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Childhood Ependymoma
Summary Type: Treatment
Summary Audience: Patients
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of childhood ependymoma.
Childhood Ependymoma
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.
About 1 in 11 childhood brain
tumors are
ependymomas . 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 of 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.
There are many different types of brain tumors. Brain tumors can occur in both children and adults; however,
treatment for children may be different than treatment for adults. Refer to the following PDQ summaries for more information:
- Childhood Brain Tumors Treatment
- Adult Brain Tumors Treatment
The cause of most childhood brain tumors is unknown.
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:
Tests that examine the brain and spinal cord are used to detect
(find) childhood ependymoma.
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 ependymoma 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 brain 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 safely possible during the same surgery .
Certain factors affect prognosis (chance of
recovery).
The prognosis (chance of recovery) depends on:
- Amount of tumor removed during surgery.
- Tumor histology (how the tumor cells look under a microscope).
- The age of the child when the
tumor was found.
Stages of Childhood Ependymoma
After the childhood ependymoma has been removed, tests are done to find out if there is tumor remaining. The extent or spread of cancer is usually described as stages . For childhood ependymoma, tumors are described by grade and by where they are located in the central nervous system (brain and spinal cord ). The grade of the tumor refers to how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment. The following tests and procedures may be used:
- 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.
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 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:
Some cancer treatments cause side effects that continue or appear years after cancer treatment has ended. These are called late effects . Late effects of cancer treatment may include physical problems; changes in mood, feelings, thinking, learning or memory; and having second cancers (new types of cancer). Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. Refer to the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.
Three types of standard treatment are used:
Surgery
Surgery is used to diagnose and treat childhood ependymoma 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.
Certain ways of giving radiation therapy can help keep radiation away from healthy tissue :
Radiation therapy to the brain can affect growth and development in young
children and is not standard treatment for children younger than 3 years. For this reason, conformal radiation therapy that limits damage to healthy brain tissue is being studied in infants and children with ependymoma.
Damage to the brain in young children treated for ependymoma is not always due to the effects of radiation therapy. For example, when hydrocephalus (abnormal buildup of fluid in the brain) is found at diagnosis , it is linked with lower intelligence test scores following surgery and before radiation therapy.
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.
New types of treatment are being tested in clinical trials.
Information about ongoing clinical trials is available from the
NCI Web site.
Treatment Options for Childhood Ependymoma
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:
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:
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.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.
Information about these and other ongoing clinical trials is available from the
NCI Web site.
Recurrent Childhood Ependymoma
Standard treatment of recurrent
childhood ependymomas may include
the following:
New treatments for recurrent childhood ependymomas are being studied in clinical trials . Information about ongoing clinical trials is available from the
NCI Web site.
Changes to This Summary (07/24/2006)
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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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.
2006-07-24
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