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    Brain Cancer Health Center

    Medical Reference Related to Brain Cancer

    1. Neuroblastoma Screening (PDQ®): Screening - Patient Information [NCI] - Classification of Central Nervous System Tumors

      The classification of childhood central nervous system (CNS) tumors is based on histology and location.[1] Tumors are classically categorized as infratentorial, supratentorial, parasellar, or spinal. Immunohistochemical analysis, cytogenetic and molecular genetic findings, and measures of mitotic activity are increasingly used in tumor diagnosis and classification, and will likely alter classification and nomenclature in the future.Primary CNS spinal cord tumors comprise approximately 1% to 2% of all childhood CNS tumors. The classification of spinal cord tumors is based on histopathologic characteristics of the tumor and does not differ from that of primary brain tumors.[2,3,4]Infratentorial (posterior fossa) tumors include the following:Cerebellar astrocytomas (most commonly pilocytic, but also fibrillary and less frequently, high-grade).Medulloblastomas (classic, desmoplastic/nodular, extensive nodularity, anaplastic, or large cell) and variants.Ependymomas (cellular, papillary,

    2. Childhood Brain Stem Glioma Treatment (PDQ®): Treatment - Patient Information [NCI] - Treatment Option Overview

      There are different types of treatment for patients with adult brain and spinal cord tumors. Different types of treatment are available for patients with adult brain and spinal cord tumors. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.Four types of standard treatment are used:Watchful waitingWatchful waiting is closely monitoring a patient's condition without giving any treatment until symptoms appear or change.Surgery Surgery may be used to diagnose and treat adult brain and spinal cord tumors.

    3. Childhood Brain Stem Glioma Treatment (PDQ®): Treatment - Patient Information [NCI] - General Approach to Care for Children with Brain and Spinal Cord Tumors

      Important concepts that should be understood by those treating and caring for a child who has a brain tumor or spinal cord tumor include the following: The cause of most childhood brain tumors remains unknown.[1]Selection of an appropriate therapy can only occur if the correct diagnosis is made and the stage of the disease is accurately determined.Children with primary brain or spinal cord tumors represent a major therapy challenge that, for optimal results, requires the coordinated efforts of pediatric specialists in fields such as neurosurgery, neuropathology, radiation oncology, pediatric oncology, neuro-oncology, neurology, rehabilitation, neuroradiology, endocrinology, and psychology, who have special expertise in the care of patients with these diseases.[2,3] For example, radiation therapy of pediatric brain tumors is technically demanding and should be performed in centers that have experience in this area.For most childhood brain and spinal cord tumors, the optimal treatment

    4. Neuroblastoma Screening (PDQ®): Screening - Patient Information [NCI] - Evidence of Benefit

      Evidence of screening effect derives from descriptive studies of local and national programs in Japan, uncontrolled pilot experiences at a number of sites in Europe and the United States, and population-based studies in Canada and Germany.[1,2,3,4,5,6,7]An increase in survival rates among screen-detected cases would be expected if screening was detecting neuroblastoma at an earlier and more curable stage. While improved survival rates after initiation of screening have been reported,[8,9] these observations should be viewed cautiously because improvements could be caused by lead-time bias, length bias, and identification of cases through screening that would have spontaneously regressed. Screening results in an increased incidence of early-stage disease. The cases detected by screening almost exclusively have biologically favorable properties (unamplified N-myc oncogene, near triploidy, and favorable histology), and this type of favorable neuroblastoma has a high

    5. Neuroblastoma Screening (PDQ®): Screening - Patient Information [NCI] - Treatment of Newly Diagnosed Childhood Subependymoma

      In the newly diagnosed patient, careful evaluation to fully determine the extent of disease must precede the treatment of ependymoma. Surgery should be performed in an attempt at maximal tumor reduction; children have improved progression-free survival (PFS) if there is minimal residual disease present after surgery.[1,2] Postoperatively, magnetic resonance imaging (MRI) should be performed to determine the extent of resection, although the rate of dissemination is low. If not performed preoperatively, MRI of the entire neuraxis should be obtained to evaluate for disease dissemination. Myxopapillary ependymomas, considered to be a benign histologic subtype of ependymoma, have a relatively high incidence of central nervous system (CNS) tumor dissemination at diagnosis and at follow-up, and require imaging of the complete cranial spinal axis at the time of diagnosis and during follow-up.[3,4] Patients with residual tumor or disseminated disease should be considered at high risk for

