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Information from PDQ for Patients
Childhood ependymoma
208/08627
** GENERAL INFORMATION ABOUT CHILDHOOD EPENDYMOMA **
Childhood ependymoma is a disease in which malignant (cancer) cells form in the
tissues of the brain and spinal cord. The brain controls vital functions such
as memory and learning, the senses (hearing, sight, smell, taste, and touch),
and emotion. The spinal cord is made up of bundles of nerve fibers that
connect the brain with nerves in most parts of the body.
Approximately 10% of all childhood brain tumors are ependymomas. Although
brain tumors are rare in children, they are the most common type of childhood
cancer other than leukemia and lymphoma.
This summary refers to the treatment of primary brain tumors (tumors that begin
in the brain). Treatment for metastatic brain tumors, which are secondary
tumors formed by cancer cells that begin in other parts of the body and spread
to the brain, is not discussed in this summary.
Brain tumors can occur in both children and adults; however, treatment for
children may be different than treatment for adults. (Refer to the PDQ summary
on Adult Brain Tumor Treatment for more information.)
The symptoms of childhood ependymoma vary and often depend on the child's age
and where the tumor is located. These symptoms may be caused by childhood
ependymoma or other conditions. A doctor should be consulted if any of the
following problems occur:
- Frequent headaches
- Seizures
- Frequent nausea and vomiting
- Loss of balance or difficulty walking
Tests that examine the brain and spinal cord are used to help detect and
diagnose childhood ependymoma. These tests may include the following:
CT scan (CAT scan): A CT scan creates a series of detailed pictures of areas
inside the body, taken from different angles. The pictures are created by a
computer linked to an x-ray machine. This test is also called computed
tomography, computerized tomography, or computerized axial tomography.
Magnetic resonance imaging: A magnet linked to a computer is used to create
detailed pictures of areas inside the body. This test is also called MRI or
nuclear magnetic resonance imaging (NMRI).
Biopsy: After a brain tumor has been found, a biopsy is done by making a small
hole in the skull and using a needle to remove a sample of the tumor. The
tissue is then examined under a microscope by a pathologist to see what type of
tumor it is. If it is an ependymoma, the doctor will attempt to remove as much
of the tumor as possible. The pathologist will also determine the grade of the
tumor. The cells of higher grade tumors look more abnormal, grow faster, and
are more likely to spread than the cells of lower grade tumors.
Certain factors affect prognosis (chance of recovery). The most important
factors that affect prognosis (chance of recovery) are thought to be the amount
of tumor removed during surgery and the age of the child when the tumor was
found.
** STAGES OF CHILDHOOD EPENDYMOMA **
Staging is the process used to find out the type of cancer and how far the
cancer has spread. There is no standard staging system for childhood
ependymomas. The tumors are described by grade and by where they are located
in the central nervous system (brain and spinal cord).
-- Recurrent Childhood Ependymoma --
Recurrent childhood ependymoma is a tumor that has recurred (come back) after
it has been treated. Childhood ependymoma commonly recurs, usually at the
original cancer site. The tumor may come back as long as 15 years or more
after initial treatment.
** TREATMENT OPTION OVERVIEW **
There are different types of treatment for children with ependymoma. Different
types of treatment are available for children with ependymoma. Some treatments
are standard (the currently used treatment), and some are being tested in
clinical trials. A treatment clinical trial is a research study meant to help
improve current treatments or obtain information on new treatments for patients
with cancer. When clinical trials show that a new treatment is better than the
"standard" treatment, the new treatment may become the standard treatment.
Because cancer in children is rare, taking part in a clinical trial should be
considered. Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the NCI cancer.gov
Web site. Choosing the most appropriate cancer treatment is a decision that
ideally involves the patient, family, and health care team.
