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Childhood brain stem glioma is a disease in which benign (noncancer) or
malignant (cancer) cells form in the tissues of the brain stem.
The brain
stem is the part of the brain connected to the spinal cord. It is located in
the lowest part of the brain, just above the back of the neck. The brain stem is
the part of the brain that controls breathing, heart rate, and nerves and
muscles used in seeing, hearing, walking, talking, and eating.
Although cancer
is rare in children, brain tumors
are the most common type of childhood cancer other than leukemia
or lymphoma.
This summary refers to the treatment of primary
brain tumors (tumors that begin in the brain). Treatment for metastatic
brain tumors, which are secondary
tumors formed by cancer cells
that begin in other parts of the body and spread to the brain, is not discussed
in this summary. Brain tumors can occur in both children and adults; however,
treatment for children may be different than treatment for adults.
The cause of most childhood brain tumors is unknown.
The symptoms of childhood brain stem glioma vary and often depend on the
child's age and where the tumor is located.
These symptoms may be caused by a brain stem glioma or other conditions. A
doctor should be notified if any of the following problems occur:
- Loss of balance and difficulty walking.
- Vision and hearing problems.
- Morning headache or headache that goes away after vomiting.
- Nausea and vomiting.
- Unusual sleepiness or change in energy level.
Tests that examine the brain are used to detect (find) childhood brain
stem glioma.
The following tests and procedures may be used:
- 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): 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 the
patient through a vein. 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).
Childhood brain stem glioma is diagnosed and removed in surgery.
If the tumor has not spread widely within the brain stem, a biopsy
may be 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.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis
(chance of recovery) depends on the type of brain
stem glioma, where it is located within the brain stem, whether it has
spread within the brain stem, and whether or not the child has an underlying
condition called neurofibromatosis
type 1. Treatment options depend on the type and location of the tumor.
Stages of Childhood Brain Stem Glioma
After the childhood brain
stem glioma has been removed, tests are done to find out if there is tumor
remaining. The extent or spread of cancer
is usually described as stages.
For childhood brain stem glioma, the tumors are described by type:
- Diffuse intrinsic glioma
is a tumor that has spread widely throughout the brain
stem.
- Focal or low-grade glioma is a tumor that is localized
to one area of the brain stem.
Recurrent Childhood Brain Stem Glioma|
Recurrent childhood brain
stem glioma is a tumor
that has recurred (come back) after it has been treated. If childhood brain stem
glioma recurs, it may do so many years after initial treatment. The tumor may
come back in the brain or in other areas of the central
nervous system.
Treatment Option Overview
There are different types of treatment for children with brain stem glioma.
Different types of treatment are available for children with brain
stem glioma. 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. Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the NCI
Cancer.gov Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care team.
Children with brain stem glioma should have their treatment planned by a
team of doctors with expertise in treating childhood brain tumors.
Your child's treatment will be overseen by a pediatric oncologist,
a doctor who specializes in treating children with cancer. The pediatric
oncologist may refer you to other pediatric doctors who have experience and
expertise in treating children with brain tumors
and who specialize in certain areas of medicine. These may include the following
specialists:
- Neurosurgeon.
- Neurologist.
- Neuropathologist.
- Neuroradiologist.
- Rehabilitation
specialist.
- Radiation
oncologist.
- Medical
oncologist.
- Endocrinologist.
- Psychologist.
Four types of standard treatment are used:
Surgery
Surgery
is used to diagnose and treat childhood brain stem glioma.
Radiation therapy
Radiation
therapy is a cancer treatment that uses high-energy x-rays
or other types of radiation
to kill cancer cells.
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. Hyperfractionated radiation
therapy is a way of giving radiation therapy in smaller-than-usual doses two or
three times a day instead of once a day. The way the radiation therapy is given
depends on the type and stage
of the cancer being treated.
Radiation therapy may be used alone or in addition to chemotherapy.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of
cancer cells, either by killing the cells or by stopping the cells 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 in the spinal column, a
body cavity such as the abdomen,
or an organ, the drugs mainly affect cancer cells in those areas. The way the
chemotherapy is given depends on the type and stage of the cancer being treated.
Because radiation therapy to the brain can affect growth and brain
development in young children, clinical trials are studying ways of using
chemotherapy to delay or reduce the need for radiation therapy.
Cerebrospinal fluid diversion
Cerebrospinal
fluid diversion is a method used to drain fluid that has built up around the
brain and spinal cord. A shunt
(long, thin tube) is placed in a ventricle
(hollow space) of the brain and threaded under the skin to another part of the
body, usually the abdomen. The shunt carries excess fluid away from the brain so
it may be absorbed elsewhere in the body.
Other types of treatment are being tested in clinical trials.
Radiation therapy with radiosensitizers
Radiosensitizers
are drugs that make tumor cells more sensitive to radiation. Combining radiation
with radiosensitizers may kill more tumor cells.
Untreated Childhood Brain Stem Glioma
Untreated childhood brain
stem glioma is a tumor
for which no treatment has been given. The child may have received drugs or
treatment to relieve symptoms
caused by the tumor.
Treatment of diffuse intrinsic brain stem glioma may include the following:
- Radiation
therapy.
- A clinical
trial of chemotherapy
combined with radiation therapy.
- A clinical trial of chemotherapy to delay the use of radiation
therapy.
Treatment of focal or low-grade glioma may include the following:
- Surgery.
- Cerebrospinal
fluid diversion followed by careful observation
(watchful
waiting without immediate treatment). Watchful waiting is closely
monitoring a patient's condition but withholding treatment until symptoms
appear or change.
- A clinical trial of surgery followed by watchful waiting.
Treatment of brain stem glioma in children with neurofibromatosis
type 1 may be watchful waiting. The tumors are slow-growing in these
children and may not need specific treatment for years.
Recurrent Childhood Brain Stem Glioma
Treatment of recurrent
childhood brain stem glioma depends on the type of tumor, whether it comes back
in the place in which it originated or in another part of the brain, and the
type of treatment previously given.
Treatment of recurrent diffuse intrinsic brain stem glioma may include the
following:
- Surgery.
- Palliative
therapy to relieve symptoms and improve quality
of life.
- A clinical trial of a new therapy.
Treatment of recurrent focal or low-grade childhood brain stem glioma may
include the following:
Source: National Institutes of Health; National Cancer Institute
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