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When the body is unable to regulate how it handles the fluids that are within it, then diabetes insipidus will occur.
One of the most common forms of diabetes insipidus is the gestational form of this disease. For those diagnosed with a mental illness or disorder, one of the most effective medications used for treatment is lithium. There are no identified predisposing factors that lead to the development of medulloblastomas.
Current research is focusing on understanding some of the possible genetic pathways that may be involved in the development of medulloblastomas, because there are rare genetic conditions in which medulloblastomas may arise with a slightly increased frequency. The following are the most common symptoms of a medulloblastoma, however each child may experience symptoms differently. The duration of these symptoms is relatively short, up to several weeks, and often children are diagnosed with the "flu" or a viral illness. Computerized tomography scan (also called a CT or CAT scan) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. 7 magnetic resonance spectroscopy (MRS) - a test done along with MRI at specialized facilities that can detect the presence of particular compounds produced by the body's metabolism within sample tissue that can identify tissue as normal or tumor, and may be able to distinguish between different types of brain tumors. Magnetic resonance spectroscopy (MRS) - a test done along with MRI at specialized facilities that can detect the presence of particular compounds produced by the body's metabolism within sample tissue that can identify tissue as normal or tumor, and may be able to distinguish between different types of brain tumors. Biopsy - in rare cases, a tissue sample from the tumor will be taken through a needle during a simple surgical procedure performed by a surgeon to confirm the diagnosis. Ventriculoperitoneal shunt (also called a VP shunt) - a bypass, usually a type of tubing, that is placed in the head to drain excess cerebrospinal fluid (CSF) from inside the brain to space in the abdomen. Surgery - the goals of surgery are to establish a diagnosis, relieve hydrocephalus (swelling on the brain) and remove the tumor.
Radiation therapy and chemotherapy - radiation therapy uses high-energy rays (radiation) from a specialized machine to damage or kill cancer cells and shrink tumors.
While chemotherapy can be quite effective in treating certain cancers, the agents do not differentiate normal healthy cells from cancer cells.
Children with standard risk medulloblastoma are treated with craniospinal irradiation (radiation to the brain and entire spine) over a course of 4-6 weeks. Children with high-risk medulloblastoma are treated with pre-irradiation chemotherapy followed by craniospinal irradiation, then more chemotherapy.
Infants are treated with chemotherapy until they reach the age of 3 at which time craniospinal irradiation is offered and given. Throughout their therapy, children are monitored closely by their caregivers with frequent neurologic evaluations and routine MRIs of the brain and spine to monitor response to therapy. Post-operatively some children may have difficulties related to coordination, weakness in their extremities and imbalance.
The outcome for children with medulloblastoma has improved dramatically over the past several decades.
An astrocytoma is a form of glioma tumor which originates in the astrocytes (star-shaped cells in the brain). Astrocytoma symptoms are generally associated with the result of growing pressure inside of the patient's skull. Once a tumor is detected, a biopsy is taken, which may occur by itself, or in some cases during the surgery to remove the tumor. Astrocytoma treatment varies depending upon the particular case, in individual, whether the tumor is benign or malignant (cancer), etc. An ependymoma is a tumor that arises from cells of the ependymal lining of the ventricular system of brain or spinal cord. The average age at diagnosis is 5 years old, and 25-40 percent of patients are less than 2 years old. The symptoms of a brain tumor may resemble other conditions or medical problems - ranging from the simple to the serious. Microscopically, ependymomas can appear different, called either standard or anaplastic ependymoma.
A third type, which occurs at the base of the spine, called myxopapillary cauda equina ependymoma, tends to be much less malignant than any of the other forms. Ependymomas can metastasize, meaning they can spread into adjacent areas of the brain or, less commonly, to distant parts of the central nervous system. Diagnostic procedures for an ependymoma, like other brain tumors, are necessary to determine the exact type of tumor and whether the tumor has spread. Physical exam - your child's physicians can test neurologic function including: reflexes, muscle strength, eye and mouth movement, coordination, and alertness. Scans - magnetic resonance imaging (MRI) scans are obtained using computerized, large magnetic fields to produce detailed images of organs and structures within the body. Biopsy - a tissue sample from the tumor taken during surgery to remove part or all of the tumor.
