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Ependymoma - Childhood - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Childhood Ependymoma. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

Childhood ependymoma is a type of brain tumor. A tumor begins when healthy cells change and grow out of control, forming a mass. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread. Ependymoma is a rare, cancerous brain tumor.

Ependymoma starts from radial glial cells, which are a type of cell in the brain. Even though ependymoma can occur in any part of the brain or spine, it most commonly occurs in the cerebellum. The cerebellum is the part of the brain that coordinates the body’s actions.

This section covers ependymoma diagnosed in children. Learn more about brain tumors in adults.

Looking for More of an Introduction?

If you would like more of an introduction, explore this related item. Please note this link will take you to another section on Cancer.Net:

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert in childhood cancer that provides basic information and areas of research.

The next section in this guide is Statistics. It helps explain how many children are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will find information about how many children are diagnosed with ependymoma each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

Ependymoma occurs most often in young children, accounting for about 9% of all childhood brain cancers. About 200 children in the United States are diagnosed with ependymoma each year.

The 5-year survival rate tells you what percent of children live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for children with ependymoma from birth to age 19 is approximately 75%.

It is important to remember that statistics on how many children survive this type of cancer are an estimate. The estimate comes from data based on children with this cancer in the United States each year. So, your own child’s risk may be different. Doctors cannot say for sure how long any child will live with ependymoma. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Sources: American Cancer Society and the National Cancer Institute.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will find a basic drawing of the main body parts affected by this disease. To see other pages, use the menu. 

This illustration shows several views of a child’s brain and central nervous system. A medial (side) view of the brain shows the cerebrum and cerebellum. The cerebrum is largest part of the brain and made up of four lobes: the frontal lobe at the front of the skull, the parietal lobe at the upper rear of the skull, above the occipital lobe, and the temporal lobe, which is located under the frontal and parietal lobes on both sides of the cerebrum. The cerebellum is located under the occipital and temporal lobes at the rear of the skull. The cross section of the brain shows the long corpus callosum located under the cerebrum in the center of the brain, the septum pellucidum, which runs down from the corpus callosum, and the diencephalon, which connects the cerebrum and the brain stem. The brain stem is the lowest part of the brain, and made up of 3 parts: the midbrain, the pons, which bulges out from the medulla oblongata, which in turn connects to the spinal cord. The fourth ventricle is a fluid filled space between the brain stem and the cerebellum, underneath the colliculi of the midbrain. An overall view of the body show that the spinal cord extends from the brain stem down the back. Peripheral nerves branch out from the spinal cord to the rest of the body. Copyright 2004 American Society of Clinical Oncology. Robert Morreale/Visual Explanations, LLC.

The next section in this guide is Risk Factors. It explains what factors may increase the chance of developing this disease. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Risk Factors

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing ependymoma. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do.

The causes of childhood ependymoma are unknown. There is little known about the risk factors or ways to prevent the disease.

Children with neurofibromatosis type 2 (NF2) have an increased risk of developing ependymoma. NF2 is an inherited condition that increases the risk of developing tumors of the central nervous system, including ependymoma.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

Children with ependymoma may experience the following symptoms or signs. Sometimes, children with ependymoma do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not a tumor.

  • Headaches

  • Nausea and vomiting

  • Changes in vision, such as blurriness

  • Difficulty with walking or balance

  • Jerky eye movements

  • Neck pain

  • Reaching childhood developmental milestones more slowly than expected

  • Seizures/convulsions, which are sudden involuntary movements of a person’s muscles

If you are concerned about any changes your child experiences, please talk with your child’s doctor. Your doctor will ask how long and how often your child has been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If a brain tumor is diagnosed, relieving symptoms remains an important part of care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your child’s health care team about symptoms your child experiences, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, a brain tumor. They also do tests to learn if a tumor has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the tumor has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most tumor types, a biopsy is the only sure way for the doctor to know whether an area of the body has a tumor. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing ependymoma, and not all tests listed will be used for every child. Your child’s doctor may consider these factors when choosing a diagnostic test:

  • The type of tumor suspected

  • Your child’s signs and symptoms

  • Your child’s age and medical condition

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose ependymoma:

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye is usually injected into a patient’s vein.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A contrast medium is given before the scan to create a clearer picture. This dye is usually injected into a patient’s vein. A spinal MRI may be used to find out if the tumor has spread to the spine.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that a tumor is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. For ependymoma, surgery is needed to get a sample of tissue (see Treatment Options).

