Ependymoma

Ependymoma: A Brain or Spinal Cord Tumor

Ependymoma is a type of tumor that forms in the brain or spinal cord. It starts in cells called ependymal cells. These cells line the channels that carry cerebrospinal fluid (CSF). CSF cushions and protects the brain and spinal cord.

Ependymoma can affect people of all ages, but it's more common in young children. In children, symptoms might include headaches and seizures. In adults, ependymoma is often found in the spinal cord and can cause weakness in the body parts controlled by the affected nerves.

The main treatment for ependymoma is surgery. If the tumor grows quickly, or if surgery can't completely remove it, other treatments might be needed. These could include radiation therapy, radiosurgery, chemotherapy, or targeted therapy.

Diagnosing Ependymoma:

Doctors use several tests to find and understand ependymoma:

• Neurological Exam: A doctor checks things like vision, hearing, balance, coordination, strength, and reflexes. Problems in these areas can suggest where the tumor might be located in the brain or spinal cord.
• Imaging Tests: These tests, like MRI (magnetic resonance imaging), create pictures of the body's internal structures. MRI is a common way to locate and size brain tumors. Specialized MRI techniques, like magnetic resonance angiography, can also be used. Since ependymoma can develop in both the brain and spinal cord, imaging tests are done on both areas.
• Cerebrospinal Fluid (CSF) Testing (Lumbar Puncture): A thin needle is inserted into the lower spine to collect CSF. This fluid is tested to see if it contains tumor cells.

Based on these tests, a doctor might suspect ependymoma and recommend surgery to remove the tumor. The removed tumor tissue is then examined in a lab to confirm the diagnosis. Further tests can identify the specific type of cells in the tumor, which helps doctors choose the best treatment.

Treating Ependymoma:

Neurosurgeons (brain surgeons) try to remove as much of the tumor as possible. The goal is to completely remove the tumor. Sometimes, the tumor is near important brain or spinal cord tissues, making complete removal risky.

If the entire tumor is removed, additional treatments might not be necessary. If some tumor remains, more surgery or other treatments may be needed. Additional treatments, like radiation therapy, are often used for cancerous tumors or when the whole tumor can't be removed.

• Radiation Therapy: High-energy beams (like X-rays or protons) are used to kill tumor cells. A machine precisely targets the tumor with these beams. Radiation therapy might be used after surgery to prevent the tumor from returning or if the tumor wasn't fully removed. There are types of radiation that aim to minimize damage to nearby healthy cells, such as conformal radiation therapy, intensity-modulated radiation therapy, and proton therapy.

• Stereotactic Radiosurgery: This is a type of radiation where many beams of lower-powered radiation are focused on the tumor from different angles. The combined effect of the beams delivers a high dose of radiation to destroy the tumor cells.

• Chemotherapy: Drugs used to kill tumor cells. Chemotherapy is less commonly used for ependymoma but might be an option if the tumor comes back after surgery and radiation.

• Targeted Therapy: Drugs that target specific parts of tumor cells, causing them to die. Targeted therapy might be used if the ependymoma returns after treatment.

Clinical Trials: Clinical trials test new treatments. These provide a chance to try the latest options, but potential side effects might not be fully understood. Talk to your doctor if you're interested in a clinical trial.

Diagnosing a Brain Tumor: A Guide for Patients

If a healthcare provider suspects a brain tumor, several tests and procedures are necessary to confirm the diagnosis and understand the situation. These investigations help pinpoint the location, type, and characteristics of the tumor.

1. Neurological Exam: This exam checks various functions of the brain, including vision, hearing, balance, coordination, muscle strength, and reflexes. Problems in any of these areas can signal a potential issue to the healthcare provider, but a neurological exam itself doesn't diagnose a brain tumor. Instead, it helps the doctor understand which part of the brain might be affected.

2. Head CT Scan (Computed Tomography): A CT scan uses X-rays to create detailed images of the brain and surrounding structures. It's a readily available and fast imaging technique, often the first step if someone has headaches or other symptoms with multiple possible causes. The CT scan helps identify potential problems and guides the healthcare team towards the next appropriate tests. If the CT scan suggests a brain tumor, an MRI might be needed for a more detailed view.

3. PET Scan (Positron Emission Tomography): A PET scan can detect some brain tumors. A small amount of radioactive material (a tracer) is injected into a vein. This tracer travels through the bloodstream and accumulates in rapidly dividing cells, including tumor cells. The PET scan creates images highlighting areas with increased tracer activity, which can signify the presence of a tumor, especially rapidly growing ones like glioblastomas or some oligodendrogliomas. Slower-growing, non-cancerous tumors might not show up clearly on a PET scan. Not everyone needs a PET scan; talk to your doctor about whether it's necessary for your situation.

4. Brain Biopsy: This procedure involves removing a small tissue sample from the tumor for laboratory analysis. Sometimes, a surgeon takes the sample during brain tumor removal surgery. If surgery isn't an option, a needle biopsy can be performed. This involves a small incision in the skull, guided by imaging tests like CT or MRI, to insert a thin needle and extract the sample. Numbers and/or anesthesia are used to ensure the patient's comfort and prevent pain during the biopsy. A needle biopsy might be preferred over surgery if the tumor is in a critical area of the brain where surgery could cause more harm. Brain biopsy carries potential risks, including bleeding and brain tissue damage.

