Childhood Brain and Spinal Cord Tumors Treatment (PDQ®)
NCI PDQ® Summaries for Patients
Description
Stage Explanation
Treatment Option Overview
Childhood Medulloblastoma
Childhood Cerebellar Astrocytoma
Childhood Infratentorial Ependymoma
Childhood Brain Stem Glioma
Childhood Cerebral Astrocytoma/Malignant Glioma
Childhood Supratentorial Ependymoma
Childhood Craniopharyngioma
Childhood Central Nervous System Germ Cell Tumor
Spinal Cord Tumors
Childhood Visual Pathway Glioma
Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma
Recurrent Childhood Brain Tumor
To Learn More About Childhood Brain Tumors
Get More Information From NCI
Changes to This Summary (05/23/2008)
About PDQ
Childhood Brain and Spinal Cord Tumors Treatment
Description
Note: The health professional version of this summary was extensively revised in April 2008. The patient version of this summary will reflect these changes soon.
What is childhood brain tumor?
Childhood brain tumors
are a diverse group of diseases characterized by the
abnormal
growth of tissue
contained within the skull. Brain tumors can be
benign
(without cancer
cells
) or malignant
(contains cancer cells). The brain
controls vital
functions such as memory and learning, the senses (hearing,
sight, smell, taste, and touch), and emotion. It also controls other parts of
the body, including muscles, organs,
and blood vessels
. Other than leukemia
and lymphoma,
brain tumors are the most common type of cancer that occurs in
children.
This PDQ
treatment information summary refers only to tumors that originate in
the brain (primary
brain tumors). Metastatic
brain tumors, which are secondary
tumors
formed by cancer cells that begin in other parts of the body and spread
to the brain, are not included. Brain tumors can occur in both children and
adults; however, treatment may be different for adults than for children.
(Refer to the PDQ summary on Adult Brain Tumor Treatment for more information.)
If your child has symptoms
that may be caused by a brain tumor, his or her
doctor may order a computed tomographic (CT) scan
, a diagnostic test that uses
computers and x-rays
to create pictures of the body. A magnetic resonance
imaging
(MRI) scan, a diagnostic test similar to a CT scan but which uses
magnetic waves instead of x-rays, may also be performed.
Often, surgery
is required to determine whether a brain tumor exists and what
type of tumor it is. A small sample of tumor tissue may be surgically removed
and examined under a microscope. This is called a biopsy.
Sometimes a biopsy
is done by making a small hole in the skull and using a needle to extract a
sample of the tumor.
There are many types of brain tumors that occur in children. Treatment and
chance of recovery (prognosis
) depend on the type of tumor, its location within
the brain, the extent to which it has spread, and your child’s age and general
health.
Stage Explanation
Types of childhood brain tumor
Once childhood brain tumor
is detected, additional tests will be performed to
determine the type of tumor.
If a biopsy specimen
is taken, the tumor cells
will be examined carefully under a microscope to see how different they appear
from normal cells. This will determine the grade
of the tumor. The grade of a
tumor is determined by microscopic
examination of its cells to see how similar
the cells are to normal cells. Cells from higher-grade, more abnormal
-looking
tumors usually grow faster and are more malignant
than cells from lower-grade
tumors. Treatment for childhood brain tumor depends on the type and grade
of the tumor,
its location within the brain, and your child’s age and general health.
There is no staging
for childhood brain tumors. Brain tumors are grouped
according to their location within the brain and the appearance and behavior of
the tumor tissue.
The following groupings are used for childhood brain tumors:
Infratentorial tumors
Infratentorial tumors
are those that occur in the lower part of the brain.
Tumors found in this region include:
Medulloblastoma
(Refer to the PDQ
summary on Childhood Medulloblastoma Treatment for more
information.)
Cerebellar astrocytoma
(Refer to the PDQ summary on Childhood Cerebellar Astrocytoma Treatment for
more information.)
Infratentorial ependymoma
Ependymal tumors
are tumors
that begin in the ependyma, the cells
that line the
hollow cavities within the brain (called ventricles
) which are filled with
cerebrospinal fluid
. The growth of ependymal tumors can obstruct the flow of
the cerebrospinal fluid
through the brain and spinal cord
. Infratentorial
ependymomas
begin in the lower part of the brain. These tumors may spread via
the cerebrospinal fluid to other areas of the brain and spinal cord.
Brain stem glioma
(Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more
information.)
Supratentorial tumors
Supratentorial
tumors
are those that occur in the upper part of the brain.
