Childhood Ependymoma Treatment (PDQ®)
Topics in This Section
- General Information About Childhood Ependymoma
- Stages of Childhood Ependymoma
- Recurrent Childhood Ependymoma
- Treatment Option Overview
- Treatment Options for Childhood Ependymoma
- Newly Diagnosed Childhood Ependymoma
- Myxopapillary ependymoma
- Childhood ependymoma or anaplastic ependymoma
- Recurrent Childhood Ependymoma
- To Learn More About Childhood Brain Tumors
- Changes to This Summary (01/31/2014)
- About This PDQ Summary
- About PDQ
- Purpose of This Summary
- Reviewers and Updates
- Clinical Trial Information
- Permission to Use This Summary
- Contact Us
- Get More Information From NCI
The brain controls vital functions such as memory and learning, emotion, and the senses (hearing, sight, smell, taste, and touch). The spinal cord is made up of bundles of nerve fibers that connect the brain with nerves in most parts of the body.
Ependymomas form from ependymal cells that line the ventricles and passageways in the brain and the spinal cord. Ependymal cells make cerebrospinal fluid (CSF).
This summary is about the treatment of primary brain tumors (tumors that begin in the brain). Treatment of metastatic brain tumors, which are tumors 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 is 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 World Health Organization (WHO) groups ependymal tumors into four main subtypes:
- Subependymoma (WHO Grade I).
- Myxopapillary ependymoma (WHO Grade I).
- Ependymoma (WHO Grade II)
- Anaplastic ependymoma (WHO Grade III).
The grade of a tumor describes how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Low-grade (Grade I) cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade (Grade III) cancer cells.
Ependymomas can form anywhere in the fluid-filled ventricles and passageways in the brain and spinal cord. Most ependymomas form in the fourth ventricle and affect the cerebellum and the brain stem. Once an ependymoma forms, areas of the brain that may be affected include:
- 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.
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 following signs and symptoms may be caused by childhood ependymoma or by other conditions. Check with a doctor if your child has any of the following:
- Frequent headaches.
- Nausea and vomiting.
- Pain or stiffness in the neck.
- Loss of balance or trouble walking.
- Weakness in the legs.
- Blurry vision.
- Back pain.
- A change in bowel function.
- Trouble urinating.
- Confusion or irritability.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Neurological exam: A series of questions and tests to check the brain, spinal cord, and nerve function. The exam checks a person’s mental status, coordination, and ability to walk normally, and how well the muscles, senses, and reflexes work. This may also be called a neuro exam or a neurologic exam.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging) with gadolinium: A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the brain and spinal cord. A substance called gadolinium is injected into a vein and travels through the bloodstream. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Lumbar puncture: A procedure used to collect cerebrospinal fluid (CSF) from the spinal column to check for cancer cells. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). The fluid may be sent to a laboratory for testing.
If the diagnostic 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 is often done after the tumor is removed to find out whether any tumor remains.
The prognosis (chance of recovery) and treatment options depend on:
- Where the tumor has formed in the central nervous system (CNS).
- Whether there are certain changes in the genes or chromosomes.
- Whether any cancer cells remain after surgery to remove the tumor.
- The type of ependymoma.
- The age of the child when the tumor is diagnosed.
- Whether the cancer has spread to other parts of the brain or spinal cord.
- Whether the tumor has just been diagnosed or has recurred (come back).
Prognosis also depends on the type and dose of radiation therapy that is given.
Staging is the process used to find out how much cancer there is and if cancer has spread. There is no standard staging system for childhood ependymoma. Treatment is based on where the cancer is in the body and the age of the child.
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.
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.
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.
Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health 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:
- Pediatric neurosurgeon.
- Rehabilitation specialist.
- Radiation oncologist.
- Medical oncologist.
Childhood brain and spinal cord tumors may cause signs and symptoms that continue for months or years. Signs and symptoms caused by the tumor may begin before diagnosis. Signs and symptoms caused by treatment may begin during or right after treatment.
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).
If the results of diagnostic 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 check for cancer cells. If cancer cells are found, the doctor will remove as much tumor as safely possible during the same surgery.
An MRI is often done after the tumor is removed to find out whether any tumor remains. If tumor remains, a second surgery to remove as much of the remaining tumor as possible may be done.
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 to lower the risk that the cancer will come back after surgery is called adjuvant 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 of 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 number of days.
External radiation therapy can be given in different ways:
- Three-dimensional (3D) conformal radiation therapy uses a computer to create a 3D picture of the tumor. The radiation beams are shaped to fit the tumor.
- Proton-beam therapy is a type of high-energy, external radiation therapy that uses streams of protons (small, positively-charged particles of matter) to kill tumor cells.
- Stereotactic radiosurgery is a type of radiation therapy that uses a head frame attached to the skull to keep the head still. A single large dose of radiation is aimed directly at the brain tumor. This causes less damage to nearby healthy tissue. Stereotactic radiosurgery is also called stereotaxic radiosurgery, radiosurgery, and radiation surgery. This procedure does not involve surgery.
Children younger than 3 years who receive radiation therapy to the brain have a higher risk of problems with growth and development than older children. 3D conformal radiation therapy and proton-beam therapy are being studied in children younger than 3 years to see if the effects of radiation on growth and development are lessened.
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 of cancer being treated.
Information about clinical trials is available from the NCI Web site.
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. 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.
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.
Follow-up tests for childhood ependymoma include an MRI (magnetic resonance imaging) of the brain and spinal cord every 3 months for the first 1 or 2 years after treatment. After 2 years, MRIs may be done every 6 months for the next 3 years.
A child with a newly diagnosed ependymoma has not had treatment for the tumor. The child may have had treatment to relieve symptoms caused by the tumor.
Treatment of newly diagnosed subependymoma (WHO Grade I) is:
Treatment of newly diagnosed myxopapillary ependymoma (WHO Grade I) is:
- Surgery with or without radiation therapy.
Treatment of newly diagnosed childhood ependymoma (WHO Grade II) or anaplastic ependymoma (WHO Grade III) is:
After surgery, the plan for further treatment 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.
When the tumor is completely removed and cancer cells have not spread, treatment may include the following:
- Radiation therapy.
- A clinical trial of radiation therapy followed by chemotherapy.
- A clinical trial of observation for patients whose tumor is completely removed or who have no sign of cancer after chemotherapy.
When part of the tumor remains after surgery, but cancer cells have not spread, treatment may include the following:
- A second surgery to remove as much of the remaining tumor as possible.
- Radiation therapy.
- Chemotherapy followed by radiation therapy.
- A clinical trial of chemotherapy given before and after radiation therapy.
When cancer cells have spread within the brain and spinal cord, treatment may include the following:
- Radiation therapy to the brain and spinal cord.
Treatment for children younger than 3 years of age may include the following:
- Radiation therapy.
- A clinical trial of 3-dimensional (3D) conformal radiation therapy or proton-beam radiation therapy.
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. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
Treatment of recurrent childhood ependymoma may include the following:
- Radiation therapy, including stereotactic radiosurgery, if radiation therapy was not used when the tumor was first diagnosed.
- Chemotherapy, if chemotherapy was not used when the tumor was first treated.
- A clinical trial of a new treatment.
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. Talk with your child's doctor about clinical trials that may be right for your child. General information about clinical trials is available from the NCI Web site.
For more information about childhood brain tumors, see the following
For more childhood cancer information and other general cancer resources, see the following:
- Late Effects of Treatment for Childhood Cancer
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Changes were made to this summary to match those made to the health professional version.
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