Children's Health

In childhood brain and spinal cord tumors, treatment options are based on several factors.

Staging is the process used to find how much cancer there is and if cancer has spread within the brain, spinal cord, or to other parts of the body. It is important to know the stage in order to plan cancer treatment.

In childhood brain and spinal cord tumors, there is no standard staging system. Instead, the plan for cancer treatment depends on several factors:

• The type of tumor and where the tumor formed in the brain.
• Whether the tumor is newly diagnosed or recurrent. A newly diagnosed brain or spinal cord tumor is one that has never been treated. A recurrent childhood brain or spinal cord tumor is one that has recurred (come back) after it has been treated. Childhood brain and spinal cord tumors may come back in the same place or in another part of the brain, or spinal cord. Sometimes they come back in another part of the body. The tumor may come back many years after first being treated. Tests and procedures, including biopsy, that were done to diagnose and stage the tumor may be done to find out if the tumor has recurred.
• The grade of the tumor. The grade of the tumor is based on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. It is important to know the grade of the tumor and if there were any cancer cells remaining after surgery in order to plan treatment. The grade of the tumor is not used to plan treatment for all types of brain and spinal cord tumors.
• The tumor risk group. Risk groups are either average risk and poor risk or low, intermediate, and high risk. The risk groups are based on the amount of tumor remaining after surgery, the spread of cancer cells within the brain and spinal cord or to other parts of the body, where the tumor has formed, and the age of the child. The risk group is not used to plan treatment for all types of brain and spinal cord tumors.

The information from tests and procedures done to detect (find) childhood brain and spinal cord tumors is used to determine the tumor risk group.

After the tumor is removed in surgery, some of the tests used to detect childhood brain and spinal cord tumors are repeated to help determine the tumor risk group (see the General Information section). This is to find out how much tumor remains after surgery. Other tests and procedures may be done to find out if cancer has spread:

• Lumbar puncture: A procedure used to collect cerebrospinal fluid from the spinal column. This is done by placing a needle into the spinal column. Lumbar puncture is usually not used to stage childhood spinal cord tumors. This procedure is also called an LP or spinal tap.
  
  Lumbar puncture. A patient lies in a curled position on a table. After a small area on the lower back is numbed, a spinal needle (a long, thin needle) is inserted into the lower part of the spinal column to remove cerebrospinal fluid (CSF, shown in blue). The fluid may be sent to a laboratory for testing.
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.
• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
• Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
  
  Bone marrow aspiration and biopsy. After a small area of skin is numbed, a Jamshidi needle (a long, hollow needle) is inserted into the patient's hip bone. Samples of blood, bone, and bone marrow are removed for examination under a microscope.