  • Lumbar puncture (spinal tap). A lumbar puncture is a procedure in which a doctor uses a needle to take a sample of cerebral spinal fluid (CSF) to look for tumor cells. CSF is the fluid that flows around the brain and the spinal cord. Doctors generally give an anesthetic to numb the lower back before the procedure. This procedure is generally done after ependymoma is diagnosed and the tumor is removed.

After diagnostic tests are done, your child’s doctor will review all of the results with you. If the diagnosis is ependymoma, these results also help the doctor describe the tumor; this is called staging and grading.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.  

Ependymoma - Childhood - Stages and Grades

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will learn about how doctors describe the growth or spread of ependymoma. This is called the stage and grade. To see other pages, use the menu.

Staging is a way of describing where the tumor is located, if or where it has spread, and whether it is affecting other parts of the body. Doctors use diagnostic tests to find out the tumor's stage, so staging may not be complete until all of the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of tumors.

There is no formal staging system for ependymoma. However, it can be classified based on where in the brain the tumor is located and whether it has spread.

  • Supratentorial: The tumor is above the membrane that covers the cerebellum, known as the tentorium cerebella.

  • Infratentorial: The tumor is growing below the tentorium cerebella.

  • Spinal: The tumor is growing in the central canal of the spinal cord or at the bottom of the spinal canal.

  • Recurrent: A recurrent tumor is a tumor that has come back after treatment. If the tumor does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Grade (G)

Doctors also describe ependymoma by its grade, which describes how much the tumor cells look like healthy cells when viewed under a microscope. The doctor compares the tumor’s tissue with healthy tissue. Healthy tissue usually contains many different types of cells grouped together. If the tumor cells look similar to healthy tissue and contains different cell groupings, it is called differentiated or a low-grade tumor. If the tumor’s tissue looks very different from healthy tissue, it is called poorly differentiated or a high-grade tumor.

The World Health Organization (WHO) classifies ependymoma into 3 grades:

  • Grade I (1): Subependymoma

  • Grade II (2): Ependymoma or myxopapillary ependyoma

  • Grade III (3): Anaplastic ependymoma

In general, the lower the tumor’s grade, the better the prognosis. However, there is controversy about importance of grade in determining the prognosis for children diagnosed with grade II ependymoma or anaplastic ependymoma (WHO grade III).

Information about the stage and grade will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will learn about the different ways doctors treat ependymoma. To see other pages, use the menu.

In general, cancer in children is uncommon. This means it can be hard for doctors to plan treatments unless they know what has been most effective in other children. That’s why more than 60% of children with cancer are treated as part of a clinical trial. Clinical trials are research studies that compare the standard of care with newer approaches to treatments that may be more effective. The “standard of care” is the best treatments known. Clinical trials may test such approaches as a new drug, a new combination of standard treatments, or new doses of current therapies. The health and safety of all children participating in clinical trials are closely monitored.

To take advantage of these newer treatments, children with a brain tumor should be treated at a specialized cancer center. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research. A doctor who specializes in treating children with cancer is called a pediatric oncologist. If a pediatric cancer center is not nearby, general cancer centers sometimes have pediatric specialists who are able to be part of your child’s care.

Treatment overview

In many cases, a team of doctors works with a child and the family to provide care; this is called a multidisciplinary team. Pediatric cancer centers often have extra support services for children and their families, such as child life specialists, dietitians, physical and occupational therapists, social workers, and counselors. Special activities and programs to help your child and family cope may also be available.

