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What is PDQ?
PDQ is a computer system that gives up-to-date information on cancer treatment. It is a service of the National Cancer Institute (NCI) for people with cancer and their families, and for doctors, nurses, and other health care professionals.
PDQ tells about the current treatments for most cancers. The information in PDQ is reviewed each month by cancer experts. It is updated when there is new information.
PDQ also lists information about research on new treatments (clinical trials), doctors who treat cancer, and hospitals with cancer programs. The treatment information in this summary is based on information in the PDQ treatment summary for health professionals on this cancer.
How to use PDQ
Cancer in children is not common, with about 7,000 new cases diagnosed each year in the United States. The majority of children with cancer are treated at cancer centers with special facilities to treat children with cancer. There are organized groups of doctors and other health care professionals who work together to improve treatments for children with cancer by doing clinical trials.
A clinical trial is a study that tries to improve current treatment or find new treatments to care for patients. Each trial is 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 clinical trials, more and more information is collected about new treatments, their risks, and how well they do or do not work.
If clinical trials show that the new treatment is better than the one currently being used, the new treatment may become the "standard" treatment. Children who are treated on clinical trials have the advantage of getting the best available therapy. In the United States, about two-thirds of children with cancer are treated on a clinical trial at some point in their illness.
Listings of clinical trials are a part of PDQ. In the United States, there are two major groups (called cooperative groups) that organize clinical trials for childhood cancers: the Childrens Cancer Group (CCG) and the Pediatric Oncology Group (POG). Doctors who belong to these groups or who take part in other clinical trials are listed in PDQ.
You can use PDQ to learn more about current treatments for your child's kind of cancer. Bring this material from PDQ with you when you see your child's doctor. You can talk with the doctor, who knows your child and has the facts about your child's disease, about which treatment would be best.
If you want to know more about cancer and how it is treated, or if you wish to learn about clinical trials for your child's kind of cancer, you can call the National Cancer Institute's Cancer Information Service. The number is 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. The call is free and a trained information specialist will talk with you and answer your questions.
PDQ may change when there is new information. Check with the Cancer Information Service to be sure that you have the most up-to-date information.
What is childhood brain stem glioma?
Childhood brain stem glioma is a type of brain tumor in which cancer (malignant) cells begin to grow in the tissues of the brain. The brain controls memory and learning, the senses (hearing, sight, smell, taste, and touch), and emotion. It also controls other parts of the body, including muscles, organs, and blood vessels. Other than leukemia or lymphoma, brain tumors are the most common type of cancer that occur in children.
Gliomas are a type of astrocytoma, tumors that start in brain cells called astrocytes. A brain stem glioma occurs in the area of the brain called the brain stem (where the spinal cord joins the brain), which is just above the back of the head. They may grow rapidly or slowly, depending on the grade of the tumor.
This PDQ statement covers tumors that start in the brain (primary brain tumors). Often cancer found in the brain has started somewhere else in the body and has spread (metastasized) to the brain. This is called brain metastasis. A separate patient information statement containing information on brain cancer that occurs in adults is also available in PDQ.
Like most cancers, childhood brain stem glioma is best treated when it is found (diagnosed) early. If your child has symptoms, the doctor may order a computed tomographic (CT) scan, a special x-ray that uses a computer to make a picture of your child's brain. A magnetic resonance imaging (MRI) scan, which uses magnetic waves to make a picture of your child's brain, may also be done.
Often, surgery is required to see whether there is a brain tumor and to tell what type of tumor it is. The doctor may cut out a piece of tissue from the brain and look at it under a microscope. This is called a biopsy.
Your child's chance of recovery (prognosis) depends on the type of tumor, where it is located within the brain, and your child's age and general health.
Once childhood brain stem glioma is found, more tests will be done to find out the type of tumor. If a biopsy specimen is taken, the cancer cells will be looked at carefully under a microscope to see how different they are from the normal cells. This will determine the histologic grade of the tumor. Your child's doctor needs to know the type and grade of tumor in order to plan treatment.
