The brain stem consists of the midbrain, pons and medulla located deep in the posterior part of the brain. Tumors that arise along these structures are called brain stem gliomas. Most brain stem gliomas occur in the pons ("pontine gliomas"). The pontine tumors have a poorer prognosis than the less common midbrain and medullary gliomas.

Brain stem tumors are perhaps the most dreaded cancers in pediatric oncology, owing to their historically poor prognosis, yet they remain an area of intense research.

How often does it occur?

Brain stem tumors account for 10-15 percent of pediatric brain tumors. The peak incidence is between ages 5 and 10. Pediatric brain tumors remain the most stubborn of childhood diseases. They are the second leading cause of cancer-related death in children, behind leukemia, and make up 21 percent of childhood tumors.

Clinical Features and Symptoms

Pontine brain stem tumors affect the cranial nerves, causing symptoms related to the nerves that supply the muscles of the eye and face, and muscles involved in swallowing. These symptoms include double vision, inability to close the eyelids completely, dropping one side of the face, and difficulty chewing and swallowing. The tumor also affects the "long tracks" of the brain, with resultant weakness of the arms or legs and difficulty with speech and walking. Symptoms usually worsen rapidly because the tumor is rapidly growing.

Treatments and Strategies

Surgery is used when possible to treat brain stem gliomas. Depending on where the cancer is, the doctor may remove as much of the tumor as possible by creating an opening in the skull in an operation called a craniotomy. If the brain stem glioma is in a place where it cannot be removed, surgery may be limited to a biopsy of the cancer.

Radiation therapy has been the main treatment approach to kill cancer cells and shrink tumors.

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body.

Survival Rates

Pontine Gliomas - The patients' symptoms often improve dramatically during or after six weeks of irradiation. Unfortunately, problems usually recur after six to nine months, and progress rapidly. Survival past 12 to 14 months is uncommon, and new approaches to treating these tumors are urgently needed.

The Dark Realm of Brain Tumors

Brain cancer sneaks up on a child like a monster under the bed. Lurking in its shadowy niche, it stays hidden until it's big enough to cause an all-out crisis. Not only is a brain tumor out of sight, but it's also out of reach of many treatments that work against other types of cancer. It can steal a child's very essence by disrupting the development of the mind, making it potentially the most life-altering of all pediatric cancers.