Children with ependymoma should have their treatment planned by a team of
doctors with expertise in treating childhood brain tumors. Your child's
treatment will be overseen by a pediatric oncologist, a doctor who specializes
in treating children with cancer. The pediatric oncologist may refer you to
other pediatric doctors who have experience and expertise in treating children
with brain tumors and who specialize in certain areas of medicine. These may
include the following specialists:
- Neurosurgeon
- Neurologist
- Neuropathologist
- Neuroradiologist
- Rehabilitation specialist
- Radiation oncologist
- Medical oncologist
- Endocrinologist
- Psychologist
Three types of standard treatment are used:
-- Surgery --
Surgery is used to treat childhood ependymomas. Once a childhood ependymoma
has been diagnosed, the child's doctor will remove as much of the tumor as
safely possible during a craniotomy (an operation in which an opening is made
in the skull). If the ependymoma is in a place where it cannot be removed,
surgery may be limited to a biopsy of the tumor.
After surgery, tests will be done to find out if the ependymoma has spread to
other parts of the central nervous system (brain and spinal cord). These tests
include:
- Magnetic resonance imaging of the total spine: A magnet linked to a computer
is used to create detailed pictures of the spine. This test is also called MRI
or nuclear magnetic resonance imaging (NMRI).
- Lumbar puncture: A procedure in which a needle is put into the lower part of
the spinal column to collect cerebrospinal fluid. Also called a spinal tap.
-- Radiation therapy --
Radiation therapy is the use of x-rays or other types of radiation to kill
cancer cells and shrink tumors. Radiation therapy may use external radiation
(using a machine outside the body) or internal radiation. Internal radiation
involves putting radioisotopes (materials that produce radiation) through thin
plastic tubes into the area where cancer cells are found. External radiation
is usually used to treat childhood ependymoma.
Radiation therapy can affect growth and development in young children and is
not standard treatment for children younger than 3 years of age.
-- Chemotherapy --
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be
taken by mouth, or it may be put into the body by inserting a needle into a
vein or muscle. Either type of chemotherapy is called systemic treatment
because the drugs enter the bloodstream, travel through the body, and can kill
cancer cells throughout the body.
Other types of treatment are being tested in clinical trials. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site.
** TREATMENT OPTIONS FOR NEWLY DIAGNOSED CHILDHOOD EPENDYMOMA **
Newly diagnosed childhood ependymoma is a tumor that has not been treated. The
patient may have received drugs or treatment, however, to relieve symptoms
caused by the tumor.
Initial treatment for newly diagnosed childhood ependymoma is usually surgery,
with or without additional treatment.
After surgery, treatment depends on the age of the child, the amount of tumor
that was removed, and whether cancer cells have spread to other parts of the
central nervous system.
When the tumor is completely removed by surgery and cancer cells have not
spread within the central nervous system, treatment may include the following:
- Radiation therapy to the tumor
- A clinical trial of radiation therapy and chemotherapy
When a part of the tumor remains after surgery, but cancer cells have not
spread within the central nervous system, treatment may include the following:
- Additional surgery
- Radiation therapy to the tumor
- A clinical trial of radiation therapy and chemotherapy
When cancer cells have spread within the central nervous system, treatment may
include the following:
- Radiation therapy to the whole brain and spine
- A clinical trial of radiation therapy and chemotherapy
Treatment after surgery for children younger than 3 years of age may include
the following:
- A clinical trial of chemotherapy to delay the need for radiation therapy
- A clinical trial of radiation therapy
This summary section refers to specific treatments under study in clinical
trials, but it may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the NCI cancer.gov Web site.
** TREATMENT OPTIONS FOR RECURRENT CHILDHOOD EPENDYMOMA **
Treatment of recurrent childhood ependymomas may include the following:
- Surgery
- Radiation therapy
- Chemotherapy
- A clinical trial of a new therapy
Information about ongoing clinical trials is available from the NCI cancer.gov
Web site.