5. Lab Analysis of the Biopsy Sample: The tissue sample is sent to a laboratory for detailed analysis. The lab tests look for signs of cancer (malignancy) and analyze how quickly the tumor cells are growing and multiplying. This is called the tumor's grade, which is classified on a scale from 1 to 4. Grade 1 tumors grow slowly and look similar to healthy cells, while grade 4 tumors grow rapidly and appear significantly different from healthy cells. The lab tests also look for specific DNA changes within the tumor cells. This information helps the healthcare team create a personalized treatment plan.

6. Brain MRI (Magnetic Resonance Imaging): An MRI uses strong magnets to create detailed images of the brain. It's often used to diagnose brain tumors because it provides a clearer picture than other imaging techniques. Sometimes, a special dye is injected to enhance the image quality, making it easier to spot smaller tumors and differentiate them from healthy brain tissue. Different types of MRIs, like functional MRI, help identify areas of the brain controlling functions like speech and movement, which assists in surgical planning. Magnetic resonance spectroscopy measures the levels of certain chemicals in the tumor cells; abnormal levels can provide clues about the tumor type. Magnetic resonance perfusion assesses blood flow in the tumor, highlighting areas with increased activity.

Understanding the Prognosis:

The healthcare team combines information from all these tests to assess the prognosis, or the likelihood of a successful treatment outcome. Factors influencing the prognosis include:

• The type of brain tumor.
• The tumor's growth rate.
• The tumor's location within the brain.
• Genetic changes within the tumor cells.
• The possibility of complete surgical removal.
• The patient's overall health.

Discuss any concerns about the prognosis with your healthcare team.

Brain Tumor Treatment Options

A brain tumor diagnosis can be frightening. Treatment depends on several factors, most importantly whether the tumor is cancerous (a brain cancer) or non-cancerous (benign). Other crucial considerations include the type, size, severity (grade), and location of the tumor. The best approach often involves a combination of treatments, which your healthcare team will tailor to your specific needs and preferences. These treatments might include:

• Surgery: The goal of surgery is to remove as many tumor cells as safely possible. This is often the first step in treating both cancerous and benign tumors. Sometimes, complete removal isn't possible due to the tumor's location or size, or because it's intertwined with healthy brain tissue. If complete removal isn't feasible, the surgeon might try to remove as much of the tumor as safely possible (subtotal resection). This can help reduce symptoms. Several surgical approaches exist, each with its own advantages and risks:

  • Craniotomy: This is the most common brain tumor removal procedure. A section of the skull is temporarily removed to access the tumor. Special tools and sometimes lasers are used to carefully remove the tumor, while protecting healthy brain tissue. The skull section is then replaced. This procedure is done under general anesthesia (sleep medication) with the patient's scalp numbed. In some cases, awake brain surgery may be necessary to ensure that vital parts of the brain aren't damaged during the removal process.
  • Endoscopic Surgery: This procedure uses a long, thin tube (endoscope) with a camera and tools inserted into the brain through a small opening, often the nose. This method is particularly useful for treating tumors near the pituitary gland, located just behind the nasal cavity. In other cases, a small hole might be drilled in the skull to allow for access.

• Radiation Therapy: Powerful energy beams (like X-rays or protons) are used to kill tumor cells. External beam radiation, where the beams originate from a machine outside the body, is the most common approach. Treatments are usually given a few times a week for several weeks. Sometimes, radiation is precisely targeted to the tumor site or the entire brain (whole-brain radiation) depending on the specifics of the tumor. Proton therapy is a newer, more targeted form of radiation, which may be better for children or tumors near vital brain areas.

• Radiosurgery: This precise form of radiation therapy uses multiple beams of radiation aimed at the tumor from different angles. The radiation is delivered in a single session or a few sessions, and the patient can typically go home after the treatment. Different technologies, like the Gamma Knife and linear accelerators (LINACs, like CyberKnife), are used for radiosurgery.

• Chemotherapy: Strong medicines are used to kill tumor cells. These medicines can be taken as pills or injected into a vein, or sometimes directly into the brain during surgery. Chemotherapy is often used in combination with radiation therapy.

• Targeted Therapy: These medicines target specific chemicals within the tumor cells, causing them to die. Targeted therapies are available for certain types of brain tumors and are often tested to see if they're likely to be beneficial.

Post-Treatment Support: After treatment, some patients may require rehabilitation to regain lost function. This might include physical therapy, occupational therapy, speech therapy, or tutoring for children.

Complementary Therapies: While no alternative treatments have been proven to cure brain tumors, some complementary therapies might help patients cope with the emotional and physical stress of the diagnosis. Examples include art therapy, exercise, meditation, and music therapy. It's essential to discuss these options with your healthcare team.

Important Considerations: Every individual's situation is unique. The best treatment plan will be determined by the healthcare team in consultation with the patient and their family. It's crucial to actively participate in the decision-making process by asking questions, seeking information from reliable sources, and maintaining strong support networks.