National Cancer Institute


Posted Date: Jul 3, 2008

TABLE OF CONTENTS


General Information About Childhood Medulloblastoma

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Note: This PDQ® summary contains content that is included in the new PDQ® Childhood Central Nervous System Embryonal Tumors summary. A health professional version of the Childhood Central Nervous System Embryonal Tumors summary is currently available on the National Cancer Institute (NCI) Web site and a patient version is coming soon.

In the near future, the health professional and patient versions of the PDQ® Childhood Medulloblastoma summary will be removed from the NCI Web site.

Key Points for This Section
  • Childhood medulloblastoma is a disease in which benign (noncancer) or malignant (cancer) cells form in the tissues of the brain.
  • 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.
  • Tests that examine the brain and spinal cord are used to detect (find) childhood medulloblastoma.
  • Childhood medulloblastoma is diagnosed and removed in surgery.
  • Certain factors affect prognosis (chance of recovery) and treatment options.
  • 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 tumors formed by cancer cells that begin in other parts of the body and spread to the brain, is not discussed in this summary. See the PDQ® treatment summary on Childhood Brain and Spinal Cord Tumors Treatment Overview for information about the different types of childhood brain and spinal cord tumors.

    Brain tumors can occur in both children and adults; however, treatment for children may be different than treatment for adults. (See the PDQ® treatment summary on Adult Brain Tumors 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.

    The following symptoms and others may be caused by medulloblastoma. Other conditions may cause the same symptoms. A doctor should be consulted if any of these problems occur:

    • Loss of balance, trouble 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. 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) with gadolinium: 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 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 prognosis (chance of recovery) and treatment options.

    The prognosis (chance of recovery) and treatment options depend on:

    • The age of the child when the tumor is found.
    • The location of the tumor.
    • The amount of tumor remaining after surgery.
    • 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.
    • Whether the tumor has just been diagnosed or has recurred (come back).


    Stages of Childhood Medulloblastoma

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    Key Points for This Section
  • The child's risk group is used in place of a staging system to plan cancer treatment.
  • Average risk
  • High risk
  • There are three ways that cancer spreads in the body.
  • The information from tests and procedures done to detect (find) childhood medulloblastoma is used to plan cancer treatment.
  • The child's risk group is used in place of a staging system to plan cancer treatment.

    Staging is the process used to find out how much cancer there is and if cancer has spread. It is important to know the stage in order to plan treatment.

    There is no standard staging system for childhood medulloblastoma. Instead, the plan for cancer treatment depends on the child's risk group:

    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.

    High risk

    Childhood medulloblastoma is called a high 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 high risk group.

    There are three ways that cancer spreads in the body.

    The three ways that cancer spreads in the body are:

    • Through tissue. Cancer invades the surrounding normal tissue.
    • Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
    • Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

    When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

    The information from tests and procedures done to detect (find) childhood medulloblastoma is used to plan cancer treatment.

    Some of the tests used to detect childhood medulloblastoma are repeated after the tumor is removed by surgery. (See the General Information section.) This is to find out how much tumor remains after surgery. Other tests and procedures may be done to find out if the cancer has spread:

    • Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. This procedure is also called an LP or spinal tap.
    • Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
    • Bone scan: A procedure to check 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 bloodstream. The radioactive material collects in the bones and is detected by a scanner.


    Recurrent Childhood Medulloblastoma

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    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

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    Key Points for This Section
  • There are different types of treatment for children with childhood medulloblastoma.
  • Children with medulloblastoma should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors.
  • Childhood brain and spinal cord tumors may cause symptoms that begin before diagnosis and continue for months or years.
  • Some cancer treatments cause side effects months or years after treatment has ended.
  • Four types of standard treatment are used:
  • New types of treatment are being tested in clinical trials.
  • High-dose chemotherapy with stem cell transplant
  • Patients may want to think about taking part in a clinical trial.
  • Patients can enter clinical trials before, during, or after starting their cancer treatment.
  • Follow-up tests may be needed.
  • 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. Some clinical trials are open only to patients who have not started treatment.

    Children with medulloblastoma should have their treatment planned by a team of health care providers who are experts in treating childhood brain tumors.

    Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health care providers who are experts in treating children with brain tumors and who specialize in certain areas of medicine. These may include the following specialists:

    Childhood brain and spinal cord tumors may cause symptoms that begin before diagnosis and continue for months or years.

    Childhood brain and spinal cord tumors may cause symptoms that continue for months or years. Symptoms caused by the tumor may begin before diagnosis. Symptoms caused by treatment may begin during or right after treatment.

    Some cancer treatments cause side effects months or years after treatment has ended.

    These are called late effects. Late effects of cancer treatment may include the following:

    • Physical problems.
    • Changes in mood, feelings, thinking, learning or memory.
    • Second cancers (new types of cancer).

