Diseases

Ependymoma (Brain Tumor) Information

Brain tumor (primary) definition and facts*

*Brain tumor facts medically edited by: Charles P. Davis, MD, PhD

• The brain is the body organ composed of nerve cells and supportive tissues like glial cells and meninges – there are three major parts – they control your activity like breathing (brain stem), activity like moving muscles to walk (cerebellum) and your senses like sight and our memory, emotions, thinking and personality (cerebrum).
• Primary brain tumors can be either malignant (contain cancer cells) or benign (do not contain cancer cells). A primary brain tumor is a tumor which begins in the brain tissue. If a cancerous tumor starts elsewhere in the body, it can spread cancer cells, which grow in the brain. These type of tumors are called secondary or metastatic brain tumors.
• Brain tumors can occur at any age.
• Researchers and doctors do not know exact cause of brain tumors.
• Risk factors include exposure to ionizing radiation and family history of brain tumors.
• The signs symptoms of brain tumors depend on their size, type, and location. The most common signs symptoms include headaches; numbness or tingling in the arms or legs; seizures; memory problems; mood and personality changes; balance and walking problems; nausea and vomiting; or changes in speech, vision, or hearing.
• Doctors group brain tumors are classified by grade (grade I, grade II, grade III, or grade IV -the most severe). The grade is determined by the way the cells look under a microscope. The higher the grade number, the more abnormal the cells appear, and the more aggressively the tumor usually behaves.
• The most common types of primary brain tumors among adults are astrocytoma, meningiom (a tumor that arises from the membranes surrounding the brain and spinal cord) and oligodendroglioma.
• The most common type of primary brain tumors in children are medulloblastoma, grade I or II astrocytoma, (or glioma) ependymoma, and brain stem glioma.
• Studies have found risk factors for brain tumors to include ionizing radiation from high dose X-rays (for example, radiation therapy where the machine is aimed at the head), and family history.
• Diagnosis of a brain tumor is done by a neurologic exam (by a neurologist or neurosurgeon), CT (computer tomography scan) and/or magnetic resonance imaging (MRI), and other tests like an angiogram, spinal tap and biopsy. Your diagnosis helps predict the treatment.
• Neurologists base the treatment of brain tumors on the type, location, and size of the tumor, your health, and age. Treatment options may include surgery, radiation therapy, or chemotherapy (or a combination of treatments).
• Supportive care is important before, during and after treatment to minimize symptoms and to improve your quality of life.Some patients can qualify for clinical trials. Contact information is provided at the end of this article.

Brain tumor grades

Doctors group brain tumors by grade. The grade of a tumor refers to the way the cells look under a microscope:

• Grade I: The tissue is benign. The cells look nearly like normal brain cells, and they grow slowly.
• Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a Grade I tumor.
• Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing (anaplastic).
• Grade IV: The malignant tissue has cells that look most abnormal and tend to grow quickly.

Brain tumor types

When most normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.Primary brain tumors can be benign or malignant:Benign brain tumors do not contain cancer cells:

• Usually, benign tumors can be removed, and they seldom grow back.
• Benign brain tumors usually have an obvious border or edge. Cells from benign tumors rarely invade tissues around them. They don't spread to other parts of the body. However, benign tumors can press on sensitive areas of the brain and cause serious health problems.
• Unlike benign tumors in most other parts of the body, benign brain tumors are sometimes life threatening.
• Benign brain tumors may become malignant.

• Malignant brain tumors are generally more serious and often are a threat to life.
• They are likely to grow rapidly and crowd or invade the nearby healthy brain tissue.
• Cancer cells may break away from malignant brain tumors and spread to other parts of the brain or to the spinal cord. They rarely spread to other parts of the body.

Chemotherapy for brain tumors

Chemotherapy, the use of drugs to kill cancer cells, is sometimes used to treat brain tumors. Drugs may be given in the following ways:

• By mouth or vein (intravenous): Chemotherapy may be given during and after radiation therapy. The drugs enter the bloodstream and travel throughout the body. They may be given in an outpatient part of the hospital, at the doctor's office, or at home. Rarely, you may need to stay in the hospital. The side effects of chemotherapy depend mainly on which drugs are given and how much. Common side effects include nausea and vomiting, loss of appetite, headache, fever and chills, and weakness. If the drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. Some side effects may be relieved with medicine.
• In wafers that are put into the brain: For some adults with high-grade glioma, the surgeon implants several wafers into the brain. Each wafer is about the size of a dime. Over several weeks, the wafers dissolve, releasing the drug into the brain. The drug kills cancer cells. It may help prevent the tumor from returning in the brain after surgery to remove the tumor. People who receive an implant (a wafer) that contains a drug are monitored by the health care team for signs of infection after surgery. An infection can be treated with an antibiotic.

• Why do I need this treatment?
• What will it do?
• Will I have side effects? What can I do about them?
• When will treatment start? When will it end?
• How will treatment affect my normal activities?

Nutrition during brain tumor treatment

It's important for you to take care of yourself by eating well. You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth blisters) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to deal with these problems.

