Childhood brain and spinal tumours

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Ependymoma

Ependymomas start in the lining of the ventricles of the brain. They usually occur in the back of the brain in the cerebellum. They can also occur in the upper brain in the cerebrum and sometimes in the spinal cord.

Grading

Ependymomas are usually graded from I to III.

  • Grade I ependymomas (also called myxopapillary ependymomas) are slow-growing tumours.
  • Grade II ependymomas (also called ependymomas) are the most common.
  • Grade III ependymomas (also called anaplastic ependymomas) are fast-growing tumours.

Recurrent ependymomas are tumours that have come back after treatment.

Treatment of ependymomas

Treatment of ependymomas depends on:

  • the size and location of the tumour
  • whether the cancer has spread
  • the child’s age, neurological condition and overall health

Ependymomas are commonly treated with surgery and radiation therapy.

Surgery

Surgery is commonly used to treat ependymomas whenever possible. The goal is to remove as much of the tumour as possible. Surgery is usually followed with radiation therapy. If all of the tumour is not removed with surgery, second-look surgery may be used. Second-look surgery is used to see how treatment worked and to remove more tumour if possible. It can be done a few days after the first surgery or after chemotherapy. Surgery may be used to relieve cerebrospinal fluid (CSF) buildup.

Radiation therapy

Radiation therapy is usually given after surgery to treat as many remaining ependymoma cells as possible and prevent the cancer from coming back (recurring). The spine may also be treated with radiation therapy if the cancer has spread to the spinal cord. Whenever possible, doctors avoid giving radiation to children under 3 years old because of its long-term effects on developing brain cells.

Chemotherapy

Chemotherapy is not usually effective against ependymomas and is not considered a standard treatment. It may be tried in certain cases, such as when the child is under 3 years old, to delay radiation therapy. Chemotherapy may also be given after surgery to shrink any tumour left behind and increase the possibility of being able to remove the tumour in second-look surgery.

Treatment of recurrent ependymomas

Treatment of recurrent ependymomas may include surgery, radiation therapy (if not already given) and chemotherapy. Doctors may recommend that the child participate in a clinical trial.

Clinical trials

Many children with ependymomas are treated in a clinical trial. Clinical trials look at new ways to prevent, find and treat cancer. Find out more about clinical trials.

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