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Childhood brain stem glioma


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is childhood brain stem glioma?
STAGE EXPLANATION
Untreated childhood brain stem glioma
Recurrent childhood brain stem glioma
TREATMENT OPTION OVERVIEW
Treatment by stage
UNTREATED CHILDHOOD BRAIN STEM GLIOMA
RECURRENT CHILDHOOD BRAIN STEM GLIOMA
TO LEARN MORE

OVERVIEW OF PDQ


What is PDQ?

PDQ is a computer system that provides up-to-date information on cancer and its prevention, detection, treatment, and supportive care. PDQ is a service of the National Cancer Institute (NCI) for people with cancer and their families and for doctors, nurses, and other health care professionals.

To ensure that it remains current, the information in PDQ is reviewed and updated each month by experts in the fields of cancer treatment, prevention, screening, and supportive care. PDQ also provides information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ summary for health professionals on this cancer.


How to use PDQ

Cancer in children and adolescents is rare. The majority of children with cancer are treated at cancer centers with special facilities to treat childhood cancers. There are organized groups of doctors and other health care professionals who work together by doing clinical trials to improve treatments for children with cancer.

PDQ can be used to learn more about current treatment of different kinds of cancer. You may find it helpful to discuss this information with your child's doctor, who knows your child and has the facts about your child's disease. PDQ can also provide the names of additional health care professionals and hospitals that specialize in treating children who have cancer.

Before your child begins treatment, you may want to consider entering your child in a clinical trial. PDQ can be used to learn more about the trials. A clinical trial is a research study that attempts to improve current treatments or find new treatments for people with cancer. Clinical trials are based on past studies and information discovered in the laboratory. Each trial answers specific scientific questions in order to find new and better ways to help people with cancer. During clinical trials, information is collected about new treatments, their risks, and how well they do or do not work. When a clinical trial shows that a new treatment is better than the treatment currently used as "standard" treatment, the new treatment may become the "standard" treatment. Children who are treated in clinical trials have the advantage of getting the best available therapy. 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 current clinical trials are available on PDQ. In the United States, there are two major groups (called cooperative groups) that organize clinical trials for childhood cancers: the Childrens Cancer Group (CCG) and the Pediatric Oncology Group (POG). Doctors who belong to these groups or who take part in other clinical trials are listed in PDQ.

To learn more about cancer and how it is treated or to learn more about clinical trials for your child's kind of cancer, call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will be available to answer your cancer-related questions.

PDQ is updated whenever there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.


DESCRIPTION


What is childhood brain stem glioma?

Childhood brain stem glioma is a type of brain tumor. A brain tumor is an abnormal growth of tissue contained within the skull, and 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. A separate patient information summary containing information on brain cancer that occurs in adults is also available in PDQ.

Brain stem gliomas are tumors located in the area of the brain called the brain stem, which connects the spinal cord with the brain and is located in the lowest portion of the brain, just above the back of the neck. Gliomas may grow rapidly or slowly, depending on the grade of the tumor. The grade of a tumor is determined by examining its cells under a microscope 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.

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 there is a brain tumor and what type of tumor it is. The doctor may surgically remove a small sample of the tumor tissue, which is then 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.

Your child's treatment and chance of recovery (prognosis) depend on the type and size of tumor, where it is located within the brain, and his or her age and general health.


STAGE EXPLANATION

Once childhood brain stem glioma is found, additional tests will be done to learn more about the tumor. If a biopsy specimen is taken, the tumor cells will be examined carefully under a microscope to see how different they look from normal cells. This will determine the grade of the tumor (described above). Your child's doctor needs to know the type and grade of tumor in order to plan treatment.

There is no staging for childhood brain stem glioma. The type of treatment given depends on whether or not your child has received previous treatment.


Untreated childhood brain stem glioma

Untreated childhood brain stem glioma means that no treatment has been given except to alleviate symptoms.


Recurrent childhood brain stem glioma

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may recur in the brain or in another part of the body.


TREATMENT OPTION OVERVIEW

There are treatments for all children with brain stem gliomas. Three kinds of treatment are used:

radiation therapy (using high-dose x-rays to kill cancer cells)
surgery (removing the cancer in an operation)
chemotherapy (using drugs to kill cancer cells).

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 stem gliomas. 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 doctors, 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.

Surgery is used when possible to treat brain stem gliomas. Depending on where the cancer is, your child's doctor may remove as much of the tumor as possible by creating an opening in the skull in an operation called a craniotomy. If the brain stem glioma is in a place where it cannot be removed, surgery may be limited to a biopsy of the cancer.

Because tumors in the brain stem often cannot be removed, radiation therapy is the most common treatment for children with brain stem gliomas. Radiation therapy uses high-energy radiation from x-rays and other sources to kill cancer cells and shrink tumors. Radiation therapy for brain stem gliomas usually comes from a machine outside the body (external radiation therapy). 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 a 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 or eliminating the need for radiation therapy in younger patients, as well as for use prior to or during radiation therapy.


Treatment by stage

There is no staging for childhood brain stem glioma. Treatment depends on the grade of the tumor, its location, and whether or not the child has received previous treatment.

Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child enter a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients. Clinical trials are ongoing in most parts of the country for childhood brain stem gliomas. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


UNTREATED CHILDHOOD BRAIN STEM GLIOMA

Your child's treatment depends on where the tumor is located within the brain stem. In some cases, surgery is not possible and radiation therapy is given. In other cases, as much of the tumor as possible may be removed surgically and the patient may be watched carefully before more therapy is given. Children younger than 3 years of age may be given chemotherapy so that a lower dose of radiation may be given, or to delay radiation therapy. Clinical trials are currently evaluating radiation therapy given twice a day (hyperfractionated radiation therapy).


RECURRENT CHILDHOOD BRAIN STEM GLIOMA

Treatment for recurrent childhood brain stem glioma depends on the type of tumor, whether the tumor comes back in the place in which it originated or in another part of the brain, and the type of treatment previously given. Surgery may be performed or chemotherapy may be given. You may want to consider entering your child into a clinical trial of new chemotherapy drugs.


TO LEARN MORE

TO LEARN MORE..... CALL 1-800-4-CANCER

To learn more about childhood brain stem glioma, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is toll-free and a trained information specialist can answer your questions.

The Cancer Information Service can also send you booklets. The following booklet about brain tumors may be helpful to you:

What You Need To Know About Brain Tumors

The following booklets on childhood cancer may be helpful to you:

Young People with Cancer: A Handbook for Parents
Talking with Your Child About Cancer
Managing Your Child's Eating Problems During Cancer Treatment
When Someone in Your Family Has Cancer

The following general booklets on questions related to cancer may also be helpful:

What You Need To Know About Cancer
Taking Time: Support for People with Cancer and the People Who Care About
Them
What Are Clinical Trials All About?
Chemotherapy and You: A Guide to Self-Help During Treatment
Radiation Therapy and You: A Guide to Self-Help During Treatment
Eating Hints for Cancer Patients
Advanced Cancer: Living Each Day
When Cancer Recurs: Meeting the Challenge Again

There are many other places where material about cancer treatment and information about services are available. Check the hospital social service office for local and national agencies that help with finances, getting to and from treatment, care at home, and dealing with other problems.

Write to the National Cancer Institute at this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Date Last Modified: 09/1999


If you want to know more about cancer and how it is treated, or 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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