Descriptions of the most common treatment options for childhood ependymoma are below. Treatment options and recommendations depend on several factors, including the type of tumor, its grade, possible side effects, the family’s preferences, and the child’s overall health. Your child’s care plan may also include treatment for symptoms and side effects, an important part of care for ependymoma. Take time to learn about all of your child’s treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your child’s doctor and what your child can expect while receiving treatment. Learn more about making treatment decisions.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A neurosurgeon is a doctor who specializes in treating a tumor in the brain or spine with surgery. Surgery is usually the first treatment for ependymoma. It is also used to diagnose ependymoma, using a surgical biopsy (see Diagnosis). The goal of surgery is to remove as much of the tumor as possible.

Surgery to the brain requires the removal of part of the skull, a procedure called a craniotomy. After the surgeon removes the tumor, the patient’s own bone will be used to cover the opening in the skull. There have been rapid advances in surgery for brain tumors. These advances include cortical mapping, which allows doctors to identify certain areas of the brain that control the senses, language, and motor skills. And with better imaging tests, surgeons now have more tools to plan and perform surgery. Sometimes, surgery cannot be performed because the tumor is located in a place that the surgeon cannot reach or is near a vital structure; these tumors are called inoperable. If the tumor is inoperable, the doctor will recommend other treatment options.

After surgery, the doctor will create a treatment plan based on the following criteria:

  • The amount of tumor removed
  • Your child’s age
  • Whether disease has spread

Side effects from surgery for ependymoma can vary, and you are encouraged to talk with the doctor about possible short-term and long-term side effects in detail. Learn more about the basics of surgery.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Radiation therapy may be used after surgery to treat ependymoma. If the cancer has not spread, radiation therapy is directed at the tumor. If the cancer has spread, radiation therapy may treat the whole brain and the spine. It may also be used to treat a tumor that cannot be treated with surgery. Although there has been concern about using radiation therapy for children younger than 3 years old, there are clinical trials showing that it is safe and effective for children with ependymoma in this age range.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach tumor cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time.

Chemotherapy alone is often not effective to treat ependymoma, but it may be beneficial if used in combination with other treatments. Clinical trials combining radiation therapy and chemotherapy after surgery are underway. The use of chemotherapy has also helped surgeons perform additional surgery to destroy any part of a tumor that could not be removed during the original surgery (see Latest Research).

The side effects of chemotherapy depend on the individual and the dose used, but they can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your child’s doctor is often the best way to learn about the medications prescribed for your child, their purpose, and their potential side effects or interactions with other medications. Learn more about your child’s prescriptions by using searchable drug databases.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the tumor, an important part of care is relieving a child’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting your child with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process. Children often receive treatment for the tumor and treatment to ease side effects at the same time. In fact, people who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. Your child may also receive palliative treatments similar to those meant to eliminate the tumor, such as surgery, radiation therapy, or chemotherapy. Talk with your child’s doctor about the goals of each treatment in the treatment plan.

Before treatment begins, talk with your child’s health care team about the possible side effects of the specific treatment plan and palliative care options. And during and after treatment, be sure to tell your child’s doctor or another health care team member if your child is experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions are permanent, it’s important to talk with the doctor about the possibility of the tumor returning. Understanding your child’s risk of recurrence and the treatment options may help people feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place, called a local recurrence, nearby, called a regional recurrence, or in another place, called a distant recurrence.

When this occurs, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your child’s doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your child’s doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent tumor. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

If your child is diagnosed with a recurrence, you and your family may experience emotions such as disbelief or fear. You are encouraged to talk with your child’s health care team about these feelings and ask about support services to help your family cope. Learn more about dealing with a recurrence.

If treatment fails

Although treatment is successful for the majority of children with cancer, sometimes it is not. If a child’s tumor cannot be cured or controlled, this is called advanced or terminal cancer. This diagnosis is stressful, and advanced ependymoma may be difficult to discuss. However, it is important to have open and honest conversations with your child’s doctor and health care team to express your family’s feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families.

Parents or guardians are encouraged to think about where the child would be most comfortable: at home, in a home-like setting elsewhere, in the hospital, or in a hospice environment. Hospice care is a type of palliative care for people who are expected to live less than 6 months. It is designed to provide the best possible quality of life for people who are near the end of life. Nursing care and special equipment can make staying at home a workable alternative for many families. Some children may be happier if they can arrange to attend school part-time or keep up other activities and social connections. The child’s health care team can help parents or guardians decide on an appropriate level of activity. Making sure a child is physically comfortable and free from pain is extremely important as part of end-of-life care. Learn more about caring for a terminally ill child and advanced care planning.