There is no staging for childhood brain stem glioma. The treatment depends on whether or not your child has received treatment.
Untreated childhood brain stem glioma
Untreated childhood brain stem glioma means that no treatment has been given except to treat symptoms.
Recurrent childhood brain stem glioma
Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the brain or in another part of the body.
There are treatments for all children with brain stem gliomas. Three kinds of treatment are used:
Experienced doctors working together can often give the best treatment for children with brain stem glioma. Your child's treatment will often be coordinated by a pediatric oncologist, a doctor who specializes in cancer in children. The pediatric oncologist may refer you to other doctors, such as a pediatric neurosurgeon (a specialist in childhood brain surgery), a pediatric neurologist, a psychologist, a radiation oncologist, and other doctors who specialize in the type of treatment your child requires. The radiation therapy should be performed at a hospital experienced in radiation therapy for children.
Radiation therapy is the most common treatment for a child with brain stem glioma. Radiation therapy uses high-energy x-rays to kill cancer cells and shrink tumors. Radiation therapy for childhood brain stem glioma usually comes from a machine outside the body (external radiation therapy). The use of radiation put into the brain through thin plastic tubes (internal radiation therapy) is under study. For some types of brain tumors, clinical trials are evaluating radiation therapy given in several small doses per day (hyperfractionated radiation therapy). Radiation therapy can affect growth and brain development, so clinical trials are testing ways to decrease or delay radiation therapy, especially for younger children.
Surgery is sometimes used to treat brain stem gliomas. Depending on where the cancer is and the type of cancer, your child's doctor may remove as much of the tumor as possible. If the brain stem gliomas are in a place where it cannot be removed, surgery may be limited to a biopsy of the cancer.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle. Chemotherapy is called a systemic treatment because the drug enters the bloodstream, travels through the body, and can kill cancer cells throughout the body. Chemotherapy is being studied to delay the use of radiation therapy in some patients. Clinical trials are studying different chemotherapy drugs for brain stem gliomas.
Treatment by stage
Treatment for childhood brain stem glioma depends on the type and stage of the disease and your child's age and overall health.
Your child may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to have your child go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to test new treatments and to find better ways to treat cancer patients. Clinical trials are going on in most parts of the country for childhood brain stem gliomas. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
Your child's treatment depends on where the tumor is within the brain stem. In some cases, no surgery is performed and radiation therapy is given. In other cases, as much of the tumor as possible may be removed during surgery and the patient may be watched carefully before more therapy is given. Children younger than 3 years of age may be given chemotherapy to delay radiation therapy or so a lower dose of radiation may be given. Clinical trials are evaluating radiation therapy given twice within a day (hyperfractionated radiation therapy).
Treatment for recurrent childhood brain stem glioma depends on the type of tumor, whether the tumor comes back in the same place or in another part of the brain, and the treatment that was given before.
Surgery or chemotherapy may be given. You may want to consider having your child enter a clinical trial of new chemotherapy drugs.
TO LEARN MORE..... CALL 1-800-4-CANCER
To learn more about childhood brain stem glioma, call the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615. By dialing this toll-free number, you can speak with someone who can answer your questions.
The Cancer Information Service can also send you booklets. The following booklet about brain tumors may be helpful to you:
The following booklets on childhood cancer may be helpful to you:
The following general booklets on questions related to cancer may also be helpful:
There are other places where you can get material about cancer treatment and information about services to help you. You can check the social service office at your hospital for local and national agencies that help with your finances, getting to and from treatment, care at home, and dealing with your problems.
You can also write to the National Cancer Institute at this address:
Date Last Modified: 05/97
If you want to know more about cancer
and how it is treated, or if you if you wish to know about clinical trials
for your type of cancer, you can call the NCI's Cancer Information Service
at 1-800-422-6237, toll free. A trained information specialist can talk
with you and answer your questions.