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Childhood Brain Stem Glioma Treatment (PDQ®)
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General Information About Childhood Brain Stem Glioma
Key Points:
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. Most childhood brain stem gliomas are pontine gliomas, which form in a part of the brain stem called the pons.
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 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. (Refer to
the PDQ treatment summary on Adult Brain Tumors for more information.)
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 and other symptoms may be caused by a brain stem glioma. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Loss of balance and trouble 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 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 the tumor is located and if it has spread within the brain stem.
- Whether or not the child has an
underlying condition called neurofibromatosis type 1.
- Whether the glioma has just been diagnosed or has recurred (come back).
Treatment options depend
on the type and location of the glioma.
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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:
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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 parts of the central nervous
system.
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Treatment Option Overview
Key Points:
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 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:
Five types of standard treatment are used:
Surgery
Surgery is used to diagnose and treat childhood brain stem glioma as discussed in the General Information section of this summary.
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.
Radiation therapy to the brain can affect growth and development in young children. Certain ways of giving radiation therapy can help keep radiation from damaging healthy tissue:
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, 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 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.
Watchful waiting
Watchful waiting is closely monitoring a patient’s condition without giving any treatment until symptoms appear or change.
New types of treatment are being tested in clinical trials.
Radiation therapy with radiosensitizers
Radiosensitizers are
drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy
with radiosensitizers may kill more tumor cells.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
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Treatment Options for Childhood Brain Stem Glioma
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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.
Standard treatment of diffuse intrinsic pontine glioma is usually radiation therapy.
Some of the treatments being studied in clinical trials for diffuse intrinsic pontine glioma include the
following:
- A clinical trial
of chemotherapy combined with
radiation therapy.
- A clinical trial of a new kind of treatment given during and/or after radiation therapy.
Information about these and other ongoing clinical trials is available from the
NCI Web site
Standard treatment of focal or low-grade glioma may include the
following:
Information about ongoing clinical trials is available from the
NCI Web site
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.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with untreated childhood brain stem glioma.
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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 started or in another part of the brain,
and the type of treatment previously given.
Standard treatment of recurrent diffuse intrinsic pontine glioma is usually palliative therapy, to relieve symptoms and improve the patient's
quality of life. The patient may also be treated in a clinical trial of a new treatment. Information about ongoing clinical trials is available from the NCI Web site.
Standard treatment of recurrent focal or low-grade childhood brain stem
glioma may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood brain stem glioma.
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Changes to This Summary (07/24/2006)
The PDQ cancer information summaries are reviewed regularly and updated as
new information becomes available. This section describes the latest
changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
This information is provided from the PDQ® database in collaboration with the NCI.