Ventriculo-peritoneal shunt (VP shunt) - when a tumor causes blockage of CSF flow leading to symptoms, special tubing can be surgically implanted in the ventricles to drain excess CSF into the abdomen. Radiation therapy - precisely targeted and dosed radiation is used to kill cancer cells left behind after surgery. Chemotherapy - the role of anti-tumor medications in treating ependymoma is actively being studied. Follow-up care - to manage disease complications, to screen for early recurrence of tumor and to manage late effects of treatment, regular visits with physical exams, laboratory testing, and scans are routine follow-up.
Rehabilitation - speech, physical, and occupational therapists are also part of the neuro-oncology team, and may be involved during and after treatments. Within the brain and posterior fossa, patients do best when their tumor can be completely removed surgically, and if high dose focal radiation therapy is given. Ependymoma of the brain treated with complete resection and radiation to the tumor area can result in an approximately 50 percent cure rate. Craniopharyngiomas are benign brain tumors that arise near the pituitary gland and pituitary stalk and are typically both cystic and solid in structure. Surgery: The typical initial treatment for a craniopharyngioma is surgical removal by either the endonasal transsphenoidal approach or by a supra-orbital “eyebrow” craniotomy. Radiosurgery (SRS) or Stereotactic Radiotherapy (SRT): With incomplete removal, stereotactic radiotherapy (SRT) or stereotactic radiosurgery (SRS), are typically used to prevent further tumor growth.
Hormonal Replacement Therapy: Many patients with a craniopharyngioma will develop pituitary hormonal deficits because of the tumor itself, surgery or as a consequence of radiotherapy. Brain stem glioma is most often diffused (spread freely) through the brain stem by the time of diagnosis.
A risk factor is anything that increases a person's chance of developing a disease, including cancer.
To take advantage of these newer treatments, all children with cancer should be treated at a specialized cancer center.
Three types of therapies can be used to treat brain stem glioma in children: radiation therapy, surgery, and chemotherapy. Fatigue, drowsiness, nausea, vomiting, and headache are common side effects of radiation therapy. Chemotherapy alone is not an effective treatment for brain stem glioma; however, in some cases, a doctor may use chemotherapy during or after radiation treatments. Because chemotherapy attacks rapidly dividing cells, including those in normal tissues such as the hair, lining of the mouth, intestines, and bone marrow, children receiving chemotherapy may lose their hair, develop mouth sores, or have nausea and vomiting. Surgery is used to treat brain stem glioma only when the tumor's appearance on an MRI scan is focal, thus suggesting it may be possible to remove the cancer without damaging the brain, such as when a tumor grows out from the brain stem. Depending on individual circumstances, the doctor may recommend either surgery or chemotherapy. Cancer and cancer treatment can cause a variety of side effects; some are easily controlled and others require specialized care.
The child's follow-up care plan and the long-term risks following therapy depend on several factors, such as the type of tumor and its location, the age of the child, and the type of treatment. A Spinal tumor - a cancerous or noncancerous growth that develops with the cervical (neck), thoracic (midback) or lumbosacral (lowback) regions or near the spinal cord or bones of the spine. The spine is composed of individual bones (vertebrae) stacked one on top of the other in a column. The spinal cord is contained within the spinal canal and is covered by a layer of connective tissue, the dura mater. Primary spinal cord tumors may be extramedullary (occurring outside the spinal cord) or Intramedullary (occurring within the cord itself).
Extramedullary tumors may be intradural (meningiomas and schwannomas) which account for 60% of all primary spinal cord neoplasms or extradural (metastatic tumors like from breasts, lungs, prostate, leukemia or lymphomas) which account for 25% of these neoplasms. Paralysis that may occur in varying degrees and n different parts of body depending on which nerves are compressed.


DRUGS-because surgery and radiation therapy as well as tumors themselves can cause inflammation inside the spinal cord, doctors sometimes prescribe corticosteroids to reduce swelling either following surgery or during treatment.
Radition therapy- This therapy is used following an operation to eliminate the remnant of tumors that can't be completely removed or to treat inoperable tumors. These symptoms include:headache (generally upon awakening in the morning), vomiting, fatigue, lethargy. A lumbar puncture, or spinal tap, is never performed in patients with medulloblastoma because such a procedure can lead to catastrophic deterioration in the child's condition. It has been shown through national studies that outcome is correlated with the degree of removal, and therefore an attempt is made to completely remove the tumor, without compromising the child's neurologic function. Chemotherapy is a drug treatment that works by interfering with the cancer cell's ability to grow or reproduce.