    Some late effects may be treated or controlled. It is important to talk with your child's doctors about the effects cancer treatment can have on your child. (See the PDQ® summary on Late Effects of Treatment for Childhood Cancer for more information).

    Four types of standard treatment are used:

    Surgery

    Surgery is used to diagnose and treat childhood medulloblastoma as described in the General Information section of this summary.

    Surgery to remove the tumor may cause temporary or permanent damage to the brain.

    Radiation therapy

    Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. 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. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

    Radiation therapy to the brain can affect growth and development in young children. For this reason, ways of giving radiation therapy that limit damage to healthy brain tissue are being studied.

    Chemotherapy

    Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them 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 into 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 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 (fluid-filled 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.

    New types of treatment are being tested in clinical trials.

    This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.

    High-dose chemotherapy with stem cell transplant

    High-dose chemotherapy with bone marrow or stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

    Patients may want to think about taking part in a clinical trial.

    For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

    Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

    Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

    Patients can enter clinical trials before, during, or after starting their cancer treatment.

    Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

    Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's clinical trials database.

    Follow-up tests may be needed.

    Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.

    Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.


    Treatment Options for Childhood Medulloblastoma

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    A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.


    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.

    Standard treatment of average risk childhood medulloblastoma is usually surgery and radiation therapy to the brain and spinal cord, with or without chemotherapy.

    One of the treatments being studied in clinical trials for average risk medulloblastoma in children 3 years and older is surgery followed by radiation therapy (including conformal radiation therapy), with chemotherapy during and after radiation therapy.

    Standard treatment of high risk childhood medulloblastoma may include surgery followed by radiation therapy to the brain and spinal cord, with or without chemotherapy. Treatment within a clinical trial may be considered for children with high risk medulloblastoma.

    Treatment of childhood medulloblastoma in children younger than 3 years of age is usually within a clinical trial and may include the following:

    Check for U.S. clinical trials from NCI's PDQ® Cancer Clinical Trials Registry that are now accepting patients with untreated childhood medulloblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.


    Recurrent Childhood Medulloblastoma

    Standard treatment of recurrent childhood medulloblastoma may include surgery with or without chemotherapy and/or stereotactic radiation therapy.

    Some of the treatments being studied in clinical trials for recurrent childhood medulloblastoma include the following:

    Check for U.S. clinical trials from NCI's PDQ® Cancer Clinical Trials Registry that are now accepting patients with recurrent childhood medulloblastoma. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.


    To Learn More About Childhood Brain Tumors

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    For more information from the National Cancer Institute about childhood brain tumors, see the following:

    For more childhood cancer information and other general cancer resources from the National Cancer Institute, see the following:


    Get More Information From NCI

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    Call 1-800-4-CANCER

    For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.

    Chat online

    The NCI's LiveHelp online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.

    Write to us

    For more information from the NCI, please write to this address:

    • NCI Public Inquiries Office
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    • 6116 Executive Boulevard, MSC8322
    • Bethesda, MD 20892-8322

    Search the NCI Web site

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    There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.

    Find Publications

    The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.


    Changes to This Summary (07/03/2008)

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    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.

    Several enhancements have been made to this summary to better explain certain medical concepts and to help readers find information about clinical trials. The following changes were made:

    • Text describing the way cancer spreads in the body was added to the Stages section.
    • Information about patients taking part in clinical trials and about follow-up tests was added to the Treatment Option Overview section.
    • Links to ongoing clinical trials listed in NCI's PDQ® Cancer Clinical Trials Registry were added to the Treatment Options section.
    • A new section called "To Learn More" was added. It includes links to more information about this type of cancer and about cancer in general.
    • The "Get More Information from NCI" section (originally called "To Learn More") was revised.


    About PDQ®

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    PDQ® is a comprehensive cancer database available on NCI's Web site.

    PDQ® is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ® is available online at NCI's Web site. PDQ® is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.

    PDQ® contains cancer information summaries.

    The PDQ® database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.

    The PDQ® cancer information summaries are developed by cancer experts and reviewed regularly.

    Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.

    PDQ® also contains information on clinical trials.

    A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." In the United States, about two-thirds of children with cancer are treated in a clinical trial at some point in their illness.

    Listings of clinical trials are included in PDQ® and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. For additional help in locating a childhood cancer clinical trial, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

    The PDQ® database contains listings of groups specializing in clinical trials.

    The Children's Oncology Group (COG) is the major group that organizes clinical trials for childhood cancers in the United States. Information about contacting COG is available on the NCI Web site or from the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.

    The PDQ® database contains listings of cancer health professionals and hospitals with cancer programs.

    Because cancer in children and adolescents is rare, the majority of children with cancer are treated by health professionals specializing in childhood cancers, at hospitals or cancer centers with special facilities to treat them. The PDQ® database contains listings of health professionals who specialize in childhood cancer and listings of hospitals with cancer programs. For help locating childhood cancer health professionals or a hospital with cancer programs, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.


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