    6. Childhood Central Nervous System Atypical Teratoid/Rhabdoid Tumor Treatment (PDQ®): Treatment - Patient Information [NCI] - Treatment of High-Risk Neuroblastoma

      The Children's Oncology Group (COG) high-risk group assignment criteria are described in Table 8.Table 8. Children's Oncology Group (COG) Neuroblastoma High-Risk Group Assignment Schema Used for COG-P9641 and COG-A3961 StudiesaINSS StageAgeMYCNStatusINPC ClassificationDNA PloidybINPC = International Neuroblastoma Pathologic Classification; INSS = International Neuroblastoma Staging System.a The COG-P9641 and COG-A3961 trials established the current standard of care for neuroblastoma patients in terms of risk group assignment and treatment strategies.b DNA Ploidy: DNA Index (DI) > 1 is favorable, DI = 1 is unfavorable; hypodiploid tumors (with DI 1 (DI < 1 [hypodiploid] to be considered favorable ploidy).c INSS stage 2A/2B symptomatic patients with spinal cord compression, neurologic deficits, or other symptoms are treated with immediate chemotherapy for four cycles.d INSS stage 3 or stage 4 patients with clinical symptoms

    7. Childhood Brain and Spinal Cord Tumors Treatment Overview (PDQ®): Treatment - Patient Information [NCI] - About This PDQ Summary

      About PDQPhysician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government's center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.Purpose of This SummaryThis PDQ cancer information summary has current

    8. Neuroblastoma Screening (PDQ®): Screening - Patient Information [NCI] - Risks of Neuroblastoma Screening

      Screening tests have risks.Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.The risks of neuroblastoma screening include the following: Neuroblastoma may be overdiagnosed. When a screening test result leads to the diagnosis and treatment of a disease that may never have caused symptoms or become life-threatening, it is called overdiagnosis. For example, when a urine test result shows a higher than normal amount of homovanillic acid (HMA) or vanillyl mandelic acid (VMA), tests and treatments for neuroblastoma are likely to be done, but may not be needed. At this time, it is not possible to know which neuroblastomas found by a screening test will cause symptoms and which neuroblastomas will not. Diagnostic tests (such as biopsies)

    9. Neuroblastoma Screening (PDQ®): Screening - Patient Information [NCI] - Cellular Classification of Pituitary Tumors

      Pituitary adenomas can be classified according to staining affinities of the cell cytoplasm, size, endocrine activity, histologic characteristics, hormone production and contents, ultrastructural features, granularity of the cell cytoplasm, cellular composition, cytogenesis, and growth pattern.[1] Recent classifications, however, omit criteria based on tinctorial stains (i.e., acidophilic, basophilic, and chromophobic) because of the poor correlation between staining affinities of the cell cytoplasm and other pathological features of pituitary tumors, such as the type of hormone produced and cellular derivation.[1,2]A unifying pituitary adenoma classification incorporates the histological, immunocytochemical, and electron microscopic studies of the tumor cells, and stresses the importance of hormone production, cellular composition, and cytogenesis. This classification emphasizes the structure-function relationship and attempts to correlate morphologic features with secretory

    10. Childhood Brain Stem Glioma Treatment (PDQ®): Treatment - Patient Information [NCI] - Recurrent / Progressive Childhood Brain Stem Glioma Treatment

      Diffuse Intrinsic Pontine GliomasGiven the dismal prognosis for patients with diffuse intrinsic pontine glioma, progression of the pontine lesion is anticipated generally within 1 year from initial radiation therapy. In most cases, biopsy at the time of clinical or radiologic progression is neither necessary nor recommended. To date, no salvage regimen has been shown to extend survival. Patients should be considered for entry into trials of novel therapeutic approaches because there are no standard agents that have demonstrated a clinically significant activity. Concomitant palliative care should be provided for these patients whether or not disease-directed therapy is administered. Focal or Low-Grade Brain Stem GliomasAt the time of recurrence, a complete evaluation to determine the extent of the relapse may be indicated for selected low-grade lesions. Biopsy or surgical resection should be considered for confirmation of relapse when other entities such as secondary tumor and

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