Your child’s doctor will do a thorough physical exam, including conducting tests to check  how well your child’s central nervous system (the brain and spinal cord) is working. This might include tests of reflexes, coordination, strength, alertness, vision, and eye and mouth movement.

The doctor will also ask questions about your child’s medical history, including when symptoms started. If you’re seeing your child’s regular doctor and the exam indicates the need for more tests, the doctor will refer your child to a pediatric neurologist or neurosurgeon — doctors who specialize in the nervous system of children.

In some cases, dye is injected into the bloodstream for an imaging test. Otherwise, these scans are noninvasive. 

• MRI scan: Magnetic resonance imaging, or MRI, uses radio waves (not radiation, like X-rays), a large magnet and a computer to create detailed images of the body’s internal structures. This is the most common tool used to check whether a child  has a brain or spinal cord tumor. Doernbecher has state-of-the-art MRI equipment, including an intraoperative MRI for exceptional precision during surgery and a "quick brain" MRI for rapid scans that require no  sedation.
• CT scan: Computed tomography imaging, also called a CT scan or CAT scan, uses an X-ray  beam that circles the body to create cross-section and three-dimensional views. Sometimes patients are given intravenous dye to help features stand out. CT scans provide detailed images of soft tissues, blood vessels and bones. They are less detailed than MRI scans but also less sensitive to movement, making them an option for children who have trouble staying still. Doernbecher introduced technology to reduce the radiation exposure from CT scans by up to 60 percent. Our doctors  also strive to limit the use of CT scans.
• Angiogram: In this test, a special injected dye highlights the brain’s blood vessels. This tool may be used as part of surgical planning.

If a tumor is discovered, doctors can generally determine its exact type only by looking at a sample under a microscope. How the cells look indicates whether the tumor is cancer and how fast it is likely to grow.

In a biopsy, a piece of the tumor is removed. A type of doctor called a pathologist or neuropathologist — a pathologist who specializes in the nervous system — stains the tissue with special dyes to highlight types of cells or features. The doctor then examines tiny slices of the tissue under a microscope. Photos of these slices can be shared with other doctors so they can confer on the diagnosis and treatment.

There are three main types of brain biopsy:

• Needle biopsy: Doctors make a small hole in the skull and insert a needle to extract a piece of the tumor.
• Stereotactic needle biopsy: The patient’s head is secured in a metal frame, and doctors use computer-assisted imaging to pinpoint the tumor and extract a sample. This may be done when doctors need to analyze the tumor but have already decided it’s too risky to remove it.
• Open biopsy: If scans show a tumor can be surgically removed, doctors may do a biopsy at the same time as surgery. A piece of skull is removed in a procedure called a craniotomy. The tumor is exposed, and samples are immediately sent to a pathologist. The pathologist’s findings can help the neurosurgeons decide on the extent of the surgery.

In this  procedure, commonly called a spinal tap, a needle is inserted into the lower spinal canal to withdraw some cerebrospinal fluid, or CSF. This fluid, which bathes the brain and spinal cord, can be examined for cancer cells or other tumor “markers.” Germ cell tumors, for example, release specific proteins into CSF.

In most cases, surgically removing all or as much of the tumor possible is the best option. Some tumors can be cured with surgery alone, and others with a combination of surgery and other therapies.

Doernbecher has exceptionally skilled pediatric neurosurgeons with expertise in computer-assisted imaging, minimally invasive techniques and complex approaches to skull base tumors. They also have the latest technology, such as the West Coast’s only child-dedicated intraoperative MRI suite. This enables them to map the tumor during surgery so they can precisely and completely remove the tumor, or as much of it as possible, while preserving healthy brain tissue.

Some tumors are too deep in the brain, too extensive or too entangled in vital structures for surgery, however. Other tumors, such as germinomas, don’t require surgery. In those cases, other treatments are recommended.

Radiation  therapy uses X-rays or other forms of radiation to kill cancer cells or to destroy their ability to divide and spread. Radiation therapy can be targeted to the tumor or, for tumors that tend to spread or have spread within the central nervous system, to the whole brain and spinal cord (craniospinal radiation).

Radiation therapy can be the main treatment if surgery isn’t an option. It can also be used to kill any remaining tumor cells after surgery, or to relieve symptoms of  a tumor. It isn’t invasive or painful.

Because radiation can also harm normal cells and cause serious and lasting side effects in young patients, doctors avoid radiation therapy, especially in children ages 3 and younger.

When radiation therapy is necessary, Doernbecher uses a range of techniques and technologies to target the tumor with as little radiation of nearby tissue as  possible.

Chemotherapy, or chemo for short, uses medications to attack tumor cells. Anti-cancer medications may be used to shrink a tumor before surgery or to kill any remaining tumor cells after surgery.

Chemotherapy also may be used as the main treatment; to avoid radiation therapy; or to prevent growth in a low-grade tumor that can't be surgically removed.

Most patients receive a combination of chemo medications because different medications fight tumors in different ways. Some trigger tumor cells to self-destruct, for example, while others prevent tumors from growing.

Most often, chemo medications are given intravenously on an outpatient basis. They may also be given by mouth as a pill or liquid; injected into the bloodstream; or placed into the cerebrospinal fluid through an injection into the lower spinal canal or through a catheter (flexible tube) surgically inserted into a brain cavity called a ventricle.

Targeted cancer medications attack cancer cells while minimizing damage to healthy cells. Medications in this emerging field, a form of “precision medicine,” disable cancer by exploiting a specific molecule or pathway, like fitting a key into a lock.

Researchers at Doernbecher and OHSU — a pioneer in precision medicine through the work of Dr. Brian Druker of the OHSU Knight Cancer Institute — and beyond are working to identify more pathways and matching drugs.

Doernbecher and other leading children’s hospitals are also researching other ways to fight pediatric brain tumors. Read more about Doernbecher research and access to clinical trials.

Palliative care offers pain relief, symptom control, support and care for children and teens facing a life-threatening condition. At Doernbecher, the Bridges Program brings together a full range of specialists to care for children, teens and their families. Our patients and their families often receive this care as part of active, ongoing treatment for a brain or spinal cord tumor.

Our patients are closely monitored with regular MRI scans and comprehensive exams even after a tumor is gone.