Common supratentorial tumors include:
Cerebral astrocytoma
(Refer to the PDQ summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more
information.)
Supratentorial ependymoma
Ependymal tumors
are tumors
that begin in the ependyma, the cells
that line the
hollow cavities within the brain (called ventricles) which are filled with
cerebrospinal fluid
. The growth of ependymal tumors can obstruct the flow of
the cerebrospinal fluid through the brain. Supratentorial
ependymomas begin in
the upper part of the brain. These tumors may spread to other areas of the
brain and spinal cord
, depending on their grade
.
Craniopharyngioma
Craniopharyngiomas
are tumors
that generally occur just above the pituitary
gland
. Located at the bottom of the brain, the pituitary gland is about the
size of a pea and controls many vital
functions. Craniopharyngiomas do not
spread, but may interfere with important structures near them, causing serious
problems.
Central nervous system germ cell tumor
Germ cell tumors
arise from the sex cells
found in the brain. There are
different types of germ cell tumors, including germinomas
, embryonal
cell carcinomas
, choriocarcinomas
, and teratomas.
These tumors
usually occur in the
center of the brain, and can spread to other parts of the brain and spinal
cord
.
Supratentorial primitive neuroectodermal tumors and pineoblastoma
(Refer to the PDQ summary on Childhood Supratentorial Primitive Neuroectodermal
Tumors Treatment for more information.)
Visual pathway and hypothalamic glioma
(Refer to the PDQ summary on Childhood Visual Pathway and Hypothalamic Glioma
Treatment for more information.)
Spinal Cord Tumors
Spinal cord
tumors
are rare benign
or cancerous
tumors in the spinal cord (the bundles of nerves
that carry messages between the brain and the body). The diagnosis
of spinal cord tumors depends on how the tumor looks under a microscope and its location. Spinal cord tumors compress the spinal cord and the surrounding nerves causing symptoms
such as pain or numbness in the back, arms, or legs, decreased muscle strength, and in some cases, loss of bowel
or bladder
control. X-rays
of the brain and the entire spine
are done at the time of diagnosis to determine extent of disease.
Recurrent brain tumor
Recurrent disease
means that the cancer
has come back (recurred) after it has
been treated. It may recur in its original location, in another part of the
central nervous system
, or systemically
(throughout the body).
Treatment Option Overview
Different types of treatment are available for children with brain tumors
. 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. Some clinical trials are open only to patients who have not started treatment.
Three kinds of
treatment for childhood brain tumors
are used:
More than one method of treatment may be used, depending on the needs of the
patient.
Experienced doctors working together may provide the best treatment for
children with brain tumors. Your child’s treatment will often be coordinated
by a pediatric
oncologist,
a doctor who specializes in cancer
in children. The
pediatric oncologist may refer your child to other specialists, such as a
pediatric neurosurgeon
(a specialist in childhood brain surgery), a pediatric
neurologist,
a psychologist,
a radiation oncologist
, and other doctors who
specialize in the type of treatment your child requires.
Treatment options often depend on the type of tumor and its location within the
brain. Complete or near complete removal of the tumor is often possible. If
the tumor cannot be completely removed, radiation therapy and/or chemotherapy
may also be given.
Radiation therapy uses high-energy radiation
from x-rays and other sources to
kill cancer cells and shrink tumors. Radiation therapy for childhood brain
tumors usually comes from a machine outside the body (external radiation
therapy
). For some types of brain tumors, clinical trials
are evaluating
radiation therapy given in several small doses per day (hyperfractionated
radiation therapy
). Since radiation therapy can affect growth and brain
development, other clinical trials are testing ways to decrease or delay
radiation therapy, especially for younger children who have not yet achieved
full growth.
Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy drugs may
be taken by mouth or injected
into a vein (intravenous
) or muscle.
Chemotherapy is called a systemic treatment
because the drug
enters the
bloodstream, travels through the body, and can kill cancer cells throughout the
body. Chemotherapy is being studied in clinical trials as a means of delaying,
modifying or eliminating the need for radiation therapy in younger patients, as
well as for use prior to or during radiation therapy.
Treatment in a clinical trial
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring
(coming back) or reduce the side effects
of cancer treatment.
Clinical trials are taking place in many parts of the country. In the following lists of treatments for the different types of brain tumors, a link to search results for current clinical trials is included for each section. These have been retrieved from NCI's
clinical trials database. For some types of tumors, there may not be any trials listed. Check with your child's doctor for clinical trials that are not listed here but that may be right for your child.