A multi-disciplinary team consisting of a neurosurgeon, neuro-oncologist, radiation therapist and neurologist coordinate the management of children with medulloblastoma. These typically resolve over a course of several weeks with the help of physical and occupational therapy. Children with standard risk medulloblastoma have an expected 5-year survival of 65-80 percent. In some patients, secondary tumors (most often high-grade gliomas) develop in areas of the body that received radiation therapy, usually 8-12 years after treatment. However, radiosurgery and chemotherapy are used which can provide long-term comfort with few side effects. Surgery is the most common treatment method, although radiation treatment, chemotherapy, and other options do exist. Approximately 60 percent are located in the region of the cerebellum and brain stem known as the posterior fossa, 10 percent are located in the spinal cord, and the remaining 30 percent in other parts of the brain. If you would like to view summary information about brain tumors first, see the overview on brain tumors. Tumor can block the normal flow of CSF, causing increased pressure on the brain (hydrocephalus) and enlargement of the skull and a variety of symptoms. A fourth type, called ependymoblastoma, is a more aggressive form of this tumor and more difficult to treat. The goal is to remove as much of the tumor as possible while preserving neurological function.
They occur most commonly in childhood and adolescence and in later adult life, after age 50. If the tumor compresses the pituitary stalk or gland, the tumor can cause partial or complete pituitary hormone deficiency which may lead to growth failure, delayed puberty, loss of normal menstrual function or sexual desire, increased sensitivity to cold, fatigue, constipation, dry skin, nausea, low blood pressure, and depression.
Many craniopharyngiomas will also be well seen on a CT scan especially since some are partially calcified (containing calcium deposits). The goal of surgery is to completely remove the tumor while improving vision and brain function. Additionally, because of the tendency for craniopharyngiomas to recur, repeat MRIs or CT scans should be obtained at least every six months for the first 5 years after surgery or radiation therapy and then at least annually thereafter. Most tumors grow in a part of the brain stem that can be difficult to perform surgery in, making brain stem glioma challenging to treat. There are risk factors that can be controlled, such as smoking, and risk factors that cannot be controlled, such as age and family history. Some evidence indicates that genetic factors may play a role in a small percentage of brain stem gliomas. A physical examination may include tests to determine brain function, reflexes, vision, and hearing of the child. A CT scan creates a three-dimensional picture of the inside of the child's body with an x-ray machine. Doctors at these centers have extensive experience in treating children with cancer and have access to the latest research.
Because radiation therapy can sometimes interfere with the normal growth and development of the child's brain, the doctor may choose to treat the cancer in another way. Chemotherapy may lower the body's resistance to infection, lead to increased bruising and bleeding, and cause fatigue. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. For most children with diffuse types of brain stem gliomas, surgery is not necessary or possible because of the location of the tumor and the risk involved. Below are some of the side effects that are more common to brain stem glioma and its treatments. Fatigue is extreme exhaustion or tiredness, and is the most common problem that people with cancer experience.
Mucositis is an inflammation of the inside of the mouth and throat, leading to painful ulcers and mouth sores. Vomiting, also called emesis or throwing up, is the act of expelling the contents of the stomach through the mouth. Nervous system disturbances can be caused by many different factors, including cancer, cancer treatments, medications, or other disorders. Hypersomnia, also called somnolence, excessive daytime sleepiness, or prolonged drowsiness, is a condition characterized by excessive sleeping or the inability to maintain wakefulness when desired.
For example, craniospinal radiation therapy can cause cognitive and endocrine symptoms over time, although the severity can vary greatly depending on the dose administered and the age of the child. Each vertebra possesses a cylindrical body, which participates in weight bearing and an arch of bone (laminae and spinous processes) which protects the spinal cord and its coverings. Intramedullary tumors or gliomas (astrocytomas or ependymomas) are comparatively rare accounting for only about 10% of tumors. Surgical stabilization of the spine may be necessary as a result of instability caused by tumor itself or the surgery to remove it. These tumors are located in the cerebellum, the part of the brain that controls balance and other complex motor functions. On rare occasions, it may be necessary to place a shunt or some other drain to relieve intracranial pressure prior to operating on the tumor. Typically, medulloblastomas are divided into three groups: infants (children under the age of 3), standard risk (no evidence of disease outside of the posterior fossa of the brain with a complete removal of the tumor) and high risk (evidence of incomplete removal or tumor spread elsewhere in the nervous system). Different groups of chemotherapy drugs work in different ways to fight cancer cells and shrink tumors.
