Medulloblastoma (Childhood)


General Information

What is childhood medulloblastoma?

Childhood medulloblastoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain. Childhood medulloblastoma (tumor) usually forms in the cerebellum, which is at the lower back of the brain. The cerebellum is the part of the brain that controls movement, balance, and posture. Childhood medulloblastoma may also be called primitive neuroectodermal tumor (PNET).

About 1 out of 5 childhood brain tumors are medulloblastomas. Although cancer is rare in children, brain tumors are the most common type of childhood cancer other than leukemia and 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. (Refer to Adult Brain Tumor Treatment for more information.)

The cause of most childhood brain tumors is unknown. The signs of childhood medulloblastoma vary and often depend on the child's age and where the tumor is located.
These symptoms may be caused by a medulloblastoma or other conditions. A doctor should be consulted if any of the following problems occur:

-Loss of balance, difficulty walking, worsening handwriting, or slow speech.
-Morning headache or headache that goes away after vomiting.
-Nausea and vomiting.
-Unusual sleepiness or change in energy level.
-Change in personality or behavior.
-Unexplained weight loss or weight gain.

Tests that examine the brain and spinal cord are used to detect (find) childhood medulloblastoma.

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. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet and radio waves to make a series of detailed pictures of areas inside the brain and spinal cord. The pictures are made by a computer. 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 medulloblastoma is diagnosed and removed in surgery.

If a brain tumor is suspected, a biopsy is done by removing part of the skull and using a needle to remove a sample of the tumor 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 possible during the same surgery.

Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options and prognosis (chance of recovery) depend on the age of the child when the tumor is found, the location of the tumor, the amount of tumor remaining after surgery, and whether the cancer has spread to other parts of the central nervous system (brain and spinal cord), or to other parts of the body, such as the bones.

Stages of Childhood Medulloblastoma

After childhood medulloblastoma has been diagnosed, tests are done to find out if there is tumor remaining or if cancer cells have spread. The extent or spread of cancer is usually described as stages. For childhood medulloblastoma, risk groups are used instead of stages. Risk groups are described by the amount of remaining tumor or spread of cancer cells within the central nervous system (brain and spinal cord) or to other parts of the body. It is important to know the risk group in order to plan the best treatment. The following tests and procedures may be used to determine the risk group:

MRI (magnetic resonance imaging): A procedure that uses a magnet and radio waves to make a series of detailed pictures of areas inside the brain and spinal cord. The pictures are made by a computer. 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).

Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. A pathologist views the fluid under a microscope to look for cancer cells. This procedure is also called an LP or spinal tap.

Bone marrow biopsy: The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views the samples under a microscope to look for abnormal cells.

Bone scan: A procedure to detect if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the blood stream. The radioactive material collects in the bones and is detected by a scanner.

The following risk categories are used for childhood medulloblastoma:

Average risk
Childhood medulloblastoma is called an average risk if all of the following are true:

-The child is older than 3 years of age.
-The tumor is at the very back of the brain.
-All of the tumor was removed by surgery or there was a very small amount remaining.
-The cancer has not spread to other parts of the body.

Poor risk
Childhood medulloblastoma is called a poor risk if any of the following are true:

-The child is younger than 3 years of age.
-The tumor is not at the very back of the brain.
-Some of the tumor was not removed by surgery.
The cancer has spread to other parts of the body.

In general, cancer is more likely to recur (come back) in patients in the poor risk group.

Recurrent Childhood Medulloblastoma
Recurrent childhood medulloblastoma is a tumor that has recurred (come back) after it has been treated. Childhood medulloblastoma often recurs. A tumor may come back many years later at the same place or a different place in the brain. It can also come back in other parts of the body such as the spinal cord.

Treatment Option Overview

There are different types of treatment for children with childhood medulloblastoma.

Different types of treatment are available for children with childhood medulloblastoma. 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. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Children with medulloblastoma 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 detect (find) and treat childhood medulloblastoma as described 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.

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. Because some normal cells such as blood and hair can be affected, side effects can occur. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can affect 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.

Because radiation therapy 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 process used to drain fluid that has built up around the brain and spinal cord. A shunt (a long, thin tube) is placed in a ventricle (fluid-filled cavity) of the brain and threaded under the skin to another part of the body, usually the abdomen. The shunt acts as a drainpipe to carry 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.

High-dose chemotherapy with bone marrow transplantation or stem cell transplantation and radiation therapy
High-dose chemotherapy with bone marrow or stem cell transplantation is a method of giving very high doses of chemotherapy and then replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow or blood of the patient or a donor and are frozen for storage. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. Over a short time, these reinfused stem cells grow into (and restore) the body's blood cells. Clinical trials are studying the use of this treatment followed by radiation therapy directed at the tumor only for childhood medulloblastoma.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Untreated Childhood Medulloblastoma

Untreated childhood medulloblastoma 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 average risk childhood medulloblastoma may include the following:

-Surgery.
-Radiation therapy to the brain and spinal cord with or without chemotherapy.

Treatment of poor risk childhood medulloblastoma may include the following:

-Surgery.
-Radiation therapy to the brain and spinal cord.
-Chemotherapy.

Treatment of childhood medulloblastoma in children younger than 3 years of age may include the following:

-Surgery.
-Chemotherapy.
-Radiation therapy with or without chemotherapy.
-A clinical trial of chemotherapy to delay or reduce the need for radiation therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.

Treatment Options for Recurrent Childhood Medulloblastoma
Treatment of recurrent childhood medulloblastoma may include the following:

-Surgery with or without chemotherapy.
-A clinical trial of high-dose chemotherapy and bone marrow transplantation or peripheral blood stem cell transplantation with radiation therapy.
-A clinical trial of a new therapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied.






The information on this page was obtained from the National Cancer Institute. The National Cancer Institute provides accurate, up-to-date information on many types of cancer, information on clinical trials, resources for people dealing with cancer, and information for researchers and health professionals.

The National Cancer Institute is in no way affiliated with the Mary Stolfa Cancer Foundation.

The information on this web site is provided for general information only. It is not intended as medical advice, and should not be relied upon as a substitute for consultations with qualified health professionals who are familiar with your individual medical needs. The MSCF disclaims all obligations and liabilities for damages arising from the use or attempted use of the information, including but not limited to direct, indirect, special, and consequential damages, attorneys' and experts' fees and court costs. Any use of the information will be at the risk of the user.






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