Childhood Ependymoma Treatment (PDQ®)
[Back to top]General Information About Childhood Ependymoma
Key Points: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 nervefibers 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 is about 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. See the following PDQ summaries for more information:
- Childhood Brain and Spinal Cord Tumors Treatment Overview
- Adult Brain Tumors Treatment
The central nervous system controls many important body functions.
Ependymomas most commonly form in these parts of the central nervous system (CNS):
- Cerebrum: The largest part of the brain, at the top of the head. The cerebrum controls thinking, learning, problem-solving, speech, emotions, reading, writing, and voluntary movement.
- Cerebellum: The lower, back part of the brain (near the middle of the back of the head). The cerebellum controls movement, balance, and posture.
- Brain stem: The part that connects the brain to the spinal cord, in the lowest part of the brain (just above the back of the neck). The brain stem controls breathing, heart rate, and the nerves and muscles used in seeing, hearing, walking, talking, and eating.
- Spinal cord: The column of nerve tissue that runs from the brain stem down the center of the back. It is covered by three thin layers of tissue called membranes. The spinal cord and membranes are surrounded by the vertebrae (back bones). Spinal cord nerves carry messages between the brain and the rest of the body, such as a signal from the brain to cause muscles to move or from the skin to the brain for the sense of touch.
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 Drawing of brain anatomy showing the brain stem, pons, medulla, spinal cord, cerebellum, cerebrum, meninges, ventricles (fluid-filled spaces), and skull.
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 Drawing of the inside of the brain showing ventricles (fluid-filled spaces), choroid plexus, hypothalamus, pineal gland, pituitary gland, optic nerve, brain stem, cerebellum, cerebrum, medulla, pons, and spinal cord.
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| Anatomy of the brain, showing the cerebrum, cerebellum, brain stem, and other parts of the brain. |
Anatomy of the inside of the brain, showing the pineal and pituitary glands, optic nerve, ventricles (with cerebrospinal fluid shown in blue), and other parts of the brain. |
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.
The following symptoms and others may be
caused by childhood ependymoma. Other conditions may cause the same symptoms. Check with your child’s doctor if you see any of these problems in your child:
Tests that examine the brain and spinal cord are used to detect
(find) childhood ependymoma.
The following tests and procedures may be used:
Childhood ependymoma is diagnosed and removed in surgery.
If the tests show there may be a brain tumor, 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. An MRI may be done after the tumor is removed to find out how much tumor remains.
Drawing of a craniotomy showing a section of the scalp that has been pulled back to remove a piece of the skull; the dura covering the brain has been opened to expose the brain. The layer of muscle under the scalp is also shown.
Certain factors affect prognosis (chance of
recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on:
- Whether cancer cells remain after surgery.
- The type of ependymoma and whether it begins in the brain or in the spinal cord.
- The age of the child when the tumor is diagnosed.
- Whether the cancer has spread to other parts of the central nervous system, such as the meninges (membranes covering the brain) and the spinal cord.
- Whether the cancer has spread to other parts of the body, such as the bone or lung.
- Whether the tumor has just been diagnosed or has recurred (come back).
[Back to top]Stages of Childhood Ependymoma
Key Points:The area where the tumor is found and the child’s age are used in place of a staging system to plan cancer treatment.
Staging is the process used to find out how much cancer there is and if cancer has spread. It is important to know the stage in order to plan treatment.
There is no standard staging system for childhood ependymoma. Instead, the plan for cancer treatment after surgery depends on the following:
- Whether any cancer cells remain after surgery.
- Whether the cancer has spread to other parts of the brain or spinal cord.
- The age of the child.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The information from tests and procedures done to detect (find) childhood ependymoma is used to plan cancer treatment.
Some of the tests used to detect childhood ependymoma are repeated after the tumor is removed by surgery. (See the General Information section.) This is to find out how much tumor remains after surgery. Another procedure that may be done to find out if cancer has spread is a lumbar puncture. A lumbar puncture is 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.
[Back to top]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.
[Back to top]Treatment Option Overview
Key Points: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. Some clinical trials are open only to patients who have not started treatment.
Children with ependymoma should have their treatment planned by
a team of health care providers who are experts in treating childhood brain tumors.
Treatment will be overseen by a
pediatric oncologist, a doctor who specializes
in treating children with cancer. The pediatric oncologist works with
other pediatrichealth care providers who are experts in treating children
with brain tumors and who specialize
in certain areas of medicine. These may include the following
specialists:
Childhood brain and spinal cord tumors may cause symptoms that begin before diagnosis and continue for months or years.
Childhood brain and spinal cordtumors may cause symptoms that continue for months or years. Symptoms caused by the tumor may begin before diagnosis. Symptoms caused by treatment may begin during or right after treatment.
Some cancer treatments cause side effects months or years
after treatment has ended.
These are called late effects. Late effects of cancer treatment may include the following:
- Physical problems.
- Changes in mood, feelings, thinking, learning, or memory.
- 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 effects cancer treatment can have on your child. (See 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.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. 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. Childhood ependymoma may be treated with fractionated radiation therapy, which divides the total dose of radiation into several smaller, equal doses delivered over a period of days.
Certain ways of giving radiation therapy can help keep radiation away from healthy tissue:
Radiation therapy to the brain can affect the growth and development of children younger than 3 years. For this reason, conformal radiation therapy and proton-beam therapy that limit damage to healthy brain tissue are being studied in infants and children with ependymoma.
Damage to the brain in young children treated for ependymoma is not always caused by the 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 them 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 cerebrospinal fluid, 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 clinical trials is available from the
NCI Web site.
Watchful waiting
Watchful waiting
is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.
Patients may want to think about taking part 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.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
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. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
[Back to top]Treatment Options for Childhood Ependymoma
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your child's doctor for clinical trials that are not listed here but may be right for your child.
[Back to top]Newly Diagnosed Childhood Ependymoma
A child with a newly diagnosedependymoma has not had treatment for the tumor. The child may have had treatment to relieve symptoms caused by the tumor.
Treatment for newly diagnosed childhood ependymoma is usually surgery to remove the tumor. More treatment may be given after surgery. Treatment given after surgery depends on the following:
- Age of the child.
- Amount of tumor that was removed.
- Whether cancercells have spread to other parts of the brain or spinal cord.
Treatment for children aged 3 and older
If the tumor is completely removed by surgery and cancercells have not spread within the brain and spinal cord, treatment may include the following:
If a part of the tumor remains after surgery, but cancer cells have not spread within the brain and spinal cord, treatment may include the following:
- A second surgery to remove as much of the remaining tumor as possible.
- Radiation therapy to the tumor bed.
- A clinical trial of chemotherapy given before and after radiation therapy.
If cancer cells have spread within the brain and spinal cord, treatment may include the following:
- Radiation therapy to the whole brain and spine.
- A clinical trial of radiation therapy and chemotherapy.
Treatment for children younger than 3 years of age
When the child is younger than 3 years, treatment may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with newly diagnosed childhood ependymoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
[Back to top]Recurrent Childhood Ependymoma
Treatment of recurrent
childhood ependymomas may include
the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with recurrent childhood ependymoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
[Back to top]To Learn More About Childhood Brain Tumors
For more information about childhood brain tumors, see the following
For more childhood cancer information and other general cancer resources, see the following:
[Back to top]Changes to This Summary (02/01/2013)
The PDQcancer 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.
Editorial changes were made and images were added to this summary.