Being able to anticipate these side effects can help the care team, parents, and child prepare, and, in some cases, prevent these symptoms from occurring, if possible.
In addition to these physicians, there are specialized nurses and social workers that are part of the team managing the child's care. A rare complication is that of "posterior fossa mutism" where children will awake from surgery appearing well but within 24 hours will develop an inability to speak and difficulty with swallowing. For high-risk medulloblastoma, that number is slightly lower, at 60 percent 5-year survival. The follow-up of patients with medulloblastoma consists of yearly evaluations by the multidisciplinary team with detailed physical and neurologic examinations, audiologic evaluations, endocrine assessments, neuropsychologic testing and MRIs. For instance, children with neurofibromatosis are thought to have a higher risk of developing an astrocytoma. Its diagnosis and management are similar to that of primitive neuroectodermal tumor (PNET) and is discussed in the section on PNET.
If the tumor has spread, radiation to the whole brain and spinal cord is important to treat ependymoma.
A metastatic tumor (ependymoma that has spread) requires additional whole brain and spine radiation.
They account for 10-15% of sellar and suprasellar tumors (tumors that occur in and above the pituitary gland) and 50-60% of sellar and suprasellar tumors in children.
Pituitary stalk compression can also cause diabetes insipidus (DI), and increase prolactin levels causing a milky discharge from the breast (galactohhrea). Because of their tendency to be adherent to the optic chiasm, other nerves and important blood vessels, complete tumor removal may not be possible in up to 50% of patients. Because hormonal deficiencies can develop many years after radiation treatment, patients treated with radiation should have periodic hormonal evaluations throughout their lifetimes. The brain stem controls many of the body's basic functions, such as motor and sensory activity, coordination and walking, and heart and respiratory functions.
Although risk factors can influence disease, for many risk factors it is not known whether they actually cause the disease directly.
Genetic conditions associated with a higher risk of central nervous system (CNS) tumors include Li-Fraumeni syndrome, tuberous sclerosis, nevoid basal cell syndrome, and Turcot syndrome. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer.
A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors.


Clinical trials are research studies that compare standard treatments (the best treatments available) with newer treatments that may be more effective. To avoid or reduce the need for radiation treatment in young children, the doctor may use chemotherapy to shrink the tumor. These side effects can be controlled during treatment and usually go away after chemotherapy is completed. Learn more about your prescriptions through PLWC's Drug Information Resources, which provides links to searchable drug databases.
For more detailed information on managing these and other side effects of cancer and cancer treatment, visit the PLWC Managing Side Effects section. More than half of patients experience fatigue during chemotherapy or radiation therapy, and up to 70% of patients with advanced cancer experience fatigue. Radiation therapy and chemotherapy cause hair loss by damaging the hair follicles responsible for hair growth. Symptoms that result from a disruption or damage to the nerves caused by cancer treatment (such as surgery, radiation treatment, or chemotherapy) can appear soon after treatment or many years later.
Somnolence syndrome is a type of hypersomnia associated with cranial radiation therapy (radiation treatment to the head) in children. Similarly, the risks and potential side effects of surgery vary dramatically, depending on the location and characteristics of the tumor. This is indicated in situations when the children are experiencing extreme symptoms from intracranial pressure problems and awaiting definitive surgery, which should be performed on an emergency basis. Chemotherapy is systemic treatment, meaning it is introduced to the bloodstream and travels throughout the body to kill cancer cells.
This is often associated with large tumors and recovers over several weeks up to several months. The results in infants are disappointing and many studies are being performed to evaluate treatment strategies in infants that will improve overall outcome. In children, this procedure is safely performed under sedation, and is less difficult and less painful than placing an intravenous (IV) catheter. They are usually not discovered until they impinge upon important structures around them, and are frequently quite large (over 3 cm) when detected.
Other possible diagnoses to consider with a cystic pituitary mass is a cystic pituitary adenoma or an arachnoid cyst.
Regular follow-up with an endocrinologist is recommended for all patients with a craniopharyngioma.