Radiation therapy for brain tumors

Radiation therapy kills brain tumor cells with high-energy x-rays, gamma rays, or protons.Radiation therapy usually follows surgery. The radiation kills tumor cells that may remain in the area. Sometimes, people who can't have surgery have radiation therapy instead.Doctors use external and internal types of radiation therapy to treat brain tumors:

• External radiation therapy: You'll go to a hospital or clinic for treatment. A large machine outside the body is aimed to direct beams of radiation at either the whole brain or more commonly, at specific portions of the brain. Some people need radiation aimed at the spinal cord also. The treatment schedule depends on your age, and the type and size of the tumor. Fractionated external beam therapy, in which small doses or fractions of radiation are given usually once each day, is the most common method of radiation therapy used for people with brain tumors. Giving the total dose of radiation over several weeks helps to protect healthy tissue in the area of the tumor. Treatments are usually 5 days a week for several weeks. A typical visit lasts less than an hour, and each treatment takes only a few minutes.Some treatment centers are studying other ways of delivering external beam radiation therapy:
  • Intensity-modulated radiation therapy or 3-dimensional conformal radiation therapy: These types of treatment use computers to more closely target the brain tumor to lessen the damage to healthy tissue.
  • Proton beam radiation therapy: The source of radiation is protons rather than X-rays. The doctor aims the proton beam at the tumor. The dose of radiation to normal tissue from a proton beam is less than the dose from an X-ray beam.
  • Stereotactic radiation therapy: Narrow beams of X-rays or gamma rays are directed at the tumor from different angles. For this procedure, you wear a rigid head frame. The therapy may be given during a single visit (stereotactic radiosurgery) or over several visits.
• Internal radiation therapy (implant radiation therapy or brachytherapy): Internal radiation isn't commonly used for treating brain tumors and is under study. The radiation comes from radioactive material usually contained in very small implants called seeds. The seeds are placed inside the brain and give off radiation for months. They don't need to be removed once the radiation is gone.

• Why do I need this treatment?
• When will the treatments begin? When will they end?
• How will I feel during therapy? Are there side effects?
• What can I do to take care of myself during therapy?
• How will we know if the radiation is working?
• Will I be able to continue my normal activities during treatment?

Sources of support

Learning you have a brain tumor can change your life and the lives of those close to you. These changes can be hard to handle. It's normal for you, your family, and your friends to need help coping with the feelings that such a diagnosis can bring.Concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, keeping your job, or continuing daily activities.Here's where you can go for support:

• Doctors, nurses, and other members of your health care team can answer questions about treatment, working, or other activities.
• Social workers, counselors, or members of the clergy can be helpful if you want to talk about your feelings or concerns. Often, social workers can suggest resources for financial aid, transportation, home care, or emotional support.
• Support groups also can help. In these groups, people with brain tumors or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. You may want to talk with a member of your health care team about finding a support group.
• Information specialists at 1-800-4-CANCER (1-800-422-6237) and at LiveHelp (http://www.cancer.gov/livehelp) can help you locate programs, services, and publications. They can send you a list of organizations that offer services to people with cancer.

Taking part in cancer research

Cancer research has led to real progress in the detection and treatment of brain tumors. Continuing research offers hope that in the future even more people with brain tumors will be treated successfully.Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). Clinical trials are designed to find out whether new approaches are safe and effective.Doctors are trying to find better ways to care for adults and children with brain tumors. They are testing new drugs and combining drugs with radiation therapy. They are also studying how drugs may reduce the side effects of treatment.Even if the people in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about brain tumors and how to control them. Although clinical trials may pose some risks, doctors do all they can to protect their patients.If you're interested in being part of a clinical trial, talk with your doctor. You may want to read the NCI booklet Taking Part in Cancer Treatment Research Studies. It describes how treatment studies are carried out and explains their possible benefits and risks.The NCI Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of brain tumors. NCI's Information Specialists at 1-800-4-CANCER (1-800-422-6237) and at LiveHelp (http://www.cancer.gov/livehelp) can answer questions and provide information about clinical trials.

Types of primary brain tumors

There are many types of primary brain tumors. Primary brain tumors are named according to the type of cells or the part of the brain in which they begin. For example, most primary brain tumors begin in glial cells. This type of tumor is called a glioma.Among adults, the most common types are:

• Astrocytoma: The tumor arises from star-shaped glial cells called astrocytes. It can be any grade. In adults, an astrocytoma most often arises in the cerebrum.
  • Grade I or II astrocytoma: It may be called a low-grade glioma.
  • Grade III astrocytoma: It's sometimes called a high-grade or an anaplastic astrocytoma.
  • Grade IV astrocytoma: It may be called a glioblastoma or malignant astrocytic glioma.
• Meningioma: The tumor arises in the meninges. It can be grade I, II, or III. It's usually benign (grade I) and grows slowly.
• Oligodendroglioma: The tumor arises from cells that make the fatty substance that covers and protects nerves. It usually occurs in the cerebrum. It's most common in middle-aged adults. It can be grade II or III.

• Medulloblastoma: The tumor usually arises in the cerebellum. It's sometimes called a primitive neuroectodermal tumor. It is grade IV.
• Grade I or II astrocytoma: In children, this lowgrade tumor occurs anywhere in the brain. The most common astrocytoma among children is juvenile pilocytic astrocytoma. It's grade I.
• Ependymoma: The tumor arises from cells that line the ventricles or the central canal of the spinal cord. It's most commonly found in children and young adults. It can be grade I, II, or III.
• Brain stem glioma: The tumor occurs in the lowest part of the brain. It can be a low-grade or high-grade tumor. The most common type is diffuse intrinsic pontine glioma.