Ependymoma

It occurs from the ependymal cells that line the ventricles of the brain and the middle of the spinal cord. The various types of ependymomas can appear in different areas within the brain and spinal cord. They are soft, greyish or red tumors that may contain cysts or mineral calcifications.
ependymoma signs and treatment

What are the different types of ependymomas?

There are four types of ependymomas:

  • Anaplastic ependymomas: Most commonly found in the brain of adults and can appear in the lower back part of the skull (posterior fossa) in children. This type is rarely found in the spinal cord
  • Ependymomas: Occur along, within or next to the ventricular system
  • Myxopapillary ependymomas: Tend to occur in the lower part of the spinal column
  • Subependymomas: This type normally occurs near a ventricle

SYMPTOMS OF EPENDYMOMA

The signs and symptoms of an ependymoma are related to the location and size of the tumor. The first symptom of ependymoma in babies is an increased head size.  As the tumor develops, the symptoms may include:

  • Irritability
  • Sleeplessness
  • Vomiting

Common symptoms that older children and adults may experience are:

  • Nausea
  • Vomiting
  • Headache

TREATMENT OPTIONS AVAILABLE FOR EPENDYMOMA

Your treatment will be based on the size, grade, position of the tumor and your general health. The main treatments used to treat this condition are surgery and sometimes radiotherapy.

A specialist and a nurse will explain the aims of your treatment and the steps involved. They will also talk to you about the benefits and disadvantages of different treatment types and what is involved. The risks and side effects will also be explained to you.

Surgery

This is the main treatment for ependymoma. The aim of this procedure is to remove as much tumor as possible without compromising nearby areas of the brain or spine. Your surgeon will talk to you and explain what your operation will involve.

They will talk to you about the possible complications and risks that may occur. Some people may require extra support to help with their recovery. The support may be from a physiotherapist who can assist you in improving your balance, walking or strength. Equipment may be provided by occupational therapist to help you become more independent.

Recovery after surgery may take a whole so it is important to take good care of yourself during this time. You will need to get plenty of rest, eat well and follow the advice given by your surgeon and specialist nurse.

If you had a low grade ependymoma and it has been completely removed, you will not require any other treatment. However, if your doctor can’t remove your tumor completely, you may be advised to undergo radiotherapy to treat any remaining tumor cells.

In certain cases, an operation may not be possible. This may be due to the position of the tumor and it makes it too difficult to reach and surgery would not be safe to perform. In this case, radiation therapy would be the next best option instead of performing surgery.
primary brain tumors treatment

Radiotherapy

This therapy uses high energy rays to destroy the tumor cells. Your oncologist will talk to you and let you know how long you will be under treatment and what type of radiation therapy you will undergo. Radiotherapy may be used:

  • On its own (when surgery is not required)
  • After surgery (when the tumor cannot be completely removed)
  • After surgery (to reduce the risk of recurrences)

This therapy may make you feel extremely tired. The treatment will carry on for weeks or longer after it finishes. During this time, it is important for you to get plenty of rest but try to balance this with some gentle activity such as short walks. This will help you feel less tired.

Your skin the treated area may become red or darker and itchy. Your hair will fall out in the area of treatment. However, your hair will start growing back again after two to three months.

The side effects of radiotherapy will be explained to you by your oncologist and specialist nurse. They will talk to you about how you can manage these side effects and also explain the risk of late side effects. These are side effects that can occur months or even years after radiotherapy.

There are newer ways of administering radiotherapy to treat ependymoma. You will receive a higher dose of treatment to the tumor without compromising nearvy areas of the brain or spine. This will help make the treatment more effective and reduce the side effects.

Chemotherapy

This is the use of cytotoxic drugs (anti-cancer) to kill cancer cells. Chemotherapy is rarely used to treat this condition in adults. However, doctors may sometimes suggest undergoing chemotherapy if an ependymoma returns.

Steroids

These are drugs that reduce the swelling around a tumor. You may receive steroid treatment before or after surgery or during radiotherapy. This treatment can help improve your symptoms and help you feel better.

Some of the side effects of steroids include:

  • Indigestion
  • Weight gain
  • Restlessness
  • Agitation
  • Sleep disturbance.

If this treatment is causing you problems or if you notice other side effects, be sure to let your doctor know. Consuming steroids with food can help to reduce indigestion.

It is important to only consume steroids exactly as your doctor has prescribed them.

DIAGNOSING EPENDYMOMA

  • Physical exam and history taking: A physical examination will be performed by your doctor. You will also be asked about your medical history to check if you have any risk factors for stomach cancer or any family members who have had it.
  • Blood tests: To check for signs of cancer in your body.
  • Gastroscopy: The most common way to detect any abnormalities in the stomach is by gastroscopy. During the examination, the doctor would insert a flexible tube with a miniature camera attached at the end, known as endoscope, through the mouth into the stomach. The doctor will inspect the stomach linings and take samples if required. These biopsy samples are taken to the lab for tests to detect cancer and whether there are any Helicobacteria Pylori bacteria in your stomach. Patients are required to fast at least 6 hours prior to the procedure, which will last only 15 to 20 mins. You may be given light sedation to ease any discomfort during the procedure and can usually be discharged on the same day.
  • Biopsy: During a gastroscopy, a biopsy is performed where your doctor will take a sample of tissue from the abnormal looking area of your stomach which will then be sent for testing to determine if the tissue is cancerous.
  • Upper GI series test: Before the procedure, you will be asked to drink a chalky drink with a substance called barium. This fluid will coat your stomach and make it show up clearer on X-rays.
  • CT scan: When stomach cancer has been diagnosed, chest x-rays and CT scans of the abdomen will be ordered to check if the cancer has spread. A CT scan is a powerful x-ray that shows detailed images of your body on the inside.

Can I prevent stomach cancer?

Absolutely! Here are multiple ways to prevent stomach cancer:

  • Treat stomach infections: Ulcers like H. pylori infection should get treated. Antibiotics and other drugs can kill the bacteria and can heal the sores in your stomach lining to reduce the risk of developing stomach cancer in the future.
  • Eat healthy: Consume more fresh fruits and vegetables on every day basis. They are high in fibre and certain vitamins that can lower cancer risk. Foods that are very salty, pickled, cured or smoked such as hot dogs, processed lunch meats or smoked cheeses should be avoided. Your weight should be watched because being overweight or obese can lead to an increased risk of the disease.
  • Don’t smoke: Using tobacco can double your risk of developing stomach cancer. You should also keep yourself away from second-hand smoking.
  • Watch your aspirin and NSAID usage: If you are consuming aspirin daily to prevent heart problems or NSAID drugs for arthritis, speak to your doctor about how they may affect your stomach.