The death of a child is an enormous tragedy, and families may need support to help them cope with the loss. Pediatric cancer centers often have professional staff and support groups to help with the process of grieving. Learn more on grieving the loss of a child.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for children with ependymoma. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Children who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent brain tumors.

Deciding to join a clinical trial

People decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, people are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other people volunteer for clinical trials because they know that these studies are the only way to make progress in treating ependymoma. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with ependymoma.

Sometimes people have concerns that, in a clinical trial, their child may receive no treatment by being given a placebo or a “sugar pill.” The use of placebos in cancer clinical trials in this way is rare overall and not done at all in childhood cancer research. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

In order to join a clinical trial, parents and children must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient’s options so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

People who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that people participating in a clinical trial talk with the doctor and researchers about who will be providing treatment and care during the clinical trial, after the clinical trial ends, and/or if they choose to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all cancer types. For specific topics being studied for ependymoma, learn more in the Latest Research section.

Cancer.Net offers a lot of information about clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

PRE-ACT, Preparatory Education About Clinical Trials

In addition, this website offers free access to a video-based educational program about clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for ependymoma. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about ependymoma and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about ependymoma, ways to prevent it, how to best treat it, and how to provide the best care to children diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your child’s doctor about the diagnostic and treatment options best for your child.

  • Tumor genetics. New research has shown that there are several different subgroups of ependymoma that differ based on the patterns of changes to the genes within each tumor. Although research in this area is early, studies are being done to find out if these genetic differences can help find new ways to treat ependymoma.

  • Improved radiation therapy techniques. Although the use of radiation therapy is not a standard treatment for children younger than age 3, its usefulness and side effects continues to be studied in a clinical trial for children with ependymoma in this age group. In addition, new techniques for planning and delivering radiation therapy are also being evaluated that better target the tumor, reducing damage to healthy parts of the brain. Proton beam therapy is also being studied as a treatment for ependymoma. Proton beam therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells.

  • New combinations of chemotherapy and other treatments. New types of chemotherapy and combinations of drugs are being researched with the goal of shrinking any tumor that remains after surgery. This use of chemotherapy is allowing doctors to perform additional surgery for children with ependymoma that was not completely removed during the original surgery. The risks and benefits of this are also being studied. In addition, the use of chemotherapy after radiation therapy is being studied to find out if the combination can better manage tumor growth over the long term.

  • Predicting recurrences. The molecular features of a specific tumor are being studied to find out if they can help doctors predict the likelihood that the cancer will come back after treatment.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current ependymoma treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding childhood cancer, explore these related items that take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that ependymoma and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.  

Ependymoma - Childhood - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of a childhood brain tumor and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every treatment for ependymoma can cause side effects or changes to your child’s body and how he or she feels. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of tumor. This can make it hard to predict how your child will feel during treatment.

As your family prepares to start treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of treatment “palliative care.” It is an important part of your child’s treatment plan, regardless of his or her age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for ependymoma are described within the Treatment Options section. Learn more about side effects of a brain tumor and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the tumor’s stage, the length and dose of treatment, and your child’s general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of care for childhood cancer survivors. Learn more by reading the Follow-up Care section of this guide or talking with your child’s doctor.

Coping with emotional and social effects

Your family can have emotional and social effects as well as physical effects after a diagnosis of ependymoma. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your family’s needs.

Coping with financial effects

Treatment for a brain tumor can be expensive. It is often a big source of stress and anxiety for families dealing with the diagnosis. In addition to treatment costs, many people find they have extra, unplanned expenses related to their child’s care. Learn more about managing financial considerations, in a separate part of this website.

Caring for a child with ependymoma

Family members and friends often play an important role in taking care of a person with ependymoma. This is called being a caregiver. As a parent or guardian, you are the primary caregiver for your child. However, friends and family members can give your family valuable support, even if they live far away.

