Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®): Treatment - Health Professional Information [NCI]

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Childhood Astrocytoma

Childhood astrocytomas are classified as low-grade or high-grade.

Childhood Low-Grade Astrocytomas:

  • Pilocytic astrocytoma.
  • Pilomyxoid astrocytoma.
  • Diffuse fibrillary astrocytoma.
  • Fibrillary astrocytoma.
  • Gemistocytic astrocytoma.
  • Protoplasmic astrocytoma.

Childhood High-Grade Astrocytomas:

  • Anaplastic astrocytoma.
  • Glioblastoma multiforme.
  • Giant cell glioblastoma.
  • Gliosarcoma.
  • Gliomatosis cerebri.

Refer to the PDQ summary on Childhood Astrocytomas Treatment for more information.

Childhood Brain Stem Glioma

Childhood brain stem gliomas include the following:

  • Diffuse intrinsic pontine gliomas.
  • Focal or low-grade brain stem gliomas.

Refer to the PDQ summary on Childhood Brain Stem Glioma Treatment for more information.

Childhood Central Nervous System (CNS) Embryonal Tumors

Childhood CNS embryonal tumors include the following:

  • Medulloblastoma.
    • Classic.
    • Medulloblastoma with extensive nodularity.
    • Desmoplastic/nodular.
    • Anaplastic.
    • Large cell.
  • CNS primitive neuroectodermal tumors (PNETs).
    • CNS neuroblastoma.
    • CNS ganglioneuroblastoma.
    • Medulloepithelioma.
    • Ependymoblastoma.
  • CNS atypical teratoid/rhabdoid tumors. (Refer to the PDQ summary on Childhood Central Nervous System Atypical Teratoid/Rhabdoid Tumor Treatment for more information.)

Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.

Childhood CNS Germ Cell Tumors

Childhood CNS germ cell tumors include the following:

  • Germinomas.
  • Non-germinomatous germ cell tumors.
    • Embryonal carcinoma.
    • Yolk sac tumors.
    • Choriocarcinomas.
    • Immature teratomas.
    • Mature teratomas.
    • Teratomas with malignant transformation.
    • Mixed germ cell tumors.

Germ cell brain tumors usually arise in the pineal or suprasellar regions. Histologic subtypes include teratomas (both mature and immature), germinomas, choriocarcinomas, and nongerminomatous germ cell tumors (i.e., embryonal cell carcinoma, yolk cell or endodermal sinus tumors, and mixed germ cell tumors). These tumors have a propensity for subarachnoid spread. Every patient with a germinoma or malignant germ cell tumor should be evaluated with diagnostic imaging of the spinal cord and whole brain. The best method for evaluating spinal cord subarachnoid metastasis is magnetic resonance imaging with gadolinium enhancement. Cerebrospinal fluid (CSF) should be examined cytologically and levels of alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) determined. AFP and/or HCG may be elevated in the serum of such patients. Prognosis is related to histology; patients with pure germinoma have a more favorable outcome than those with nongerminomatous germ cell tumors (nongerminomas).[1,2]

Childhood CNS Primitive Neuroectodermal Tumors

Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.

Childhood Craniopharyngioma

Refer to the PDQ summary on Childhood Craniopharyngioma Treatment for more information.

Childhood Ependymoma

Refer to the PDQ summary on Childhood Ependymoma Treatment for more information.

Childhood Ependymoblastoma

Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.

Childhood Malignant Glioma

Refer to the PDQ summary on Childhood Astrocytomas Treatment for more information.

Childhood Medulloblastoma

Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.

Childhood Medulloepithelioma

Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information.

Childhood Spinal Cord Tumors

There is no uniformly accepted staging system for childhood primary spinal cord tumors. These tumors are classified based on their location within the spinal cord and histology. On the basis of the tumor histology, refer to one of the following summaries for more information:

  • Childhood Astrocytomas Treatment
  • Childhood Ependymoma Treatment
  • Childhood Central Nervous System Embryonal Tumors Treatment

Childhood Tumors of the Pineal Region

Childhood tumors of the pineal region include the following:

  • Pineoblastomas.
  • Pineocytomas.
  • Pineal parenchymal tumors of intermediate differentiation.
  • Papillary tumors of the pineal region.

Refer to the PDQ summary on Childhood Central Nervous System Embryonal Tumors Treatment for more information on pineoblastomas and papillary tumors of the pineal region.

References:

  1. Matsutani M, Sano K, Takakura K, et al.: Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg 86 (3): 446-55, 1997.
  2. Balmaceda C, Modak S, Finlay J: Central nervous system germ cell tumors. Semin Oncol 25 (2): 243-50, 1998.

Purpose of This Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of childhood brain and spinal cord tumors. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

Reviewers and Updates

This summary is reviewed regularly and updated as necessary by the PDQ Pediatric Treatment Editorial Board. Board members review recently published articles each month to determine whether an article should:

  • be discussed at a meeting,
  • be cited with text, or
  • replace or update an existing article that is already cited.

Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.

The lead reviewers for Childhood Brain and Spinal Cord Tumors Treatment Overview are:

  • Kenneth J. Cohen, MD, MBA (Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Hospital)
  • Roger J. Packer, MD (Children's National Medical Center)
  • Malcolm Smith, MD, PhD (National Cancer Institute)

Any comments or questions about the summary content should be submitted to Cancer.gov through the Web site's Contact Form. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.

Levels of Evidence

Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Pediatric Treatment Editorial Board uses a formal evidence ranking system in developing its level-of-evidence designations.

Permission to Use This Summary

PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as "NCI's PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary]."

The preferred citation for this PDQ summary is:

National Cancer Institute: PDQ® Childhood Brain and Spinal Cord Tumors Treatment Overview. Bethesda, MD: National Cancer Institute. Date last modified <MM/DD/YYYY>. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/childbrain/healthprofessional. Accessed <MM/DD/YYYY>.

Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in Visuals Online, a collection of over 2,000 scientific images.

Disclaimer

Based on the strength of the available evidence, treatment options may be described as either "standard" or "under clinical evaluation." These classifications should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the Coping with Cancer: Financial, Insurance, and Legal Information page.

Contact Us

More information about contacting us or receiving help with the Cancer.gov Web site can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the Web site's Contact Form.

Last Revised: 2010-10-29

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