Focal tumors often are low-grade (the cells look close to normal) tumors, and behave in a more benign (less aggressive) fashion. Some people with several risk factors never develop the disease, while others with no known risk factors do. However, biopsies are rarely used and are often specifically avoided in children with diffuse brain stem glioma because they do not influence treatment, and they can carry major risks. Sometimes, a contrast medium (a special dye) is injected into a vein to provide better detail. If possible, a neurosurgeon (a specialist who operates on the head and brain) will remove a small piece of tissue from the brain. Cancer in children is rare, so it can be hard for doctors to plan treatments unless they know what has been most effective in other children. Pediatric cancer centers often have extra support services for children and their families, such as nutritionists, social workers, and counselors. The severity of the side effects depends on the type and amount of the drug being given and the length of time the child receives the drug.
Patients who feel fatigue often say that even a small effort, such as walking across a room, can seem like too much. Hair loss may occur throughout the body, including the head, face, arms, legs, underarms, and pubic area.
Mucositis can be caused by a chemotherapeutic drug directly, the reduced immunity brought on by chemotherapy, or radiation treatment to the head and neck area.
Likewise, the risks of chemotherapy and the likelihood of secondary cancers are strongly influenced by the drugs used and their doses. The circular canal between the body, arch, and pedicles houses the spinal cord and is called the spinal canal.
Tumors arising inside the dura, but outside the actual substance of the spinal cord are termed intradural-extramedullary. They occur with equal frequency in men and women with the exception of meningiomas which occur most often in women. Certain chemotherapy drugs may be given in a specific order depending on the type of cancer it is being used to treat.
In approximately 15 percent of the children diagnosed with medulloblastoma hydrocephalus may develop, requiring the placement of a shunt to drain spinal fluid into the peritoneal cavity. Some include administering aggressive chemotherapy and only local irradiation of the posterior fossa to minimize the deleterious effects of radiation on the developing brain. However, tumor location and other characteristics may limit removal to a partial or sub-total resection.
Although they are benign (not malignant) tumors, these tumors tend to become adherent to structures around the pituitary gland and stalk, including the optic nerves, optic chiasm, intracranial arteries and the brain itself. Involvement of the hypothalamus, an area at the base of the brain, may result in obesity, increased drowsiness and temperature regulation abnormalities. In addition, the diagnosis can generally be made by magnetic resonance imaging (MRI) alone (see below). For a brain stem tumor, this test is generally insufficient to establish the diagnosis conclusively, and an MRI is required (see below).
Investigating new treatments involves careful monitoring using scientific methods, and all participants are followed closely to track progress. If the level of RBCs is too low, parts of the body do not get enough oxygen and cannot work properly.
Fatigue can seriously impact family and other daily activities, can make patients avoid or skip cancer treatments, and may even impact the will to live. Nausea and vomiting are common in patients receiving chemotherapy for cancer and in some patients receiving radiation therapy.
Nightmares are vivid, frightening dreams that usually cause the dreamer to wake up able to remember part or most of the nightmare. For each of these issues, it is important to discuss the specific aspects of the tumor and the options for treatment with the neurosurgeons and neuro-oncologists that are involved in the child's care. They are thought to arise from remnants of the craniopharyngeal duct or Rathke's pouch which are developmental structures related to the primitive gut.
Other symptoms especially with larger tumors may include personality changes, headache, confusion, and vomiting. In some cases, the hair will simply thin-sometimes unnoticeably-and may become duller and dryer. Many patients with cancer say they fear nausea and vomiting more than any other side effects of treatment. Most people have nightmares from time to time, but the frequency or vividness of nightmares can increase after a cancer diagnosis and during cancer treatment. Tumors arising within the substance of the spinal cord itself are called intramedullary tumors.
The high powered microscopes used in microsurgery for instance make it easier to distinguish tumors from healthy tissue. This is frequently done if the tumor is in an area with sensitive structures around it that may be injured during removal. The fatigue (tiredness) associated with anemia can seriously affect quality of life and make it more difficult for patients to cope with cancer and treatment side effects. Losing one's hair can be a psychologically and emotionally challenging experience and can affect a patient's self-image and quality of life. When it is minor and treated quickly, nausea and vomiting can be quite uncomfortable but cause no serious problems.
If a biopsy is not deemed possible, the doctor may suggest other tests that will help make a diagnosis. Persistent vomiting can cause dehydration, electrolyte imbalance, weight loss, depression, and avoidance of chemotherapy.
Your child's doctor may consider these factors when choosing a diagnostic test:Age and medical condition, The type of cancer, Severity of symptoms, Previous test results.



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