Ependymoma - Childhood: Stages and Grades

Approved by the Cancer.Net Editorial Board, 11/2022

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

What is cancer staging?

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 recommend the best kind of treatment, and it 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. These descriptions are:

  • 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.

Tumor Grade

Doctors also describe ependymoma by its grade. The grade 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 has 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 ependymoma

  • Grade III (3): Anaplastic ependymoma

In general, the lower the tumor’s grade, the better the prognosis. However, there are different opinions among doctors about importance of grade in determining the prognosis for children diagnosed with "classic" ependymoma (WHO grade II) and 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 Types of Treatment. Use the menu to choose a different section to read in this guide.