Childhood Medulloblastoma
(Refer to the PDQ
summary on Childhood Medulloblastoma Treatment for more
information.)
Childhood Cerebellar Astrocytoma
(Refer to the PDQ
summary on Childhood Cerebellar Astrocytoma Treatment for
more information.)
Childhood Infratentorial Ependymoma
Treatment for childhood infratentorial ependymoma
is usually surgery
to remove
as much of the tumor
as possible, followed by radiation therapy
. For children
younger than 3 years of age, chemotherapy
may be given to delay, modify, or
eliminate the use of radiation therapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood infratentorial ependymoma.
Childhood Brain Stem Glioma
(Refer to the PDQ
summary on Childhood Brain Stem Glioma Treatment for more
information.)
Childhood Cerebral Astrocytoma/Malignant Glioma
(Refer to the PDQ
summary on Childhood Cerebral Astrocytoma/Malignant Glioma Treatment for more
information.)
Childhood Supratentorial Ependymoma
Treatment for childhood supratentorial
ependymoma
may be surgery
followed by
radiation therapy
. Clinical trials
are evaluating surgery followed by
chemotherapy
with or without radiation therapy. For children younger than 3
years of age, chemotherapy may be given to delay or modify the use of
radiation therapy. Clinical trials evaluating radiation therapy with or
without chemotherapy are ongoing.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood supratentorial ependymoma.
Childhood Craniopharyngioma
Treatment for childhood craniopharyngioma
may be surgery,
radiation therapy
, or
a combination of the two.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood craniopharyngioma.
Childhood Central Nervous System Germ Cell Tumor
Treatment for childhood central nervous system
germ cell tumor
may be radiation
therapy
. In some cases, chemotherapy
may be given in addition to radiation
therapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood central nervous system germ cell tumor.
Spinal Cord Tumors
Treatment for spinal cord
tumors
may be surgery
with or without radiation therapy
. In some cases, chemotherapy
may be given in addition to radiation therapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with childhood spinal cord neoplasm.
Childhood Visual Pathway Glioma
(Refer to the PDQ
summary on Childhood Visual Pathway and Hypothalamic Glioma
Treatment for more information.)
Childhood Supratentorial Primitive Neuroectodermal Tumors and Pineoblastoma
(Refer to the PDQ
summary on Childhood Supratentorial Primitive Neuroectodermal Tumors Treatment for more information.)
Recurrent Childhood Brain Tumor
Treatment for recurrent disease
depends on the type of tumor,
whether the tumor
recurs
in the site in which it originated or elsewhere, the amount of time
between initial treatment and the recurrence, and the type of treatment
previously given.
Recurrent low-grade glial tumors
Treatment options consist of surgery
, radiation therapy
, and chemotherapy
.
Clinical trials
are currently evaluating the role of chemotherapy for treatment
of these tumors.
Recurrent infratentorial ependymomas
Treatment options include surgery
and chemotherapy
. Clinical trials
are
currently evaluating the role of chemotherapy for treatment of these tumors
.
Recurrent supratentorial ependymoma
Treatment usually consists of chemotherapy
. Clinical trials
are currently
evaluating the role of chemotherapy for treatment of these tumors
.
Recurrent central nervous system germ cell tumors
Treatment usually consists of chemotherapy
. Clinical trials
are currently
evaluating the role of chemotherapy for treatment of these tumors
.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood brain tumor.
To Learn More About Childhood Brain Tumors
For more information from the National Cancer Institute
about childhood brain tumors, see the following:
For more childhood cancer
information and other general cancer resources from the National Cancer Institute, see the following:
Get More Information From NCI
Call 1-800-4-CANCER
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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For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
Search the NCI Web site
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. For a quick search, use our “Best Bets” search box in the upper right hand corner of each Web page. The results that are most closely related to your search term will be listed as Best Bets at the top of the list of search results.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find 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. 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.
Changes to This Summary (05/23/2008)
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.
Several enhancements have been made to this summary to better explain certain medical concepts and to help readers find information about clinical trials
. The following changes were made:
- Information about patients taking part in clinical trials was added to the Treatment Option Overview section.
- Links to ongoing clinical trials listed in NCI’s PDQ Cancer Clinical Trials Registry were added to the treatment sections.
- A new section called “To Learn More” was added. It includes links to more information about this type of cancer and about cancer in general.
- The “Get More Information from NCI” section (originally called “To Learn More”) was revised.
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.
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 the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.
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.
Date last modified: 2008-05-23