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Childhood Medulloblastoma
Summary Type: Treatment
Summary Audience: Patients
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of childhood medulloblastoma.
Childhood Medulloblastoma
General Information About Childhood Medulloblastoma
Childhood medulloblastoma is a disease in which benign
(noncancer) or malignant (cancer) cells form in the tissues of the
brain.
Childhood medulloblastoma (tumor ) usually forms in the cerebellum , which is at the lower back of the brain.
The cerebellum is the part of the brain that controls movement, balance, and posture. Childhood medulloblastoma may also be called primitive neuroectodermal tumor (PNET).
About 1 out of 5 childhood brain tumors are medulloblastomas. Although cancer is rare in
children, brain tumors 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 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 treatment summary on Adult Brain Tumors for more information.)
The cause of most childhood brain tumors is unknown.
The signs of childhood medulloblastoma vary and often depend on the child’s age and where the tumor is located.
These symptoms may be caused by a medulloblastoma or other conditions. A doctor should be consulted if any of the following problems occur:
- Loss of balance, difficulty walking, worsening handwriting, or slow speech.
-
Morning headache or headache that goes away after vomiting.
- Nausea and vomiting.
- Unusual sleepiness or change in energy level.
- Change in personality or behavior.
- Unexplained weight loss or weight gain.
Tests that examine the brain and spinal cord are used to detect (find) childhood medulloblastoma.
The following tests and procedures may be used:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Childhood medulloblastoma is diagnosed and removed in surgery.
If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the tumor tissue . A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are found, the doctor will remove as much tumor as possible during the same surgery .
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on:
- The age of the child when the tumor is found.
- The location of the tumor.
- The amount of tumor remaining after surgery.
- Whether the cancer has spread to other parts of the central nervous system (brain and spinal cord), or to other parts of the body, such as the bones.
Stages of Childhood Medulloblastoma
After childhood medulloblastoma has been diagnosed, tests are done to find out if there is tumor remaining or if cancer cells have spread.
The extent or spread of cancer is usually described as stages . For childhood medulloblastoma , risk groups are used instead of stages. Risk groups are described by the amount of remaining tumor or spread of cancer cells within the central nervous system (brain and spinal cord) or to other parts of the body. It is important to know the risk group in order to plan treatment. The following tests and procedures may be used to determine the risk group:
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into the patient through a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Lumbar puncture :
A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
- Bone marrow biopsy : The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and the bone marrow samples under a microscope to look for signs of cancer.
- Bone scan : A procedure to detect if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the blood stream. The radioactive material collects in the bones and is detected by a scanner.
The following risk categories are used for childhood medulloblastoma:
Average risk
Childhood medulloblastoma is called an average risk if all of the following are true:
- The child is older than 3 years of age.
- The tumor is at the very back of the brain.
- All of the tumor was removed by surgery or there was a very small amount remaining.
- The cancer has not spread to other parts of the
body.
Poor risk
Childhood medulloblastoma is called a poor risk if any of the following are true:
- The child is younger than 3 years of age.
- The tumor is not at the very back of the brain.
- Some of the tumor was not removed by
surgery.
- The cancer has spread to other parts of the
body.
In general, cancer is more likely to recur (come back) in patients in the poor risk group.
Recurrent Childhood Medulloblastoma
Recurrent childhood medulloblastoma is a tumor that has recurred
(come back) after it has been treated. Childhood medulloblastoma often recurs.
A tumor may come back many years later at the same place or a different place in the brain. It can also come back in other parts of the body such as the spinal cord.
Treatment Option Overview
There are different types of treatment for children with childhood medulloblastoma.
Different types of treatment are available for children with
childhood medulloblastoma . 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 medulloblastoma 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:
Four types of standard treatment are used:
Surgery
Surgery is used to
diagnose and treat childhood medulloblastoma as described in the General Information section of this summary.
Radiation therapy
Radiation
therapy is a cancer treatment that uses high-energy x-rays or
other types of radiation to kill cancer cells . There are two types of
radiation therapy. External radiation therapy uses a machine outside the
body to send radiation toward the cancer. Internal radiation therapy uses a
radioactive substance sealed in needles, seeds , wires, or catheters that are
placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of
cancer cells, either by killing the cells or by stopping the cells from
dividing. When chemotherapy is taken by mouth or injected
into a vein or muscle, the drugs enter the bloodstream and can reach cancer
cells throughout the body (systemic chemotherapy ). When chemotherapy is
placed directly into the spinal column, an organ, or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Because radiation therapy can affect growth and brain development
in young children, clinical trials are studying ways of using chemotherapy to
delay or reduce the need for radiation therapy.
Cerebrospinal fluid diversion
Cerebrospinal fluid diversion is a method used to drain fluid that has built up around the brain and spinal cord. A shunt (long, thin tube) is placed in a ventricle (hollow space) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt carries excess fluid away from the brain so it may be absorbed elsewhere in the body.
Other types of treatment are being tested in clinical
trials.
High-dose chemotherapy with bone marrow
transplantation or stem cell transplantation and radiation
therapy
High-dose chemotherapy with bone marrow or stem cell transplantation is a
method of giving high doses of chemotherapy and then replacing
blood-forming cells destroyed by the cancer treatment. Stem cells (immature
blood cells) are removed from the blood or bone marrow of the patient or a
donor and are frozen and stored. After the chemotherapy is completed, the
stored stem cells are thawed and given back to the patient through an
infusion . These reinfused stem cells grow into (and
restore) the body’s blood cells. Clinical trials are studying the use of
this treatment followed by radiation therapy directed at the tumor only for
childhood medulloblastoma.
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 Childhood Medulloblastoma
Untreated Childhood Medulloblastoma
Untreated childhood medulloblastoma is a tumor for which no
treatment has been given. The child may have received drugs or treatment to relieve symptoms caused by the tumor.
Standard treatment of average risk childhood medulloblastoma may include the
following:
- Surgery .
- Radiation
therapy to the brain and spinal cord with or without chemotherapy .
- A clinical trial of new combinations of radiation therapy and chemotherapy for children 3 years and older.
Standard treatment of poor risk childhood medulloblastoma may include the
following:
- Surgery.
- Radiation therapy to the brain and spinal cord.
- Chemotherapy.
Standard treatment of childhood medulloblastoma in children younger than 3
years of age may include the following:
- Surgery with or without chemotherapy.
- Chemotherapy.
- Radiation therapy with or without chemotherapy.
Some of the treatments being studied in clinical trials for untreated childhood medulloblastoma in children younger than 3 years of age include the following:
- A clinical trial of chemotherapy to delay or reduce the need for
radiation therapy.
- A clinical trial of high-dose chemotherapy with bone marrow transplantation followed by radiation therapy.
- A clinical trial of chemotherapy followed by surgery and radiation therapy.
Information about this and other ongoing clinical trials is available from the
NCI Cancer.gov Web site.
Recurrent Childhood Medulloblastoma
Standard treatment of recurrent childhood medulloblastoma may include the
following:
- Surgery with or without chemotherapy.
Some of the treatments being studied in clinical trials for recurrent childhood medulloblastoma include the following:
Information about these and other ongoing clinical trials is available from the
NCI Cancer.gov Web site.
Changes to This Summary (08/24/2004)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
To Learn More
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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.
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The NCI Web site 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.
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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. 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.
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About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at 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, nontechnical 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 NCI's Web site. 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 the NCI Web site 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.
2004-08-24
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