. Often a child’s own bone marrow is collected and then given back to the patient at a alter date. This is known as an autologous stem cell transplant
• Biologic therapy: Newer targeted therapies, known as immune therapies, are often utilized for the treatment of neuroblastoma. Immune therapies include drugs known as monoclonal antibodies which target neuroblastoma cells, as well as special vitamins such as retinoic acid (isotretinoin) which help the body eliminate neuroblastoma.

These different types of treatments are used alone or in combination depending on the neuroblastoma risk group. In general, recommended treatment for the three neuroblastoma risk groups is:

• Low-risk neuroblastoma: Patients with low-risk neuroblastoma usually require only surgery and/or observation. Occasionally, a patient with a low-risk tumor will need chemotherapy (or radiation treatment) to shrink a tumor before it is removed
• Intermediate-risk neuroblastoma: Patients with intermediate-risk disease are treated with chemotherapy to shrink the tumor before the tumor can be surgically removed.
• High-risk neuroblastoma: High-risk neuroblastoma is an aggressive disease that is treated with a multimodality therapy including chemotherapy, surgery, radiation, stem cell transplant and biologic therapy.

What are kidney tumors/Wilm’s tumor?

There are several different types of tumors that can arise from the kidney in children, however by far the most common is known at Wilm’s tumor, or nephroblastoma. Wilm’s tumor is very different than kidney cancer in adults. It usually occurs in young children, almost always younger than 8 years old. Most children with Wilm’s tumor can be successfully treated by surgical removal of the affected kidney. Some children will also require chemotherapy and/or radiation, depending on characteristics of the tumor.

At Ochsner for Children, our Pediatric Oncologists work with a multidisciplinary team to provide state-of–the-art care to children and young adults diagnosed with Wilm’s. This includes pediatric oncologists, pediatric surgeons, radiation oncologists and pediatric urologists. We are very active in research and clinical trials designed to increase cure rates, decrease treatment-related side effects and improve care for long-term survivors.

How are kidney tumors/Wilm’s tumors diagnosed?

A variety of techniques may be used to diagnose and stage kidney tumors. These include:

• Biopsy, in which a pediatric surgeon performs a procedure to take a sample of the tumor in order to determine what type of tissue it is and to run special molecular tests.
• Nephrectomy, in which the pediatric surgeon removes the entire affected kidney with the tumor inside of it. This is often done if the tumor has not spread outside of the kidney.
• Computed tomography (CT) scan, which uses a combination of X-rays and computer to produce images of the body, is useful for evaluating both bones and soft tissues.

How are kidney tumors/Wilm’s tumor treated?

Treatment for kidney tumors may involve a combination of therapies including surgery, radiation and/or chemotherapy. Treatment options may vary greatly, depending on your child's situation. Our pediatric oncologists work closely with a multidisciplinary team to create a personalized treatment plan that is best for your child.

• Surgery - Surgery is usually the first step in treating children with kidney tumors. In some cases, only a biopsy is done. This is often necessary when the tumor is too close to critical structures in the brain, or when the surgeon does not feel the tumor can be safely removed. In other cases, the tumor can be removed completely. This may require the entire kidney to be removed, a procedure known as a nephrectomy.
• Chemotherapy - To decrease the size of the tumor, kill tumor that has spread and prevent further tumor spread, your child may receive chemotherapy. This can be done before or after surgery, depending on your child’s unique circumstances.
• Radiation therapy - High-energy X-rays or other types of radiation can kill cancer cells or stop them from growing. Radiation therapy is used in certain types of tumors to either shrink the tumor prior to surgery, or to try to prevent the tumor from coming back after surgery.

Genetics

Pediatric cancers often have a genetic component. Genetic consultation and testing is available at Ochsner. Learn more.

Need a Second Opinion?

Our pediatric oncologists are often called upon to give second opinions. To schedule an appointment, call 504-842-4249.

Pediatric Family Assistance Fund

Financial assistance is available for families who qualify. To find out more, call 504-842-4249.

Clinical Trials

As part of the Children’s Oncology Group, Ochsner Hospital for Children is an active participant in children’s cancer research. We currently have multiple clinical trials available to treat children and young adults with various types of cancers.