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Childhood medulloblastoma


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is childhood medulloblastoma?
STAGE EXPLANATION
Untreated childhood medulloblastoma
Recurrent childhood medulloblastoma
TREATMENT OPTION OVERVIEW
Treatment by type
UNTREATED CHILDHOOD MEDULLOBLASTOMA
RECURRENT CHILDHOOD MEDULLOBLASTOMA
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 medulloblastoma?

Childhood medulloblastoma is a type of brain tumor in which cancer (malignant) cells begin to grow in the tissues of the brain. The brain controls memory and learning, your 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 or lymphoma, brain tumors are the most common type of cancer that occur in children.

Brain tumors are grouped by their location within the brain and the type of brain cells where the cancer began. Infratentorial tumors are found in the lower part of the brain. Medulloblastoma is an infratentorial tumor. Medulloblastoma is usually found only in children or young adults. It can spread from the brain to the spine or to other parts of the body.

This PDQ treatment information summary refers only to tumors that start in the brain (primary brain tumors). Often cancer found in the brain has started somewhere else in the body and has spread (metastasized) to the brain. This is called brain metastases. There is a separate PDQ patient information summary on brain cancer that occurs in adults.

A magnetic resonance imaging (MRI) scan, which uses magnetic waves to make a picture of your child's brain, may be done.

Often, surgery is required to see whether there is a brain tumor and to tell what type of tumor it is. The doctor may cut out a piece of tissue from the brain and look at it under a microscope. This is called a biopsy.

Your child's chance of recovery (prognosis) depends on the type of tumor, where it is located within the brain, and your child's age and general health.


STAGE EXPLANATION

Once childhood medulloblastoma is found, more tests will be done to find out the type of tumor. If a biopsy specimen is taken, the cancer cells will be looked at carefully under a microscope to see how different they are from the normal cells. This will determine the histologic grade of the tumor. Your child's doctor needs to know the type and grade of tumor in order to plan treatment.


Untreated childhood medulloblastoma

Children with medulloblastoma are grouped as average-risk or high-risk depending on the child's age, how much of the tumor remains following surgery, and whether the cancer has spread from where it started.


Recurrent childhood medulloblastoma

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


TREATMENT OPTION OVERVIEW

There are treatments for all children with medulloblastoma. Three kinds of treatment are used:

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

Experienced doctors working together can often give the best treatment for children with medulloblastoma. 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 you 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 the most common treatment for a child with medulloblastoma. Depending on where the cancer is and the type of cancer, your child's doctor may remove as much of the tumor as possible. If the tumor cannot be totally removed, radiation therapy and chemotherapy may also be given. If the cancer is in a place where it cannot be removed, surgery may be limited to a biopsy of the cancer.

Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation therapy for childhood medulloblastoma usually comes from a machine outside the body (external radiation therapy). The use of radiation put into the brain through thin plastic tubes (internal radiation therapy) is under study. For some types of brain tumors, clinical trials are evaluating radiation therapy given in several small doses each day (hyperfractionated radiation therapy). Radiation therapy can affect growth and brain development, so clinical trials are testing ways to decrease or delay radiation therapy, especially for younger children.

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein 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 to delay the use of radiation therapy in some patients. Clinical trials are studying different chemotherapy drugs for childhood medulloblastoma.

Bone marrow transplantation is a newer type of treatment that is being studied in clinical trials. Sometimes standard doses of chemotherapy do not destroy the cancer. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy your child's bone marrow, marrow is taken from your child's bones before treatment. The marrow is then frozen and your child is given high-dose chemotherapy with or without radiation therapy to treat the cancer. The marrow your child had taken out is then thawed and returned to your child through a needle inserted into a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant.


Treatment by type

Treatment for childhood medulloblastoma depends on the type and stage of the disease and your child's age and overall health.

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 go into 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 medulloblastoma. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


UNTREATED CHILDHOOD MEDULLOBLASTOMA

Your child's treatment will probably be surgery to remove as much of the cancer as possible. After surgery, your child's treatment depends on the risk of the cancer coming back and the child's age.

If your child is older than 3 years of age, the cancer is in the very back part of the brain, there is no or only a very small amount of cancer left after surgery, and no sign that the cancer has spread, the risk is called "average" that the cancer will come back (recur). After surgery, your child will probably receive radiation therapy.

If your child is younger than 3 years of age, the cancer is not in the very back part of the brain, all of the cancer could not be removed during surgery, or the cancer has spread to other parts of the brain, the risk is higher that the cancer will recur (this is called poor risk). After surgery, your child will probably receive radiation therapy and chemotherapy. Clinical trials are evaluating whether chemotherapy can be given to children under the age of 3 to delay or reduce radiation therapy. If your child's cancer does not completely disappear after chemotherapy, your child may receive higher doses of chemotherapy, followed by a bone marrow transplant. Clinical trials are evaluating new treatment options for these patients.


RECURRENT CHILDHOOD MEDULLOBLASTOMA

Treatment for recurrent disease depends on the type of tumor, whether the tumor comes back in the same place or in another part of the brain, and the treatment that was given before. You may want to consider entering your child on a clinical trial of new treatments.


TO LEARN MORE

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

To learn more about childhood medulloblastoma, 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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