Treatment for Ependymoma

An ependymoma usually begins in the ependymal cells in the brain and spinal cord. These cells line the passageways where cerebrospinal fluid is located. Most of the time, that passage serves as a conduit for the fluid that helps nourish and protect the brain. As a tumor develops, however, it can lead to serious complications and consequences for the patient. Each year, over 1,000 individuals are estimated to be diagnosed with ependymoma. While children may be at a higher risk of developing ependymoma than adults, these tumors can occur in adult patients.

Typically, ependymomas do not spread outside the central nervous system to impact other parts of the body. However, those cancerous cells can travel through the cerebrospinal fluid to impact other areas of the body. Centers for Neurosurgery, Spine, and Orthopedics is NJ’s only comprehensive facility that can provide the assessment, treatment, rehabilitation, and compassionate care for patients with brain tumors such as ependymoma.

Causes and Risk Factors for Ependymomas

Currently, there are few known risk factors associated with ependymomas. “Risk factors” may include anything that increases a patient’s risk of developing cancer. Parents, in particular, may worry about the likelihood that their child will develop a brain or spinal tumor. However, there are no known causes of childhood or adult ependymomas. Children with neurofibromatosis type 2, also known as NF2, may have a higher risk than other children of developing several types of tumors in the central nervous system, including ependymomas. For other patients, however, the occurrence of ependymoma does not seem to have an obvious cause. In some cases, patients with a family history of brain tumors may have a higher likelihood of developing ependymoma. 

Symptoms of Ependymoma

Symptoms of Ependymoma can depend on the location of the tumor. Patients with an ependymoma that develops in the brain may have neurological symptoms, including:

• Headaches
• Dizziness
• Nausea and/or vomiting
• Vision problems
• Loss of balance
• Changing sensation in the arms and legs
• Difficulty with decision-making or following instructions
• Seizures, especially in someone who does not have a history 

Symptoms may vary by individual and depend significantly on the location of the ependymoma. Any patient who notices unusual symptoms should contact a doctor as soon as possible. 

Ependymoma in the Spine: Symptoms

Patients who develop ependymoma in the spine often suffer several types of physical symptoms. It can cause: 

• Back pain
• Weakness or numbness in the limbs or the trunk of the body
• Sexual function problems
• Urinary function concerns
• Bowel issues

Diagnosis of Ependymoma

Diagnosing ependymoma usually begins with a neurological exam, during which the doctor will go over signs and symptoms. If the patient has trouble with coordination, strength, balance, or reflexes, it could indicate possible ependymoma. 

Next, an imaging test, including an MRI, may be recommended. MRIs can be conducted of both the brain and the spine, depending on the suspected location of the tumor. In some cases, patients may need to have imaging done of both areas to better assess the ependymoma. A spinal tap may also be recommended, which will remove a small quantity of spinal fluid to look for tumor cells or abnormalities that could indicate an ependymoma.

Treatment Options for Patients with Ependymoma

Patients with ependymoma may undergo one of several types of treatment, depending on the specific type of tumor, its location, and how much of it can be removed during surgery.

Surgical Treatment

Surgery is the first line of treatment for most patients with ependymoma. Many doctors may want to move forward with surgical treatment before discussing future prognosis or other treatment options since those options often depend on the specific type of tumor, its size, and other factors that will be uncovered in more detail during the surgical process. 

The surgery has two purposes: first, it attempts to remove as much of the tumor as possible without unnecessarily impacting the surrounding tissue or creating additional symptoms in the patient. Removing the tumor will often alleviate the symptoms the patient has faced before surgery and provide the patient with a better overall quality of life. Sometimes, however, the tumor may be too close to vital parts of the brain or spinal cord, which may make removing it completely impossible. In those cases, the neurosurgeon may attempt to remove part of the tumor, if possible. 

During the surgery, the neurosurgeon will also take a sample of the tumor to be used for testing. During that testing, it will be determined what the type of tumor is and whether further treatment is necessary. For example, if the tumor is highly aggressive, additional treatments may be recommended. If the tumor is benign, the doctor may not recommend further treatment. In the case of a slow-growing tumor, the doctor may recommend waiting to see how the tumor progresses over time. 

Radiation

Radiation therapy targets the cancer cells in the tumor with high-energy beams, including X-rays or protons. Modern radiation therapy usually delivers that high-dose radiation to the cancer cells while protecting the healthy cells around the tumor as much as possible. In part, this is accomplished by carefully aligning the radiation beam during treatment. 

During radiation therapy, the patient will lie still while a machine carefully targets radiation to specific points on the tumor. Radiation may have some side effects, including hair loss around the site, dry mouth, and nausea. 

In some cases, patients with ependymoma may also have a specific type of radiation known as radiosurgery. During this process, multiple beams of high-intensity, pinpoint radiation are delivered directly to the tumor in an effort to remove it completely. Radiosurgery is sometimes used following the recurrence of a tumor after surgery and traditional radiation, but may also be used to help deal with aggressive tumors. 

Chemotherapy

While chemotherapy is a common cancer treatment, it is not always effective in cases of ependymoma. Chemotherapy uses medications that are designed expressly to kill cancer cells. Generally, cancerous cells grow and divide much faster than normal cells. Chemotherapy is specifically designed to target those fast-growing cells, including those that may be present in ependymomas. However, chemotherapy is often ineffective in cases of ependymoma, and is often used only when other methods of treatment have not achieved the desired outcome. 

Clinical Trials

Cancer research of many types is ongoing, and there are often clinical trials running that can offer new treatment options for patients with all types of cancer, including ependymoma. Patients with ependymoma that do not respond to typical treatment, or patients who have conditions that may prevent current treatments like surgery and radiation, may choose to attend clinical trials in an effort to decrease their symptoms. While clinical trials may offer new methods for treating ependymomas, they may also come with unknown side effects. Each patient should discuss the available options with their doctor before determining what type of treatment should be considered for brain or spinal tumors.  

The General Prognosis for Patients with Ependymomas

Patients who develop an ependymoma have a relative five-year survival rate of approximately 83.9%. A patient’s prognosis can depend on several factors, including the type of tumor, the amount of tumor left after surgery, and the type of treatment necessary in order to create the best possible outcome following surgery. Patients should always follow up with their doctors following surgery to fully understand their prognosis. Without treatment, however, an ependymoma can continue to grow, causing worsening symptoms. In some cases, it may lead to death without proper treatment. 

Let The Experienced New Jersey Surgeons at Centers for Neurosurgery, Spine & Orthopedics Help

Each neurosurgeon at Centers for Neurosurgery, Spine & Orthopedics has more than ten years of experience in dealing with a wide range of health conditions, including ependymomas and other types of tumors in the brain and spine. The CNSO physicians have also been recognized as some of the best spinal surgeons in the country every year since 2013. At each of the six convenient locations throughout New Jersey, Centers for Neurosurgery, Spine & Orthopedics has pain management physicians, spine surgeons, and brain surgeons who can help address a variety of conditions and offer highly effective treatment options. Contact CNSO today to schedule an appointment.