When your child has ependymoma, you may have an additional range of responsibilities. These may include giving medications or managing symptoms and side effects. However, it is important to seek help from others. Below are some of the responsibilities your family or friends could help with:

  • Providing short-term care for your child

  • Giving support and encouragement

  • Assisting with meals or household chores

  • Helping with insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your child’s doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of a brain tumor.

Also, ask how much care your child may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of check-ups after treatment is finished. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will read about your child’s medical care after cancer treatment is finished and why this follow-up care is important. To see other pages, use the menu.

Care for children diagnosed with ependymoma doesn’t end when active treatment has finished. Your child’s health care team will continue to check to make sure the tumor has not returned, manage any side effects, and monitor your child’s overall health. This is called follow-up care. All children treated for a brain tumor, including ependymoma, should have life-long, follow-up care.

Your child’s follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your child’s recovery in the months and years ahead. Follow-up care recommendations are specific to each child.

The following factors can affect your child’s recovery from ependymoma:

  • Tumor location

  • How much of the tumor could be removed during surgery

  • The need for and type of treatment after surgery

  • Your child’s age during treatment.

Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of tumor cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up care, a doctor familiar with your child’s medical history can give you personalized information about the risk of recurrence. Your doctor will also ask specific questions about your child’s health. Some children may have blood tests or imaging tests as part of regular follow-up care. However, testing recommendations depend on several factors, including the type of tumor originally diagnosed and the types of treatment given.

MRI scans are often recommended to watch for signs that the tumor is growing or has come back. If a tumor does come back, it is most likely to do so within the first several years after the first diagnosis. That’s why scans are performed more often during the first 2 to 3 years after treatment, and less often thereafter. However, ependymoma can recur many years after initial treatment, and long-term follow-up care is extremely important.

Managing long-term and late side effects of ependymoma

Sometimes, side effects may linger beyond the active treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Late effects can occur almost anywhere in the body and include physical problems, such as heart and lung problems and second cancers, and emotional and cognitive (memory, thinking, and attention) problems, such as anxiety, depression, and learning difficulties.

Based on the type of treatment your child received, the doctor will recommend what examinations and tests are needed to check for late effects. Follow-up care should address your child’s quality of life, including any developmental or emotional concerns. Some children may need a combination of rehabilitative services, including physical therapy and occupational therapy for nervous system side effects from the tumor or its treatment, speech therapy, hearing assistance, and cognitive therapy. Learn more about rehabilitation. After surgery, some children may need a tracheostomy or a gastrostomy. A tracheostomy is a surgical opening in the windpipe to help with breathing. A gastrostomy is a surgical opening into the stomach where a feeding tube is inserted. Others may develop hormonal problems or other new problems if the tumor recurs.

The Children's Oncology Group (COG) has studied the physical and psychological effects that survivors face. Based on these studies, COG has created recommendations for long-term follow-up care for childhood, adolescent, and young adult survivors that can be found on a separate website: www.survivorshipguidelines.org.

Keeping a child’s personal health record

You are encouraged to organize and keep a personal record of the child’s medical information. The doctor will help you create this. That way, as the child enters adulthood, he or she has a clear, written history of the diagnosis, the treatment given, and the doctor’s recommendations about the schedule for follow-up care. ASCO offers forms to help create a treatment summary to keep track of the treatment your child received and develop a survivorship care plan once treatment is completed.

Some children continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type of tumor, side effects, health insurance rules, and your family’s personal preferences. Talk with your health care team about your child’s ongoing medical care and any concerns you have about his or her future health.

If a doctor who was not directly involved in your child’s care will lead the follow-up care, be sure to share the treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about the specific treatment given are very valuable to the health care professionals who will care for your child throughout his or her lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a diagnosis of ependymoma. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will read about how to cope with challenges in everyday life after your child’s diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people, but it often describes living with, through, and beyond cancer. In some ways, survivorship is one of the most complex aspects of the experience because it is different for every patient and his or her family.

After active treatment for ependymoma ends, children and their families may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after the diagnosis. Other families stay very anxious about their child’s health and become uncertain of how to cope with everyday life.

