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Childhood brain tumor


Table of Contents

OVERVIEW OF PDQ
What is PDQ?
How to use PDQ
DESCRIPTION
What is childhood brain tumor?
STAGE EXPLANATION
Types of childhood brain tumor
Infratentorial tumors
Medulloblastoma
Cerebellar astrocytoma
Infratentorial ependymoma
Brain stem glioma
Supratentorial tumors
Cerebral astrocytoma
Supratentorial ependymoma
Craniopharyngioma
Central nervous system germ cell tumor
Supratentorial primitive neuroectodermal and pineal tumors
Visual pathway and hypothalamic glioma
Recurrent brain tumor
TREATMENT OPTION OVERVIEW
Treatment by type
CHILDHOOD MEDULLOBLASTOMA
CHILDHOOD CEREBELLAR ASTROCYTOMA
CHILDHOOD INFRATENTORIAL EPENDYMOMA
CHILDHOOD BRAIN STEM GLIOMA
CHILDHOOD CEREBRAL ASTROCYTOMA
CHILDHOOD SUPRATENTORIAL EPENDYMOMA
CHILDHOOD CRANIOPHARYNGIOMA
CHILDHOOD CENTRAL NERVOUS SYSTEM GERM CELL TUMOR
CHILDHOOD VISUAL PATHWAY GLIOMA
CHILDHOOD SUPRATENTORIAL PRIMITIVE NEUROECTODERMAL AND PINEAL TUMORS
RECURRENT CHILDHOOD BRAIN TUMOR
Recurrent low-grade glial tumors
Recurrent infratentorial ependymomas
Recurrent supratentorial ependymoma
Recurrent central nervous system germ cell tumors
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 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. A separate patient information summary containing information on brain tumors that occur in adults is also available in PDQ.

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. 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 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

A separate patient information summary on childhood medulloblastoma is available in PDQ.


Cerebellar astrocytoma

A separate patient information summary on childhood cerebellar astrocytoma is available in PDQ.


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

A separate patient information summary on childhood brain stem glioma is available in PDQ.


Supratentorial tumors

Supratentorial tumors are those that occur in the upper part of the brain. Common supratentorial tumors include:


Cerebral astrocytoma

A separate patient information summary on childhood cerebral astrocytoma is available in PDQ.


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 and pineal tumors

A separate patient information summary on childhood primitive neuroectodermal
and pineal tumors is available in PDQ.


Visual pathway and hypothalamic glioma

A separate patient information summary on childhood visual pathway and hypothalamic glioma is available in PDQ.


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

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

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

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 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 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 people with cancer. Clinical trials are ongoing in most parts of the country for childhood brain tumors. For more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.


CHILDHOOD MEDULLOBLASTOMA

A separate patient information summary on childhood medulloblastoma is available in PDQ.


CHILDHOOD CEREBELLAR ASTROCYTOMA

A separate patient information summary on childhood cerebellar astrocytoma is available in PDQ.


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.


CHILDHOOD BRAIN STEM GLIOMA

A separate patient information summary on childhood brain stem glioma is available in PDQ.


CHILDHOOD CEREBRAL ASTROCYTOMA

A separate patient information summary on childhood cerebral astrocytoma is available in PDQ.


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.


CHILDHOOD CRANIOPHARYNGIOMA

Treatment for childhood craniopharyngioma may be surgery, radiation therapy, or a combination of the two.


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.


CHILDHOOD VISUAL PATHWAY GLIOMA

A separate patient information summary on childhood visual pathway and hypothalamic glioma is available in PDQ.


CHILDHOOD SUPRATENTORIAL PRIMITIVE NEUROECTODERMAL AND PINEAL TUMORS

A separate patient information summary on childhood supratentorial primitive neuroectodermal and pineal tumors (PNET, cerebral neuroblastoma, and pineoblastoma) is available in PDQ.


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.


TO LEARN MORE

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

To learn more about childhood brain tumor, 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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