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Ependymoma Treatment

Ependymomas are malignant (cancerous) brain or spinal tumors that originate in the brain and occur most often in young children. The Department of Neurosurgery at Rutgers Health and RWJBarnabas Health treats these brain and spinal tumors with the utmost care and compassion for young patients. Our board-certified pediatric neurologists, neurosurgeons, neuro-oncologists and expert support staff effectively and compassionately treat children and adults with brain or spinal tumors such as ependymoma.

What Is an Ependymoma?

An estimated 1,100 people are diagnosed with ependymoma every year, according to the National Cancer Institute, and 13,294 people live with the tumor. These rare, malignant (cancerous) brain tumors are “primary” because they originate in the brain or spinal cord itself rather than traveling from somewhere else in the body. They are found through the central nervous system, including the top or back of the head and spinal compartments. These tumors are more common in infants and children than adults, and they are the 3rd most common type of brain tumor in children.

While all ependymoma tumors are malignant, that does not mean they are always incurable. In fact, as with all cancers, some can be put into remission, while others cannot. Even for those people who go into remission, it is possible for the cancer to recur. Most ependymoma tumors require surgery to remove, for the best outcome. Our hospitals are well-equipped to handle ependymoma treatment, as well as cancer recurrence.

Ependymomas rarely spread outside the brain or spinal cord, although they sometimes spread to other areas of the central nervous system through cerebrospinal fluid.

Types of Ependymoma

The World Health Organization groups ependymal tumors into 4 subtypes based on the origin of the tumor, and they are graded based on their tendency to spread – the higher the grade, the more abnormal the cancer cells look under a microscope. Most ependymomas, regardless of type, grow in young children, near the base of the brain. Spinal tumors are more common in individuals ages 12 and older.

Ependymoma subtypes include:

  • Subependymoma (Grade I): These are usually near brain ventricles and grow more slowly than other tumors, and are most common in adults and older men. Grade I describes low-grade tumor cells, which grow slowly.

  • Myxopapillary ependymoma (Grade I): These spinal tumors grow slowly and appear most often in young adults. This is also considered a low-grade tumor.

  • Ependymoma (Grade II): This is the most common type of ependymoma, and is usually found in the brain or spine.

  • Anaplastic ependymoma (Grade III): These usually occur in the brain or skull and the cells grow faster than other ependymoma types. They most often occur in the brain, but can also be found in the spine.

Ependymoma Symptoms

Depending on the location of the tumor, a variety of symptoms may affect you or your child.

Symptoms of ependymoma may include:

  • Seizures

  • Frequent headaches

  • Nausea and vomiting

  • Trouble balancing

  • Blurry vision

  • Confusion and irritability

  • Difficulty urinating

  • Stiffness or pain in the neck and/or back

  • Leg weakness

  • Confusion and irritability

  • Babies with ependymoma may have a larger than usual head

What Causes Ependymomas?

The cause of these brain tumors is unknown, but there is correlation between neurofibromatosis type 2 and ependymomas. Ependymomas affect men and women just as often. Adults between the ages of 40-70 are most commonly affected. About 1 in 3 affected children will develop an ependymoma before the age of 3.

Ependymoma Diagnosis

Ependymomas are best diagnosed by a board-certified neurologist who can determine the type of tumor you have and its precise location. Tests include:

  • Physical exam: Your doctor will ask you questions about your symptoms and medical history.

  • Neurological exam: During this exam, the doctor will inquire about your child’s symptoms, such as if they experience frequent headaches, stiffness, and so on. The doctor will check the child’s vision and hearing, as well as strength, reflexes, and coordination. If any of these areas have problems, it provides clues that the brain is not working optimally.

  • Magnetic resonance imaging (MRI) scan: This imaging test helps neurologists determine the size and location of the ependymoma tumor. These tumors may be present in either the brain or spine, so the doctor will ensure both areas are tested if an ependymoma diagnosis is probable. MRI scans of ependymomas typically show the tumor has a well-defined border.

  • Lumbar puncture: Also called a spinal tap, the doctor removes cerebrospinal fluid by inserting a needle between two vertebrae in the lower back to test for tumor cells and other abnormalities.

If a brain tumor is suspected, your neurologist will recommend surgical treatment to remove the tumor, after which a biopsy will be ordered to confirm the diagnosis. Specialized tests can determine whether the cells are cancerous and their level of aggressiveness. All of these factors, as well as the patient’s age and overall health, can help the neurologist develop a treatment plan.

Ependymoma Treatment

Conservative nonsurgical treatment, as directed by a neurologist, neurosurgeon, and neuro-oncologist, may include simple observation, or the “wait and see” approach. This is because most ependymoma tumors grow slowly and produce minimal symptoms. If you are suggested for observation only, your neurologist may recommend yearly MRIs to ensure your tumor isn’t growing more quickly.

Treatment for this brain tumor may use a combination of therapies for the optimal outcome, including:

  • Surgery: Larger tumors causing symptoms may require surgery. A brain surgeon, called a neurosurgeon, works to remove as much of the tumor as possible without damaging the adjacent sensitive brain or spinal tissue. The surgery involves removing a portion of the skull to cut out a tiny piece of brain tissue, which is then examined under a microscope to check for the presence of cancer cells (this is called a biopsy). Tumors that can be entirely removed may not require any additional treatment, but if some of the tumor remains, other therapies will be recommended. Additional treatments may involve radiation therapy or radiosurgery.

  • Radiation therapy: By utilizing high-energy X-ray or proton beams, cancer cells are killed at the precise point of the brain or spinal cord where the tumor is located. During radiation sessions, your child will lie on a table as a machine moves around them and directs beams at the site of the tumor. The surrounding healthy tissue of the brain is spared.

  • Radiosurgery: This is not an actual operation where incisions are used, but a procedure where radiation beams are focused on precise points to kill tumor cells. Sometimes, standard surgery and radiosurgery are both used to kill remaining tumor cells after the operable portion of the tumor has been removed.

  • Chemotherapy: “Chemo” is a drug therapy intended to kill cancer cells, although most neuro-oncologists think it isn’t effective for most cases of ependymoma, and the role of chemo is still mainly experimental and reserved only for certain patients who do not respond to surgery and/or radiation.

  • Clinical trials: These are research studies for new treatments and give you the chance to try the latest treatment options. One drawback, however, is that the side effects are not well-known. You may ask your doctor if you are eligible to participate in clinical trials.

Ependymoma Prognosis

According to the National Cancer Institute, the 5-year survival rate for ependymoma is approximately 83.9%.

Request an appointment online now or call 833-656-3876.