One source of stress may occur when frequent visits to the health care team end following treatment. Often, relationships built with the health care team provide a sense of security during treatment, and children and their families miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, educational issues, emotional challenges, sexual development and fertility concerns, and/or financial issues.

Every family faces different concerns and challenges. With any challenge, a good first step is being able to recognize each fear and talk about it. Effective coping requires:

  • Understanding the challenge your family is facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action your family chooses.

It may be helpful to join an in-person support group or online community of childhood cancer survivors. Support groups also exist for parents of children diagnosed with cancer. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Parents, other family members, and friends may also go through periods of transition. A caregiver plays a very important role in supporting a child diagnosed with ependymoma, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to a child’s diagnosis will become much less or come to an end as your child gets older. Family counselors at pediatric cancer centers can help with this transition. You can also learn more about adjusting to life after caregiving in this article.

Healthy living after ependymoma

Survivorship often serves as a strong motivator to make positive lifestyle changes, often for the family as a whole.

Children who have had ependymoma can enhance the quality of their future by following established guidelines for good health into and through adulthood, including not smoking, maintaining a healthy weight, eating well, managing stress, and participating in regular physical activity. Talk with the doctor about developing a plan that is best for your child’s needs. Learn more about making healthy lifestyle choices.

In addition, it is important that your child has recommended medical check-ups and tests (see Follow-up Care) to take care of his or her health. Rehabilitation may be recommended, and this could mean any of a wide range of services such as physical therapy, family or individual counseling, nutritional planning, and/or educational assistance. The goal of rehabilitation is to help survivors and their families regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your child’s needs.

Looking for More Survivorship Resources?

For more information about survivorship, explore these related items. Please note these links will take you to other sections of Cancer.Net:

  • Survivorship Resources: Cancer.Net offers a lot of information and resources to help survivors cope, including specific sections for children, teens, and young adults. There is also a main section on survivorship for people of all ages.

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps with the transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about childhood cancer survivorship.

The next section offers Questions to Ask the Doctor to help start conversations with your child’s health care team. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will find some questions to ask your child’s doctor or other members of the health care team, to help you better understand your child’s diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your child’s health care. These suggested questions are a starting point to help you learn more about your child’s care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your child’s next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your child’s care.

Questions to ask after getting a diagnosis

  • What type of brain tumor does my child have?

  • Where exactly is the tumor located?

  • Has the tumor spread? If not, is it likely to spread?

Questions to ask about choosing a treatment and managing side effects

  • What is your familiarity with my child's tumor type and its treatment?

  • What treatment options are available?

  • What clinical trials are available for my child? Where are they located, and how do I find out more about them?

  • What treatment plan do you recommend? Why?

  • What is the goal of each treatment? Is it to eliminate the tumor, help my child feel better, or both?

  • What is the chance for success with each treatment option?

  • Who will be part of my child’s health care team, and what does each member do?

  • Who will be leading my child’s overall treatment?

  • What are the possible side effects of this treatment, both in the short term and the long term?

  • How will this treatment affect my child’s daily life? Will he or she be able to go to school and perform his or her usual activities?

  • Could this treatment affect my child’s ability to become pregnant or have children in the future? If so, should I talk with a fertility specialist before treatment begins?

  • If I’m worried about managing the costs of medical care, who can help me?

  • What follow-up tests will my child need, and how often will he or she need them?

  • What support services are available to my child? To my family?

  • Whom should I call for questions or problems?

  • Is there anything else I should be asking?

Questions to ask about having surgery

  • What type of surgery will my child have?

  • How long will the operation take?

  • How long will my child be in the hospital?

  • Can you describe what recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

Questions to ask about having chemotherapy

  • What type of treatment is recommended?

  • What is the goal of this treatment?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

Questions to ask about planning follow-up care

  • What is the chance that the tumor will come back? Should I watch for specific signs or symptoms?

  • What long-term side effects or late effects are possible based on the treatment my child received?

  • What follow-up tests will my child need, and how often will he or she need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my child’s follow-up care?

  • What survivorship support services are available to my child? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Ependymoma - Childhood - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 11/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Childhood Ependymoma. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Childhood Ependymoma. Use the menu to select another section to continue reading this guide.