** TO LEARN MORE **
Call
For more information, U.S. residents may call the National Cancer Institute's
(NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237)
Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing
callers with TTY equipment may call 1-800-332-8615. The call is free and a
trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI's Cancer.gov Web site (http://cancer.gov) provides online access to
information on cancer, clinical trials, and other Web sites and organizations
that offer support and resources for cancer patients and their families. There
are also many other places where people can get materials and information about
cancer treatment and services. Local hospitals may have information on local
and regional agencies that offer information about finances, getting to and
from treatment, receiving care at home, and dealing with problems associated
with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals,
and the public. These publications discuss types of cancer, methods of cancer
treatment, coping with cancer, and clinical trials. Some publications provide
information on tests for cancer, cancer causes and prevention, cancer
statistics, and NCI research activities. NCI materials on these and other
topics may be ordered online or printed directly from the NCI Publications
Locator (https://cissecure.nci.nih.gov/ncipubs). These materials can also be
ordered by telephone from the Cancer Information Service toll-free at
1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's
Web sites, provides Internet users with the ability to chat online with an
Information Specialist. The service is available from 9:00 a.m. to 10:00 p.m.
Eastern time, Monday through Friday. Information Specialists can help Internet
users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
National Cancer Institute
Office of Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580
** ABOUT PDQ **
PDQ is a comprehensive cancer database available on Cancer.gov.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information
database. Most of the information contained in PDQ is available online at
Cancer.gov (http://cancer.gov), the NCI's Web site. PDQ is provided as a
service of the NCI. The NCI is part of the National Institutes of Health, the
federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on
cancer prevention, detection, genetics, treatment, supportive care, and
complementary and alternative medicine. Most summaries are available in two
versions. The health professional versions provide detailed information
written in technical language. The patient versions are written in
easy-to-understand, non-technical language. Both versions provide current and
accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and
reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are
responsible for writing and maintaining the cancer information summaries. The
summaries are reviewed regularly and changes are made as new information
becomes available. The date on each summary ("Date Last Modified") indicates
the time of the most recent change.
PDQ also contains information on clinical trials.
In the United States, about two-thirds of children with cancer are treated in a
clinical trial at some point in their illness. A clinical trial is a study to
answer a scientific question, such as whether one treatment is better than
another. Trials are based on past studies and what has been learned in the
laboratory. Each trial answers certain scientific questions in order to find
new and better ways to help cancer patients. During treatment clinical trials,
information is collected about new treatments, the risks involved, and how well
they do or do not work. If a clinical trial shows that a new treatment is
better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at
Cancer.gov (http://cancer.gov/clinical_trials). Descriptions of the trials are
available in health professional and patient versions. For additional help in
locating a childhood cancer clinical trial, call the Cancer Information Service
at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
The PDQ database contains listings of groups specializing in clinical trials.
The Children's Oncology Group (COG) is the major group that organizes clinical
trials for childhood cancers in the United States. Information about
contacting COG is available on Cancer.gov (http://cancer.gov) or from the
Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at
1-800-332-8615.
The PDQ database contains listings of cancer health professionals and hospitals
with cancer programs.
Because cancer in children and adolescents is rare, the majority of children
with cancer are treated by health professionals specializing in childhood
cancers, at hospitals or cancer centers with special facilities to treat them.
The PDQ database contains listings of health professionals who specialize in
childhood cancer and listings of hospitals with cancer programs. For help
locating childhood cancer health professionals or a hospital with cancer
programs, call the Cancer Information Service at 1-800-4-CANCER
(1-800-422-6237), TTY at 1-800-332-8615.
Date Last Modified: 09/2002
******************************************************************************
* If you want to know more about cancer and how it is treated, or if you *
* if you wish to know about clinical trials for your type of cancer, you *
* can call the NCI's Cancer Information Service at 1-800-422-6237, toll *
* free. A trained information specialist can talk with you and answer *
* your questions. *
******************************************************************************
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This information has been brought to you by
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